RESUMEN
The objective of this study was to elucidate whether better maternal psychological well-being contributes to the acquisition of "sleeping through the night" (STN) in infants during the early postpartum period. Fifty-two primiparous mothers completed the General Health Questionnaire-28 (GHQ-28) in the third trimester (prenatal) and when the conceptional ages of their babies reached 8-9 weeks (hereafter, 2 months), 12-13 weeks (3 months), and 16-17 weeks (4 months). They also recorded babies' nocturnal sleep patterns in a timetable for 5 consecutive days each month postpartum. "Regular STN" was defined when the mean of longest nocturnal sleep duration for 5 consecutive days was > 8 h or between 6 and 8 h with < 1.0 nocturnal awakenings. According to these criteria, a total of 14 infants (27 %) acquired regular STN at 4 months (referred to as "STN infants"), with STN infants showing a marked increase in longest nocturnal sleep duration and a decrease in nocturnal awakenings from 2 to 3 months of age. The mothers of STN infants demonstrated steady reductions in postnatal GHQ-28 scores and had significantly lower prenatal GHQ-28 scores compared with the mothers of non-STN infants (3.7 ± 3.0 vs. 6.4 ± 4.1, p = 0.027). In random forest models for binomial classification, both prenatal and postnatal (at 4 months) GHQ-28 scores were identified as significant covariates for distinguishing STN infants, and other important covariates, including weeks of delivery, stepfamily, birth weight of the infant, and maternal co-sleeping at bedtime, were selected. Among these covariates, maternal co-sleeping at bedtime had relatively stronger correlations with both STN infants (r = - 0.440) and prenatal maternal GHQ-28 scores (r = 0.377). In conclusion, because prenatal maternal psychological well-being was thought to predict the acquisition of STN in infants, infants born from mothers with better psychological well-being appear to have some advantages in acquiring STN. These cross-lagged correlations suggest that the pathway from mothers to infants may be mediated by certain parenting behaviors, such as maternal co-sleeping at bedtime.
Asunto(s)
Periodo Posparto , Bienestar Psicológico , Femenino , Embarazo , Lactante , Humanos , Sueño , Madres/psicología , Tercer Trimestre del EmbarazoRESUMEN
A number of studies have been made on the sleep characteristics of children born preterm in an attempt to develop methods to address the sleep problems commonly observed among such children. However, the reported sleep characteristics from these studies vary depending on the observation methods used, i.e., actigraphy, polysomnography and questionnaire. In the current study, to obtain reliable data on the sleep characteristics of preterm-born children, we investigated the difference in sleep properties between 97 preterm and 97 term toddlers of approximately 1.5 years of age using actigraphy. Actigraphy units were attached to the toddlers' waists with an adjustable elastic belt for 7 consecutive days, and a child sleep diary was completed by their parents. In the study, we found that preterm toddlers had more nocturnal awakenings and more daytime activity, suggesting that preterm-born children may have a different process of sleep development in their early development.
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Calidad del Sueño , Sueño , Preescolar , Humanos , Recién Nacido , Actigrafía , Polisomnografía , Recien Nacido PrematuroRESUMEN
The purpose of this study was to elucidate psychological factors that may influence nausea and vomiting during pregnancy (NVP) progression in early pregnancy based on longitudinal observations. Fifty-nine pregnant women completed the Rhodes Index of Nausea, Vomiting, and Retching (RINVR) and General Health Questionnaire-28 (GHQ-28), and recorded their resting heart rate with photoplethysmography for 5 min to determine heart rate variability (HRV) indexes at 7-9 weeks and 11-13 weeks of gestation with a 4-week interval. GHQ-28 scores (total and subclasses) and HRV indexes at 7-9 weeks were compared among groups classified according to the presence of severe NVP (RINVR ≥ 9 points) at the two measurement points. Among women without severe NVP at 7-9 weeks, women who developed severe NVP at 11-13 weeks had significantly higher levels of anxiety/insomnia in the GHQ-28 subclasses (p = 0.018). The cross-lagged relationship from anxiety/insomnia at 7-9 weeks to RINVR at 11-13 weeks was significant (ß = 0.367, p < 0.001). Among women with severe NVP at 7-9 weeks, women whose severe symptoms subsided at 11-13 weeks had significantly higher high-frequency (HF) power (p = 0.010), and women with relatively higher HF power demonstrated a significant reduction in RINVR (interaction effect, p = 0.035). During early pregnancy, women with strong anxiety/insomnia symptoms tend to have NVP symptoms that become more severe as the pregnancy progresses. The higher HF power in women whose severe NVP subsided within 4 weeks suggests a contribution of emotion regulation to early amelioration of NVP.
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Complicaciones del Embarazo , Trastornos del Inicio y del Mantenimiento del Sueño , Ansiedad , Femenino , Humanos , Náusea/psicología , Embarazo , Complicaciones del Embarazo/psicología , Vómitos/psicologíaRESUMEN
The disruption of circadian rhythm is closely related to mood disorders in night-shift workers, and a similar situation may occur in postpartum mothers. However, the situations of postpartum mothers remain largely unknown because of a lack of an appropriate circadian phase marker in the clinical setting. This study aimed to evaluate whether salivary melatonin concentration at awakening can identify misalignment between awakening time and the biological clock system, which might be associated with depressive mood in some mothers. Ninety-eight healthy mothers who were currently the primary parental caregivers were recruited at 1 month after delivery. All mothers completed the Edinburgh Postnatal Depression Scale (EPDS) and wore an actigraphy watch at home for 3 consecutive days to determine nocturnal sleep variables. While wearing the actigraphy watch, they also collected saliva samples during the awakening period for a melatonin concentration assay. The results indicated that daily salivary melatonin levels after 30 min of awakening (hereafter, melatonin levels) were positively correlated with sleep onset time and negatively correlated with sleep offset time and total sleep time. Six mothers with an EPDS score of ≥9 (the cutoff value for Japanese women at high risk for postnatal depression) had an average melatonin level of either <4 pg/ml or >16 pg/ml for 3 d. Mothers with melatonin levels <4 pg/ml or >16 pg/ml tended to have elevated EPDS scores (4.93 ± 2.95 or 4.20 ± 2.93, mean ± standard deviation) compared with mothers with melatonin levels between 4 and 16 pg/ml (3.00 ± 2.12, p = .053). Mothers whose melatonin levels were >16 pg/ml had relatively later sleep onset time and shorter nocturnal sleep duration. Backward stepwise regression demonstrated that such high/low levels of melatonin were a significant predictor of EPDS scores. These results suggest that elevated melatonin levels after 30 min of awakening could identify a phase-delayed circadian rhythm in postpartum mothers, and that relatively higher or lower melatonin levels could be associated with increased depressive mood.
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Melatonina , Ritmo Circadiano , Depresión , Femenino , Humanos , Madres , Periodo Posparto , SueñoRESUMEN
AIM: This study aimed to determine whether 1-night screening of oxygen desaturation in women with uncomplicated pregnancy about 1 month before the due date is useful to predict late-onset gestational hypertension (GH) after 37 weeks of gestation. METHODS: We recruited 102 women with uncomplicated pregnancy between 34 and 36 weeks of gestation. These women then completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Berlin Questionnaire for obstructive sleep apnea, and recorded their oxygen saturation (SpO2 ) and physical acceleration profiles during nocturnal sleep for 1 night at home using a portable pulse oximeter and actigraph, respectively. Thereafter, their blood pressure was monitored weekly until delivery. RESULTS: Pulse oximetry data between 34 and 36 weeks of gestation revealed that three women had an oxygen desaturation index (ODI) ≥5.0 and seven had a minimum SpO2 < 90%. During follow-up until delivery, two women with an ODI ≥5.0 and a minimum SaO2 <90% developed GH at 37 weeks of gestation. Among clinical measures at recruitment, body mass index (BMI) and pulse oximetry measures appeared available for the prediction of GH. The positive predictive values (95% confidence intervals) of the criteria using these measures were 0.67 (0.26-0.67) for ODI ≥5.0, 0.29 (0.10-0.35) for minimum SpO2 <90%, and 0.07 (0.02-0.07) for BMI ≥25.0. CONCLUSION: For the prediction of late-onset GH after 37 weeks of gestation, pulse oximetry measures about 1 month before the due date are particularly useful because of their high positive predictive values.
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Hipertensión Inducida en el Embarazo , Apnea Obstructiva del Sueño , Femenino , Humanos , Hipertensión Inducida en el Embarazo/diagnóstico , Oximetría , Oxígeno , Embarazo , Tercer Trimestre del EmbarazoRESUMEN
Anxiety about labor in women at the end of pregnancy sometimes reaches levels that are clinically concerning. We investigated whether low-risk pregnant women with childbirth fear during the last trimester demonstrate specific findings with regard to resting heart rate variability (HRV) and examined whether HRV biofeedback can reduce this fear and alter resting HRV. We measured the levels of childbirth fear (Wijma delivery expectancy/experience questionnaire, W-DEQ) and resting HRV indexes in 97 low-risk pregnant women in their 32nd-34th week of gestation and advised women with W-DEQ scores of ≥ 66 (n = 40) to practice HRV biofeedback (StressEraser) at home. We then reassessed these measures 3-4 weeks later in the 36th-37th week of gestation regardless of whether the women practiced the method. We found that childbirth fear had no significant effect on resting HRV indexes when the W-DEQ cutoff was conventionally set at ≥ 66. However, women with W-DEQ scores of ≥ 90 (n = 5) had a significantly lower high-frequency power than their counterparts (p = 0.028). The W-DEQ scores reduced significantly in women who performed HRV biofeedback (n = 18, p < 0.001), but there was no change in those who did not perform the method (n = 20). These findings suggested that very high W-DEQ scores (≥ 90), but not the conventional criteria (W-DEQ score ≥ 66), of the fear of childbirth were associated with low parasympathetic activity among low-risk pregnant women and that HRV biofeedback intervention can effectively decrease the fear of childbirth in these women.
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Biorretroalimentación Psicológica/métodos , Miedo/psicología , Frecuencia Cardíaca/fisiología , Parto/psicología , Adulto , Ansiedad/psicología , Biorretroalimentación Psicológica/fisiología , Femenino , Humanos , Embarazo , Atención PrenatalRESUMEN
OBJECTIVE: To elucidate characteristic sleep architecture of different nocturnal sleep patterns in early infancy. METHODS: Participants were 27 infants at the same conceptional age of 3-4months. Nocturnal sleep of these infants was monitored at home by simultaneously using actigraphy and a one-channel portable EEG device. According to the infants' activity for 6h from sleep onset, each night's sleep pattern was classified into three categories: sleeping through the night (STN), sleeping with weak signals (crying/fuss episodes <10min or fed), and sleeping with strong signals (crying/fuss episodesâ§10min). Associations of sleep patterns with sleep variables (percentage of time in sleep stages, pattern of slow-wave sleep (SWS) recurrence, etc.) were investigated. RESULTS: Analysis was conducted in 95 nights. STN pattern (n=36) was characterized by suppressed body movements while EEG represented a state of wakefulness. Weak signal pattern (n=27) tended to indicate rich and regular distributions of SWS across the night. Strong signal pattern (n=32) was characterized by reduced sleep time, although the amount of SWS was not reduced to that degree. Exclusively breastfed infants accounted for 78% of weak signal patterns, whereas formula-feeding infants, 67% of STN patterns. In several nights with STN or strong signal pattern, SWS did not occur in >50% of the sleep cycles. Multiple regression analysis showed that exclusive breastfeeding may increase the proportion of SWS in non-REM sleep. CONCLUSIONS: Each nocturnal sleep pattern was associated with some sleep architecture, part of which would be attributed to infant's feeding methods.
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Ondas Encefálicas , Actividad Motora , Fases del Sueño/fisiología , Actigrafía , Electroencefalografía , Femenino , Humanos , Lactante , Masculino , FotoperiodoRESUMEN
AIM: Although sleep-disordered breathing (SDB) might impose an underlying health threat upon some pregnant women, the influence of SDB on the health status of most pregnant women is not discernible. In order to find out which pregnant women should be evaluated for clinically meaningful SDB during the second trimester, the present study aimed to determine which overnight oximetry findings significantly affect maternal resting cardiac autonomic modulations. MATERIAL AND METHODS: Overnight arterial oxygen saturation (SaO2 ) was monitored at home using pulse oximetry by 64 women with uncomplicated pregnancy between 24 and 28 weeks of gestation. We then determined the impact of the findings on maternal resting heart rate variability (HRV) using 5-min photoplethysmography. RESULTS: A relatively increased oxygen desaturation index (number of oxygen desaturation events where SaO2 fell >3% below the baseline saturation/h) of ≥3.0 in five women did not significantly impact HRV. On the other hand, events associated with profound oxygen desaturation (minimum SaO2 ≤ 90%) in three women were associated with decreased HRV, including high- and low-frequency powers. CONCLUSION: Parasympathetic activities of cardiac autonomic modulations might be attenuated in women who experience profound night-time oxygen desaturation, even if the incidence of significant events is quite low. The oximetry finding of minimum SaO2 ≤ 90% might be a valuable criterion for clinically meaningful sleep-disordered breathing among women with early uncomplicated pregnancy.
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Sistema Nervioso Autónomo/fisiopatología , Frecuencia Cardíaca/fisiología , Segundo Trimestre del Embarazo , Síndromes de la Apnea del Sueño/fisiopatología , Adolescente , Adulto , Femenino , Humanos , Oximetría , Embarazo , Adulto JovenRESUMEN
This study examined the effectiveness of heart rate variability (HRV) biofeedback intervention for reduction of psychological stress in women in the early postpartum period. On postpartum day 4, 55 healthy subjects received a brief explanation about HRV biofeedback using a portable device. Among them, 25 mothers who agreed to implement HRV biofeedback at home were grouped as the biofeedback group, and other 30 mothers were grouped as the control group. At 1 month postpartum, there was a significant decrease in total Edinburgh Postnatal Depression Scale score (P < 0.001) in the biofeedback group; this change was brought about mainly by decreases in items related to anxiety or difficulty sleeping. There was also a significant increase in standard deviation of the normal heartbeat interval (P < 0.01) of the resting HRV measures in the biofeedback group after adjusting for potential covariates. In conclusion, postpartum women who implemented HRV biofeedback after delivery were relatively free from anxiety and complained less of difficulties sleeping at 1 month postpartum. Although the positive effects of HRV biofeedback may be partly attributable to intervention effects, due to its clinical outcome, HRV biofeedback appears to be recommendable for many postpartum women as a feasible health-promoting measure after childbirth.
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Biorretroalimentación Psicológica/métodos , Frecuencia Cardíaca/fisiología , Periodo Posparto/psicología , Estrés Psicológico/terapia , Adulto , Femenino , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: The refusal of infants to suckle from a breast that is inflamed with mastitis suggests that the taste of the milk has changed. However, the taste of milk from a breast with mastitis has never been empirically determined. The present study compares the taste of milk from breastfeeding mothers with or without mastitis and identifies specific changes in the taste of milk from mothers with mastitis. SUBJECTS AND METHODS: The intensity of four basic tastes (sourness, saltiness, bitterness, and umami) of breastmilk from 24 healthy mothers at 3-5 days and at 2-3, 4-5, and 8-10 weeks postpartum and from 14 mothers with mastitis was determined objectively using a taste sensor. The intensity of each basic taste and the concentrations of main taste substances in milk were compared between the inflamed breasts and the normal breasts of control mothers or the contralateral asymptomatic breast of mothers with unilateral mastitis. RESULTS: The transition from colostrum to mature milk was accompanied by changes in the taste of the milk, such as decreased saltiness and umami and increased bitterness and sourness. Umami and saltiness increased in milk from inflamed breasts. Contents of sodium, glutamate, and guanosine monophosphate increased in milk from inflamed breasts. CONCLUSIONS: Tastes that were specifically associated with inflamed breasts appeared to include an increase in umami and saltiness, which might have resulted from an increased content in factors associated with umami and sodium.
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Técnicas Biosensibles , Lactancia Materna , Calostro/química , Mastitis/metabolismo , Leche Humana/química , Gusto , Adulto , Biomarcadores/análisis , Calostro/metabolismo , Ácidos Grasos no Esterificados/análisis , Femenino , Humanos , Mastitis/complicaciones , Leche Humana/metabolismo , Madres , Periodo Posparto , Conducta en la LactanciaRESUMEN
OBJECTIVE: The objective of the study is to understand the relationship between sleep development and crying episodes during early infancy more accurately by longitudinal and objective sleep evaluations. DESIGN: The study is designed as a prospective longitudinal study of infants in the first 4 months of life. METHODS: This study included 31 healthy term infants. At approximately 4- to 6-week intervals, when the infants were aged 4-6 weeks, 8-10 weeks, and 14-16 weeks, their mothers recorded the duration of crying/fussy behavior of infants in a timetable and attached an actigraph to the infants for 3 days. The relationship between 24-h crying/fussy behavior duration and actigraphic sleep measures was examined from both a cross-sectional (age group) and longitudinal (within-infants) perspective. Interactions with diverse covariates were studied by multiple regression analysis. RESULTS: A significant correlation was found between 24-h crying/fussy behavior duration and proportion of active sleep in infants at 14-16 weeks and in within-infant relationships. Among potential covariates, gestational age and co-sleeping had a significant impact on proportion of active sleep. Results of multiple regression analysis showed that gestational age and co-sleeping were positively associated with proportion of active sleep, whereas 24-h crying/behavior duration was not associated with proportion of active sleep. CONCLUSIONS: Subsiding of early crying and decreasing of proportion of active sleep are parallel phenomena in some infants. However, this association was thought to be attributable to the influence of covariates, including co-sleeping or gestational age. The underlying mechanisms regulating these developmental processes might overlap with one another, as covariates that affect one process could affect the other.
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Llanto/fisiología , Recién Nacido/fisiología , Sueño/fisiología , Actigrafía , Femenino , Humanos , Lactante , MasculinoRESUMEN
BACKGROUND: There have been calls for more aggressive intervention for infants with failure in development of a sleep-wake rhythm. If development of the 'biological clock' in infants can be assessed by measuring melatonin, this may provide a useful indicator of the sleep-wake rhythm development. Thus, we investigated relationship between circadian salivary melatonin concentrations and sleep-wake behavioral parameters in infants. METHODS: Sixty-seven mothers who had infants aged 3-15 months were requested to record sleep-wake behavior of their baby for 2 days, and to collect their baby's saliva four times daily in the morning (06:00-09:00 h), noon (11:00-13:00 h), evening (16:00-18:00 h), and night (19:00-22:00 h) for measurement of melatonin concentrations by ELISA. RESULTS: The mean melatonin concentrations of the saliva were: morning 40 ± 4 pg/mL, noon 14 ± 3 pg/mL, evening 15 ± 3 pg/mL, and night 23 ± 4 pg/mL. The melatonin concentrations, at each measurement point, were highest in infants aged 3-5 months, and decreased as age increased. Morning melatonin concentrations showed a negative correlation with nocturnal sleep duration (P<0.05). Increased morning concentrations were related to early waking time (P<0.05). In infants with open air baths on most days, evening and night melatonin concentrations were significantly lower (P<0.05). CONCLUSION: Salivary melatonin concentrations in infants between 06:00 and 22:00 decreased by age, and elevation of morning values may indicate an immature sleep-wake rhythm. Frequent open air baths may contribute to decreased melatonin levels.