Study On The Relationships Among Sleep Quality, Sleepiness, Fatigue, Anxiety And Depression Of Pregnant Women

Objectives To use validated scales to describe differences in sleep quality, sleepiness, fatigue, anxiety and depression among the first-, second- and third-trimester pregnant women. To explore the factors that affect sleep disturbances, sleepiness, fatigue, anxiety and depression in pregnant women, and the relationships among sleep quality, sleepiness, fatigue, anxiety and depression of pregnant women.Methods A cross-sectional descriptive survey was used in this study. One thousand and eighty pregnant women were randomly enrolled in the study from June 2010 to February 2011. These pregnant women came from six hospitals of Changsha. The instruments used in the survey were self-documenting items for these women, Pittsburgh Sleep Quality Index questionnaire(PSQI), Epworth Sleepiness Scale(ESS), Fatigue Assessment instrument(FAI), Self-Rating Anxiety Scale(SAS) and Self-Rating Depression Scale(SDS). All datas above were analyzed by SPSS 17.0 using frequency, rate, mean and standard deviation for descriptive statistics; using t-test, rowxcolumn chi-square test, ANOVA(LSD-test), Kruskal- Wallis H test(Bonferroni-test), Spearman correlation analysis, multiple linear stepwise regression analysis and multiple linear enter regression. Significance was assumed at P<0.05.Results1. The quality of sleep was found to decline during pregnancy. The score of sleep quality during pregnancy was 6.44±3.20, and the prevalences of good, general and poor sleepers were 30.2%,37.4%, 32.4%, respectively. The sleep quality scores were 5.56±3.17,6.17±3.10,7.47±3.03 in the first-, second-, third-trimester respectively. There were significant differences between any two of them (P<0.05). All factors constructed PSQI scale had significant differences in the three trimesters (P<0.05) except factor three and factor six (that is "sleep duration" and "sleeping medications"). The poor sleep quality incidence in the three trimesters were 21.2%,30.0%,44.4%,respectively, and there were significant differences between any two of them (P<0.0167).2. The score of item "having to get up to use the bathroom" of sleep disturbance in PSQI scale was the highest one, and there were significant differences among the three trimesters (P<0.05); besides, the items, such as "awakening during the night", "subjective sleep quality", "full of energy", "difficult to fall asleep," "snoring," and other items had significant differences (P<0.05). The items "bedtime", "time to get up " and "habitual sleep efficiency" scores in the three trimesters were significant differences (P<0.05). The scores of different occupations, family incomes, pregnancy body mass index, snoring during pregnancy, having to get up to use the bathroom were different in any two periods during pregnancy (P<0.05).3. Sleepiness score of ESS was 7.09±3.14, and the prevalence of sleepiness was 40.5%. The scores were different between the first and the third trimesters, the second and the third trimester (P<0.05). The sleepiness prevalence of three trimesters were 27.8%,35.3%,56.5%, respectively, and any two of them were different (P=0.000). Pregnant women with different sleep quality levels had different ESS scores, and the prevalences of sleepiness with good, general, poor sleep quality were 33.1%,35.4%,53.0%, respectively, and the differences was statistically significant (P<0.05). That is, the worse their sleep quality, the severer their sleepiness was.4. The FAI score of pregnant women was 4.04±0.78, and the fatigue prevalence was 47.1%. FAI scores of any two periods had significantly difference (P<0.05). The fatigue prevalences of three trimesters were 44.4%,41.0%,55.4%, respectively, and the differences between any two of them were significant (P<0.05). Pregnant women with different sleep quality levels had different FAI scores, and the prevalence of fatigue with good sleep quality was 41.6%, the general one was 46.3%, and the poor one was 52.8%. And the differences were statistically significant (P<0.05). That is, the worse their sleep quality, the severer their fatigue was.5. The SAS score of pregnant women was 45.22±8.11, the prevalence of anxiety was 29.4%. The SDS score was 44.69±8.91, and its prevalences of depression was 26.7%. Anxiety prevalence of three trimesters were 29.4%,16.6%,42.1%, respectively, and the differences between any two of them were significant (P<0.05). Depression prevalences of three trimesters were 27.1%,26.5%,26.6%, respectively, and there were no differences among them (P>0.05). Pregnant women with different sleep quality levels had different SAS and SDS scores, the prevalence of anxiety and depression with good sleep quality was 13.8%, 12.8%, with general one were 31.5%,21.4%, and with poor one were 41.5%,45.7%, respectively. The differences among the three trimesters were statistically significant (P<0.05).6. Sleep quality of pregnant women had negative correlation with stational age, suffering from nasosinusitis, post-pregnancy body mass index, preconception insomnia,using sleeping medications, preconception snoring, snoring during pregnancy, having to get up to use the bathroom at night(P<0.05). Sleep quality of pregnant women had negative correlation with fatigue, anxiety, and depression (P<0.05). Sleepiness had positive correlations with fatigue and depression (P<0.05). Anxiety was positively correlated with sleepiness and depression (P<0.05).7. Multiple linear stepwise regression analysis on influential factors of sleep quality, sleepiness, fatigue, anxiety, depression.Influential factors of sleep quality of pregnant women:gestational age, educational level, preconception insomnia, snoring during pregnancy, having to get up to use the bathroom at night and the coefficients of determination of these six variables was 21.8%. The factors that affected sleepiness were:daytime dysfunction, gestational age, sleep disturbances, mental emotional symptoms, fatigue severity, having to get up to use the bathroom and sleep quality, and the coefficients of determination of these seven variables was 15.3%. The factors that affected fatigue were:having to get up to use the bathroom during pregnancy, sleep quality, subjective sleep quality, daytime dysfunction, preconception insomnia and the coefficients of determination of these five variables was 15.3%. The factors that affected anxiety were:sleep quality, sleep disturbances, sleepiness, fatigue, having to get up to use the bathroom at night, responsiveness to rest or sleep and the coefficients of determination of these six variables was 15.9%. The factors that affected depression were: sleep quality, gestational age, responsiveness to rest or sleep, daytime sleepiness and sleep disturbances and the coefficients of determination of these five variables was 32.5%.8. The multiple linear enter regression indicated that sleep quality, fatigue, sleepiness were factors of anxiety with direct action, and the path coefficient of which were 0.322,0.075,0.096, respectively. There were three indirect factors of anxiety:sleep quality indirectly influenced anxiety by influencing fatigue, the path coefficients of which were 0.141, 0.075; sleep quality indirectly influenced anxiety by influencing sleepiness, and the path coefficients of which were 0.226,0.096. Fatigue indirectly influenced anxiety by sleepiness, and the path coefficients of which were 0.141,0.164,0.096.Conclusions1. The sleep patterns during pregnancy changed a lot. And the sleep quality, sleepiness, fatigue, anxiety and depression of pregnant women were poor, especially in the third trimester.2. The sleep quality of pregnant women had negative correlation with sleepiness, fatigue, anxiety and depression. The poorer the sleep quality, the worse the sleepiness, fatigue, anxiety and depression. Fatigue and depression had positive correlation with sleepiness. Anxiety had positive correlations with sleepiness and depression.3. Influential factors of sleep quality pregnant women:gestational age,educational level, pre-pregnancy insomnia, snoring during pregnancy, having to get up to the bathroom at night. The factors that affected sleepiness were:daytime dysfunction, gestational age, sleep disturbances, mental emotional symptoms, fatigue severity, having to get up to use the bathroom and sleep quality. The factors that affected fatigue were:having to get up to use the bathroom at night, sleep quality, subjective sleep quality, daytime dysfunction, preconception insomnia. The factors that affected anxiety were:sleep quality, sleep disturbances, sleepiness, fatigue, having to get up to use the bathroom at night, responsiveness to rest or sleep. The factors that affected depression were:sleep quality, gestational age, responsiveness to rest or sleep, sleepiness, daytime dysfunction.4. The sleep quality, sleepiness and fatigue of pregnant women could directly influence anxiety and sleep quality could also indirectly influence anxiety by influencing fatigue and sleepiness.