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Am J Perinatol 2024; 41(09): 1113-1119
DOI: 10.1055/s-0044-1780537
SMFM Fellowship Series Article

Sleep Quality in Individuals with and without Persistent Postpartum Hypertension

Tiffany L. Wang
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania
,
Samantha G. Bryan
2   Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Arundhathi Jeyabalan
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania
2   Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Francesca L. Facco
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania
,
Robin E. Gandley
2   Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Carl A. Hubel
2   Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Janet M. Catov
2   Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Alisse K. Hauspurg
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pittsburgh, Pennsylvania
› Author Affiliations Funding This study received financial support from the Amy Roberts Award from Magee-Womens Research Institute, and the Jewish Healthcare Foundation. This work was additionally supported by NIH/ORWH Building Interdisciplinary Research Careers in Women's Health NIH K12HD043441 scholar funds (to A.K.H.) and the American Heart Association Go Red for Women Strategic Focused Research Network (contract AHA 16SFRN28340000).

Clinical Trials Registration Clinicaltrials.gov Number: NCT03749746
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Abstract

Objective This study aimed to compare sleep quality at 1 year postpartum following a hypertensive disorder of pregnancy (HDP) among individuals with persistent postpartum hypertension (HTN) compared with those with normal blood pressures (BPs).

Study Design We combined data from the Heart Health 4 New Moms pilot randomized trial (n = 118) and the Pathways prospective cohort study (n = 36). Individuals with a singleton pregnancy complicated by gestational HTN or preeclampsia underwent a research study visit at a mean 48.7 ± 9.5 weeks postpartum with standardized BP measurement and assessment of subjective sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Persistent postpartum HTN was defined as Stage 1 HTN or greater (mean systolic BP ≥ 130 mm Hg or mean diastolic BP ≥ 80 mm Hg over three measurements at rest) or requiring antihypertensive medication. Statistical analysis was performed using univariate and multivariable logistic regression analyses.

Results Of 154 individuals with an HDP included in the analysis, 84 (55%) were normotensive at 1 year postpartum and 70 (45%) had persistent postpartum HTN. Individuals with persistent postpartum HTN were more likely to be older, self-identify as Black race, have higher prepregnancy and 1-year postpartum body mass index (BMI), be multiparous, and deliver at an earlier gestational age. The mean global PSQI score was 8.7 ± 3.7, with 81% reporting poor sleep (PSQI > 5), and scores were higher among individuals who were persistently hypertensive (9.6 ± 3.5) compared with those who were normotensive at 1 year postpartum (7.9 ± 3.6), p < 0.01. Findings were unchanged in a multivariable model adjusting for age, self-reported race, prepregnancy BMI, and parity.

Conclusion Following an HDP, individuals reported poor sleep quality at 1 year postpartum. Individuals with persistent postpartum HTN reported lower sleep quality, suggesting that sleep behavior may be a target for intervention to improve maternal cardiovascular health following an HDP.

Key Points

  • After an HDP, poor sleep quality was common at 1 year postpartum.

  • Those with persistent postpartum HTN reported worse sleep quality at 1 year postpartum.

  • Sleep behavior may be a target for intervention to improve maternal cardiovascular health.

Keywords

hypertensive disorder of pregnancy - postpartum - sleep - sleep quality

Supplementary Material

Please see the Supplementary Material for additional data on sleep-disordered breathing questions from the Pittsburgh Sleep Quality Index and data on the control individuals from the Pathways prospective cohort.


Note

The results of this study were presented at the virtual Society for Maternal-Fetal Medicine's 42nd Annual Pregnancy Meeting in February 2022.


Supplementary Material



Publication History

Received: 15 June 2023

Accepted: 28 January 2024

Article published online:
19 February 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Wu P, Haththotuwa R, Kwok CS. et al. Preeclampsia and future cardiovascular health: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2017; 10 (02) e003497
    CrossrefPubMedGoogle Scholar
  • 2 Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007; 335 (7627) 974
    CrossrefPubMedGoogle Scholar
  • 3 McDonald SD, Malinowski A, Zhou Q, Yusuf S, Devereaux PJ. Cardiovascular sequelae of preeclampsia/eclampsia: a systematic review and meta-analyses. Am Heart J 2008; 156 (05) 918-930
    CrossrefPubMedGoogle Scholar
  • 4 Hauspurg A, Ying W, Hubel CA, Michos ED, Ouyang P. Adverse pregnancy outcomes and future maternal cardiovascular disease. Clin Cardiol 2018; 41 (02) 239-246
    CrossrefPubMedGoogle Scholar
  • 5 Berks D, Hoedjes M, Raat H, Duvekot JJ, Steegers EA, Habbema JD. Risk of cardiovascular disease after pre-eclampsia and the effect of lifestyle interventions: a literature-based study. BJOG 2013; 120 (08) 924-931
    CrossrefPubMedGoogle Scholar
  • 6 Hauspurg A, Countouris ME, Jeyabalan A. et al. Risk of hypertension and abnormal biomarkers in the first year postpartum associated with hypertensive disorders of pregnancy among overweight and obese women. Pregnancy Hypertens 2019; 15: 1-6
    CrossrefPubMedGoogle Scholar
  • 7 Possomato-Vieira JS, Khalil RA. Mechanisms of endothelial dysfunction in hypertensive pregnancy and preeclampsia. Adv Pharmacol 2016; 77: 361-431
    CrossrefPubMedGoogle Scholar
  • 8 St-Onge MP, Grandner MA, Brown D. et al; American Heart Association Obesity, Behavior Change, Diabetes, and Nutrition Committees of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council. Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American Heart Association. Circulation 2016; 134 (18) e367-e386
    Google Scholar
  • 9 Aggarwal B, Makarem N, Shah R. et al. Effects of inadequate sleep on blood pressure and endothelial inflammation in women: findings from the American Heart Association go red for women strategically focused research network. J Am Heart Assoc 2018; 7 (12) e008590
    CrossrefPubMedGoogle Scholar
  • 10 McBean AL, Kinsey SG, Montgomery-Downs HE. Effects of a single night of postpartum sleep on childless women's daytime functioning. Physiol Behav 2016; 156: 137-147
    CrossrefPubMedGoogle Scholar
  • 11 Hunter LP, Rychnovsky JD, Yount SM. A selective review of maternal sleep characteristics in the postpartum period. J Obstet Gynecol Neonatal Nurs 2009; 38 (01) 60-68
    CrossrefPubMedGoogle Scholar
  • 12 Montgomery-Downs HE, Insana SP, Clegg-Kraynok MM, Mancini LM. Normative longitudinal maternal sleep: the first 4 postpartum months. Am J Obstet Gynecol 2010; 203 (05) 465.e1-465.e7
    CrossrefPubMedGoogle Scholar
  • 13 Gay CL, Lee KA, Lee SY. Sleep patterns and fatigue in new mothers and fathers. Biol Res Nurs 2004; 5 (04) 311-318
    CrossrefPubMedGoogle Scholar
  • 14 Cattarius BG, Schlarb AA. How the sleep of couples changes from pregnancy to three months postpartum. Nat Sci Sleep 2021; 13: 251-261
    CrossrefPubMedGoogle Scholar
  • 15 Richter D, Krämer MD, Tang NKY, Montgomery-Downs HE, Lemola S. Long-term effects of pregnancy and childbirth on sleep satisfaction and duration of first-time and experienced mothers and fathers. Sleep 2019; 42 (04) zsz015
    CrossrefPubMedGoogle Scholar
  • 16 Hauspurg A, Seely EW, Rich-Edwards J. et al. Postpartum home blood pressure monitoring and lifestyle intervention in overweight and obese individuals the first year after gestational hypertension or pre-eclampsia: a pilot feasibility trial. BJOG 2023; 130 (07) 715-726
    CrossrefPubMedGoogle Scholar
  • 17 Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28 (02) 193-213
    CrossrefPubMedGoogle Scholar
  • 18 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol 2019; 133 (01) 1
    PubMedGoogle Scholar
  • 19 Hauspurg A, Lemon L, Cabrera C. et al. Racial differences in postpartum blood pressure trajectories among women after a hypertensive disorder of pregnancy. JAMA Netw Open 2020; 3 (12) e2030815
    CrossrefPubMedGoogle Scholar
  • 20 Cappuccio FP, Stranges S, Kandala NB. et al. Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II Study. [published correction appears in Hypertension. 2007 Nov;50(5):e170] Hypertension 2007; 50 (04) 693-700
    CrossrefPubMedGoogle Scholar
  • 21 Wang Y, Mei H, Jiang YR. et al. Relationship between duration of sleep and hypertension in adults: a meta-analysis. J Clin Sleep Med 2015; 11 (09) 1047-1056
    CrossrefPubMedGoogle Scholar
  • 22 Kominiarek MA, Yeh C, Balmert LC, Facco F, Grobman W, Simon M. Sleep duration during pregnancy using an activity tracking device. AJP Rep 2020; 10 (03) e309-e314
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Facco FL, Kramer J, Ho KH, Zee PC, Grobman WA. Sleep disturbances in pregnancy. Obstet Gynecol 2010; 115 (01) 77-83
    CrossrefPubMedGoogle Scholar
  • 24 Facco FL, Parker CB, Hunter S. et al; NICHD NuMoM2b and NHLBI NuMoM2b Heart Health Study Networks. Later sleep timing is associated with an increased risk of preterm birth in nulliparous women. Am J Obstet Gynecol MFM 2019; 1 (04) 100040
    CrossrefPubMedGoogle Scholar
  • 25 Facco FL, Parker CB, Hunter S. et al; NICHD NuMoM2b and NHLBI NuMoM2b Heart Health Study Networks. Association of adverse pregnancy outcomes with self-reported measures of sleep duration and timing in women who are nulliparous. J Clin Sleep Med 2018; 14 (12) 2047-2056
    CrossrefPubMedGoogle Scholar
  • 26 Facco FL, Lappen J, Lim C, Zee PC, Grobman WA. Preeclampsia and sleep-disordered breathing: a case-control study. Pregnancy Hypertens 2013; 3 (02) 133-139
    CrossrefPubMedGoogle Scholar
  • 27 Insana SP, Williams KB, Montgomery-Downs HE. Sleep disturbance and neurobehavioral performance among postpartum women. Sleep 2013; 36 (01) 73-81
    CrossrefPubMedGoogle Scholar
  • 28 Hou H, Zhao Y, Yu W. et al. Association of obstructive sleep apnea with hypertension: a systematic review and meta-analysis. J Glob Health 2018; 8 (01) 010405
    CrossrefPubMedGoogle Scholar
  • 29 Facco FL, Redline S, Hunter SM. et al. Sleep-disordered breathing in pregnancy and after delivery: associations with cardiometabolic health. Am J Respir Crit Care Med 2022; 205 (10) 1202-1213
    CrossrefPubMedGoogle Scholar
  • 30 Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14 (06) 540-545
    CrossrefPubMedGoogle Scholar
  • 31 Buysse DJ, Yu L, Moul DE. et al. Development and validation of patient-reported outcome measures for sleep disturbance and sleep-related impairments. Sleep 2010; 33 (06) 781-792
    CrossrefPubMedGoogle Scholar