Efficacy of cognitive behavioural therapy for insomnia or sleep disturbance in pregnant women: A systematic review ad meta-analysis

During pregnancy many women may experience negative emotions and sleep disturbances. This systematic review and meta-analysis was conducted to assess the efficacy of cognitive behavioural therapy for insomnia (CBT-I) or sleep disturbance in pregnant women. From the earliest available publications to 15 April 2022, seven electronic literature databases were searched: PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Database for Chinese Science and Technology Journal. Randomised controlled trials of CBT-I in pregnant women with insomnia or sleep disorders were included. The methodological bias of the included studies was assessed using the Cochrane risk of bias tool. The meta-analysis was performed using RevMan 5.4 software. Stata Statistical Software: Release 15 was used for sensitivity analysis and publication bias. We included eight randomised controlled trials involving 743 pregnant women. Meta-analysis showed that, compared with the control group, CBT-I significantly improved the Insomnia Severity Index (mean difference [MD] = −4.25, 95% confidence interval [CI, −6.32, −2.19], p < 0.001), The Pittsburgh Sleep Quality Index (MD = −3.30, 95% CI [−4.81, −1.79], p < 0.001), sleep onset latency (standardised mean difference [SMD] = −1.25, 95% CI [−2.01, −0.50], p = 0.001), anxiety (SMD = −0.99, 95% CI [−1.32, −0.67], p < 0.001), and depression (SMD = −0.40, 95% CI [−0.72, −0.07], p = 0.02). No significant differences were found in total sleep time (SMD = 0.31, 95% CI [−0.54, 1.17], p = 0.47) and sleep efficiency (SMD = 0.80, 95% CI [−0.53, 2.13], p = 0.24). CBT-I significantly improved pregnant women's sleep quality, insomnia severity, depression, and anxiety. This meta-analysis provides evidence that CBT-I is valid for insomnia or sleep disturbances during pregnancy.     

Influence of HIV-1 and/or HIV-2 infection and CD4 count on cervical HPV DNA detection in women from Senegal,West Africa

BackgroundHIV infection is associated with greater risk of precancerous lesions and cervical cancer in women. However, several factors remain unclarified regarding the association between HIV infection and HPV detection, especially among those with HIV type 2 versus type 1 infection and severely immunocompromised persons.ObjectivesTo evaluate HPV overall and type-specific detection among HIV-infected and uninfected women in Senegal.Study designDetection of HPV DNA for 38 genotypes in cervical swabs using PCR-based methods was evaluated in HIV-positive (n = 467) and HIV-negative (n = 2139) women participating in studies in Senegal. Among HIV-1 and/or HIV-2 positive women, CD4 counts were assessed. Adjusted multivariable prevalence ratios (PR) were calculated.ResultsThe prevalence of any HPV DNA and multiple HPV types was greater among HIV-infected individuals (78.2% and 62.3%, respectively) compared with HIV-negative women (27.1% and 11.6%). This trend was also seen for HPV types 16 and 18 (13.1% and 10.9%) compared to HIV-negative women (2.2% and 1.7%). HIV-infected women with CD4 cell counts less than 200 cells/μl had a higher likelihood of any HPV detection (PR_a 1.30; 95% CI 1.07–1.59), multiple HPV types (PR_a 1.52; 95% CI 1.14–2.01), and HPV-16 (PR_a 9.00; 95% CI 1.66–48.67), but not HPV-18 (PR_a 1.20, 95% CI 0.45–3.24) compared to those with CD4 counts 500 cells/μl or above.ConclusionHIV-infected women, especially those most severely immunocompromised, are more likely to harbor HPV. Measures to prevent initial HPV infection and subsequent development of cervical cancer through focused screening efforts should be implemented in these high risk populations.     

Toxoplasma prevalence among pregnant women in Norway: a cross‐sectional study

Infection by Toxoplasma gondii may lead to complications in the foetus if the mother suffers from primary infection during pregnancy . Previously infected women have produced toxoplasma‐specific IgG antibodies. The most recent study on prevalence of toxoplasma IgG in the Norwegian pregnant population was conducted 20 years ago. The present study is part of a research programme initiated by the Norwegian Institute of Public Health. We aimed to update the knowledge regarding the prevalence of toxoplasma IgG among pregnant women in Norway. In this cross‐sectional study, sera from 1922 pregnant women in Buskerud (992) and Sør‐Trøndelag counties (930) in Norway were collected consecutively. The presence of toxoplasma IgG was identified by values ≥8 IU/mL using an ELISA test. The overall prevalence of toxoplasma IgG seropositivity was 9.3% (95% CI 8.1–10.7); Sør‐Trøndelag 10.4% (95% CI 8.6–12.6) and Buskerud 8.3% (95% CI 6.7–10.2). There was no difference between the counties (p = 0.13), and the result did not differ from prevalences found in 1974 (12.1%) and 1994 (10.7%). We found a higher prevalence among women ≥40 years (OR 2.65, 95% CI 1.30–5.42). The prevalence of toxoplasma IgG among pregnant women in Norway is low and has been stable during the last decades.     

Fibrinogen may mediate the association between long sleep duration and coronary heart disease

Long sleep duration has been associated with increased risk of cardiovascular disease (CVD) and all‐cause mortality. Inflammation and coagulation have been hypothesized as possible physiological pathways to explain this association, although specific biomarkers have not been studied. Using longitudinal data from 3942 postmenopausal women in the Women's Health Initiative observational study and clinical trials, we investigated whether fibrinogen, an acute‐phase inflammatory protein involved in blood clotting, mediates the associations between sleep duration and coronary heart disease (CHD) and mortality among women. Fibrinogen levels were associated positively with self‐reported long sleep duration (9+ h per night), CHD and all‐cause mortality, even after adjustment for a range of sociodemographic characteristics, cardiovascular risk factors and comorbidities.Compared with self‐reported 7–8 h per night sleep duration, self‐reported long sleep duration was associated with increased odds of CHD [odds ratio (OR) = 2.05, 95% confidence interval (CI): 1.02–4.11]. Adjustment for fibrinogen levels reduced the increased odds of CHD associated with long sleep by approximately 8 percentage points (OR = 1.97, 95% CI: 0.98–3.97). A similar reduction in the OR was observed with mortality. For both outcomes there is support for partial mediation of 6–7%, suggesting that fibrinogen may be a mechanism through which long sleep duration is associated with CHD and mortality.     

Sleep duration and sleep disturbances partly explain the association between depressive symptoms and cardiovascular mortality: the Whitehall II cohort study

Depressive symptoms are associated with an increased risk of death, but most of this association remains unexplained. Our aim was to explore the contribution of sleep duration and disturbances to the association between depressive symptoms, all‐cause and cardiovascular disease mortality. A total of 5813 (4220 men and 1593 women) aged 50–74 years at baseline, participants of the British Whitehall II prospective cohort study, were included. Depressive symptoms, sleep duration and disturbances were assessed in 2003–04. Mortality was ascertained through linkage to the national mortality register until August 2012, with a mean follow‐up of 8.8 years. Depressive symptoms were associated with an increased risk of mortality from all causes [hazard ratio (HR) = 1.51; 95% confidence interval (CI): 1.16–1.97)] and cardiovascular diseases (HR = 1.63; 95% CI: 1.01–2.64) after adjustment for sociodemographic characteristics. Further adjustment for sleep duration and disturbances reduced the association between depressive symptoms and cardiovascular mortality by 21% (HR = 1.53; 95% CI: 0.91–2.57). Sleep seems to have a role, as a mediator or confounder, in explaining the association between depressive symptoms and cardiovascular mortality. These findings need replication in larger studies with longer follow‐up.     

Minimal nocturnal oxygen saturation predicts future subclinical carotid atherosclerosis: the Wisconsin sleep cohort

Previous data on the associations between nocturnal oxygen saturation parameters and carotid atherosclerosis are conflicting. We examined the prospective associations of nocturnal oxygen saturation (SaO₂) and cardiovascular disease (CVD) risk factors with carotid intima‐media thickness (IMT) and plaques. We used data on 689 Wisconsin sleep cohort participants who had baseline overnight polysomnography followed by carotid ultrasonography a mean (SD) of 7.8 (2.5) years later. Far wall common carotid IMT was measured using B‐mode ultrasound. Bilateral common, bifurcation and internal carotid artery segments were evaluated for plaque score. Participants (8) were aged 56 years (55% male); 32% had hypertension and mean body mass index (BMI) was 31 (7) kg m². Mean and minimum nocturnal SaO₂ were 95% (2) and 86% (7), respectively. Mean percentage sleep time with SaO₂ < 90% was 2% (8). Both mean (odds ratio [OR]: 0.60 lower plaque count per 5% higher mean SaO₂, 95% confidence interval [CI]: 0.38–0.96, P = 0.033) and minimum SaO₂ (OR: 0.88 lower plaque count per 5% higher minimum SaO₂, 95% CI: 0.80–0.97, P = 0.013) predicted carotid plaque score after adjusting for age, sex and BMI. Minimum SaO₂ predicted future plaque score after adding adjustment for traditional CVD risk factors (OR: 0.90 lower plaque count per 5% higher minimum SaO₂, 95% CI: 0.81–0.99, P = 0.038). Mean SaO₂ was not associated with carotid IMT after CVD risk factor adjustment. We conclude that minimum nocturnal SaO₂ is an independent predictor of future carotid plaque burden. Other nocturnal SaO₂ parameters are not associated with future carotid IMT or plaques after adjusting for traditional CVD risk factors.     

School start time and sleep in Canadian adolescents

Insufficient sleep is a serious problem in adolescents and school start time is thought to be a key contributor. This study provided the first comprehensive assessment of school start times across Canada and examined whether school start times were associated with sleep duration and tiredness among adolescents. We collected information on school start times from 362 schools that participated in the 2013/2014 Health Behaviour in School‐aged Children study. We calculated sleep duration from weekday bedtime and wake time reported by 29 635 students (aged 10–18 years). We classified weekday sleep as sufficient if it met national recommendations, and used data on self‐reported tiredness at school in the morning. Random‐effects regression models estimated the association of school start time with sleep duration, sleep sufficiency and tiredness. On average, schools started at 08:43 hours. Students slept an average of 8:36 h on weekdays and 69% met sleep duration recommendations, but 60% reported feeling tired in the morning. Every 10‐min delay in school start time corresponded with 3.2 [95% confidence interval (CI): 2.0, 4.5] additional minutes of sleep, a 1.6% (95% CI: 0.5, 2.8) greater probability of sufficient sleep and a 2.1% (95% CI: 1.0, 3.2) smaller probability of feeling tired at school in the morning. Students from schools that started later slept longer, were more likely to meet sleep recommendations and were less likely to report feeling tired in the morning. The study adds weight to the mounting evidence that delaying school start time benefits adolescent sleep.     

Association between objective sleep measures and cognitive performance: a cross-sectional analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study

Sleep disturbances often co-exist, which challenges our understanding of their potential impact on cognition. We explored the cross-sectional associations of insomnia and objective measures of sleep with cognitive performance in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study stratified by middle-aged and older adults. Participants aged ≥55 years underwent cognitive evaluations, polygraphy for 1 night, and actigraphy for 7 days. Insomnia was evaluated using the Clinical Interview Scheduled Revised. Obstructive sleep apnea (OSA) and short sleep duration (SSD) were defined by an apnea–hypopnea index (AHI) of ≥15 events/h and <6 h/ night, respectively. In 703 participants (mean [SD] age 62 [6] years, 44% men), cognition was evaluated using a 10-word list, verbal fluency, and trail-making tests. The frequencies of insomnia, SSD, and OSA were 11%, 24%, and 33%, respectively. In all, 4% had comorbid OSA and insomnia, and 11% had both OSA and SSD. Higher wake after sleep onset (β = −0.004, 95% confidence interval [CI] −0.008, −0.001) and the number of awakenings (β = −0.006, 95% CI −0.012, −0.001) were associated with worse verbal fluency performance. Compared to those without insomnia, older participants with insomnia had worse global performance (β = −0.354, 95% CI −0.671, −0.038). Insomnia was an effect modifier in the associations between AHI and executive function performance (p for the interaction between insomnia and AHI = 0.004) and between oxygen saturation <90% and memory performance (p for the interaction between insomnia and oxygen saturation = 0.02). Although some associations between sleep measures and cognition were significant, they should be considered with caution due to the large sample size and multiple testing performed in this study.     

Hepatitis B virus infection among pregnant women in Haiti: A cross-sectional serosurvey

BackgroundHepatitis B vaccine administered shortly after birth is highly effective in preventing mother to child transmission (MTCT) of infection. While hepatitis B vaccine was introduced in Haiti as part of a combined pentavalent vaccine in 2012, a birth dose is not yet included in the immunization schedule.ObjectivesDetermine the seroprevalence of hepatitis B virus (HBV) infection among pregnant women to evaluate the risk of MTCT.Study designWe selected 1364 residual serum specimens collected during a 2012 human immunodeficiency virus (HIV) sentinel serosurvey among pregnant women attending antenatal care clinics. Haiti was stratified into two regions: West, which includes metropolitan Port-au-Prince, and non-West, which includes all other departments. We evaluated the association between demographic and socioeconomic characteristics and HIV infection with HBV infection.ResultsOf 1364 selected specimens, 1307 (96%) were available for testing. A total of 422 specimens (32.7%) tested positive for total anti-HBc (38.2% in West vs. 27% in non-West, p < 0.001), and 33 specimens (2.5%) were HBsAg positive (2.1% in West vs. 3% in non-West, p = 0.4). Of HBsAg positive specimens, 79% had detectable HBV DNA. Women aged 30 and older had more than double the odds of positive total anti-HBc than women aged 15–19 years (p < 0.001). Women with secondary (adjusted odds ratio (aOR) = 0.54; 95% CI: 0.36–0.81) and post-secondary education (aOR = 0.40, 95% CI: 0.19–0.79) had lower odds of total anti-HBc positivity compared with women with no education. HIV-status was not associated with HBV infection.ConclusionsHaiti has an intermediate endemicity of chronic HBV infection with high prevalence of positive HBV DNA among chronically infected women. Introduction of a universal birth dose of hepatitis B vaccine might help prevent perinatal HBV transmission.     

Interleukin 6 as a marker of depression in women with sleep apnea

Depression is common in women with obstructive sleep apnea (OSA), but objective markers of depression have not yet been explored in such patients. We hypothesized that inflammation and antioxidant biomarkers may be associated with depression in a cohort of OSA women. We conducted a multicentre, cross‐sectional study in 247 women diagnosed with moderate‐to‐severe OSA. Depression was assessed by the depression subscale of the Hospital Anxiety and Depression Questionnaire (HAD‐D) and defined as a score ≥11. Associations between tumour necrosis factor α (TNFα), interleukin 6 (IL‐6), C‐reactive protein (CRP), intercellular adhesion molecule 1 (ICAM‐1), catalase (CAT), superoxide dismutase (SOD) and brain‐derived neurotrophic factor (BDNF) plasma levels and depression were assessed. The women had a median (25th‐75th percentiles) age of 58 (51–65) years, body mass index (BMI) of 33.5 (29.0–38.3) Kg/m², Epworth Sleepiness Scale (ESS) score of 10 (6–13) and apnea–hypopnea index (AHI) of 33.3 (22.8–49.3). Logistic regression analyses revealed that only IL6 levels were associated with the presence of depression (adjusted odds ratio [OR], 1.20; 95% confidence interval [CI], 1.08–1.34), whereas linear regression further confirmed that IL6 levels were significantly associated with HAD‐D scores (β = .154; 95% CI, 0.03–0.30). Multivariate regression analysis showed that IL6 (OR, 1.22; 95% CI, 1.09–1.36), ESS (OR, 1.10; 95% CI 1.02–1.19) and physical activity <30 min/day (OR, 2.51; 95% CI, 1.25–5.05) were independent predictors of depression. Thus, we conclude that in a cohort of women with moderate‐to‐severe OSA, IL6 levels are independently associated with the presence of depression and correlate with depression scores. Low physical activity and higher ESS scores are also independent indicators of risk of depression in this population.     

Analysis of dynamic,bidirectional associations in older adult physical activity and sleep quality

Sleep quality and physical activity (PA) appear to be interrelated; thus, by promoting one behaviour, it may be possible to improve the other in older adults. Examination of the within‐person day‐to‐day variation in PA and sleep quality could potentially elucidate the directionality of the association of these behaviours. We measured sleep quality (i.e. fragmentation, efficiency, duration and latency) and moderate‐to‐vigorous PA using the MotionWatch8© over 14 consecutive days and nights in community‐dwelling adults (n = 152; age range 53–101 years). Multilevel modelling estimated within‐subject autoregressive and cross‐lagged effects and between‐subject associations between PA and sleep quality. On days when individuals engaged in a high amount of PA on one day (relative to their averages), they were more likely to engage in a high amount of PA on the next day (estimate, 0.19; 95% CI, 0.14, 0.24). Nights in which individuals had a long sleep latency were followed by nights in which they also had a long sleep latency (estimate, 0.09; 95% CI, 0.03, 0.14). In contrast, nights in which individuals slept for a long period of time were followed by nights in which they slept relatively less than their averages (estimate, ?0.09; 95% CI, ?0.13, ?0.04). When individuals engaged in a large amount of PA during the day, they tended to sleep longer that following night (estimate, 0.01; 95% CI, 0.001, 0.02). All other associations between PA and sleep quality were not significant. Increasing PA therefore might increase sleep duration in older adults.     

Global prevalence of Neisseria gonorrhoeae infection in pregnant women: a systematic review and meta-analysis

BackgroundNeisseria gonorrhoeae infection (gonorrhoea) is associated with several pregnancy complications, including preterm labour, spontaneous abortion, stillbirth, miscarriage, growth retardation, and intrauterine death.ObjectivesWe performed a systematic review and meta-analysis to estimate the global and regional prevalence of gonorrhoea in pregnant women as a scientific basis for further studies.Data sourcesWe systematically searched PubMed/MEDLINE, Web of Science, Embase, Scopus, and SciELO databases from inception to 10 July 2022.Study eligibility criteriaWe included cross-sectional, cohort, and case-control studies that reported the prevalence of gonorrhoea in pregnant women. In addition, we included baseline data for randomized controlled trials.ParticipantsPregnant women who were tested for gonorrhoea.MethodsPooled prevalence estimates at 95% CIs were calculated using a random-effects meta-analysis model. We stratified countries according to WHO-defined regions and socio-economic factors. Moreover, sub-group-, meta-regression, and sensitivity analyses were conducted to investigate the effects of pre-determined factors on prevalence estimates and heterogeneity.ResultsWe identified 235 studies (249 datasets) on 19 104 175 pregnant women from 71 countries. The worldwide pooled prevalence of gonorrhoea in pregnant women was estimated at 1.85% (95% CI 1.73–1.97%), with the highest rate in the African region (3.53%) (2.84–4.29%) and the lowest rate in the European region (0.52%) (0.27–0.84%). Overall, the prevalence estimates were high among low-income countries (3.03%), pregnant women with HIV (2.81%), and pregnant women <20 years old (8.06%). A significant decreasing trend in prevalence was observed over time (β = ?0.0008, 95% CI ?0.0012 to ?0.0004, p 0.001).DiscussionOur findings indicate that a substantial number of pregnant women have been infected with gonorrhoea globally, which calls for immediate public health measures to reduce the potential risk of infection. The study highlights the inadequacy or lack of data for many countries, emphasizing the need to expand systematic data collection efforts at national and regional levels.     

Short persistent sleep duration is associated with poor receptive vocabulary performance in middle childhood

The aim of this study was to examine whether short sleep duration is associated with poor receptive vocabulary at age 10 years. In the Quebec Longitudinal Study of Child Development, parents reported their children's nocturnal sleep duration annually from ages 2.5 to 10 years, and children were assessed for receptive vocabulary using the Peabody Picture Vocabulary Test—Revised (PPVT‐R) at ages 4 and 10 years. Groups with distinct nocturnal sleep duration trajectories were identified and the relationships between sleep trajectories and poor PPVT‐R performance were characterized. In all, 1192 children with available sleep duration and PPVT‐R data participated in this epidemiological study. We identified four longitudinal nocturnal sleep trajectories: short persistent sleepers (n = 72, 6.0%), short increasing sleepers (n = 47, 3.9%), 10‐h sleepers (n = 628, 52.7%) and 11‐h sleepers (n = 445, 37.3%). In all, 14.8% of the children showed poor PPVT‐R performance at age 10 years. Nocturnal sleep trajectories and poor PPVT‐R performance at age 10 were associated significantly (P = 0.003). After adjusting for baseline receptive vocabulary performance at age 4 and other potential confounding variables, logistic regression analyses suggest that, compared to 11‐h sleepers, the odds ratio of presenting poor receptive vocabulary at age 10 was 2.67 [95% confidence interval (CI): 1.24–5.74, P = 0.012] for short persistent sleepers and 1.66 (95% CI: 1.06–2.59, P = 0.026) for 10‐h sleepers. These results corroborate previous findings in early childhood, and indicate that short sleep duration is associated with poor receptive vocabulary during middle childhood.     

A new likelihood ratio metric for the psychomotor vigilance test and its sensitivity to sleep loss

The Psychomotor Vigilance Test (PVT) is a widely used assay of behavioural alertness sensitive to the effects of sleep loss and circadian misalignment. However, there is currently no accepted PVT composite outcome metric that captures response slowing, attentional lapses and compensatory premature reactions observed typically in sleep‐deprived subjects. We developed a novel likelihood ratio metric (LRM) based on relative frequency distributions in 50 categories of reaction times (RT) and false starts in alert and sleep‐deprived subjects (acute total sleep deprivation: n = 31 subjects). The LRM had the largest effect size both in a 33‐h total sleep deprivation protocol [1.96; 95% confidence interval (CI): 1.61–2.44; followed by response speed 1/RT, effect size 1.93, 95% CI: 1.55–2.65] and in a chronic partial sleep restriction protocol (1.22; 95% CI: 0.96–1.59; followed by response speed 1/RT, effect size 1.21, 95% CI: 0.94–1.59; 5 nights at 4 h sleep per night; n = 43 subjects). LRM scores correlated highly with response speed (R² = 0.986), and less well with five other common PVT outcome metrics (R² = 0.111–0.886). In conclusion, the new LRM is a sensitive PVT outcome metric with high statistical power that takes subtle sleep loss‐related changes in the distribution of reaction times (including false starts) into account, is not prone to outliers, does not require baseline data and can be calculated and interpreted easily. Congruence between LRM and PVT response speed and their similar effect size rankings support the use of response speed as the primary, most sensitive and most parsimonious standard PVT outcome metric for determining neurobehavioural deficits from sleep loss.     

Rest–activity rhythm and sleep characteristics associated with depression symptom severity in strained dementia caregivers

Depression is associated with disturbances to sleep and the 24‐h sleep–wake pattern (known as the rest–activity rhythm: RAR). However, there remains a need to identify the specific sleep/RAR correlates of depression symptom severity in population subgroups, such as strained dementia caregivers, who are at elevated risk for major depressive disorder. We assessed the cross‐sectional associations of sleep/RARs with non‐sleep depression symptom severity among 57 (mean age: 74 years, standard deviation: 7.4) strained dementia caregivers who were currently without clinical depression. We derived sleep measures from polysomnography and actigraphy, modelled RARs using a sigmoidally transformed cosine curve and measured non‐sleep depression symptom severity using the Hamilton Depression Rating Scale (HRDS) with sleep items removed. The following sleep–wake measures were associated with greater depression symptom severity (absolute Spearman's correlations ranged from 0.23 to 0.32): more time awake after sleep onset (WASO), higher RAR middle level (mesor), relatively shorter active periods (alpha), earlier evening settling time (down‐mesor) and less steep RARs (beta). In multivariable analysis, high WASO and low RAR beta were associated independently with depression symptom severity. Predicted non‐sleep HDRS means (95% confidence intervals) in caregivers with and without these characteristics were: normal WASO/beta = 3.7 (2.3–5.0), high WASO/normal beta = 5.5 (3.5–7.6), normal WASO/low beta = 6.3 (3.6–8.9) and high WASO/low beta = 8.1 (5.3–10.9). Thus, in our sample of strained caregivers, greater sleep fragmentation (WASO) and less sustained/sharply segregated resting and active periods (low RAR beta) correlate uniquely with depression symptom severity. Longitudinal studies are needed to establish whether these independent sleep–wake correlates of depression symptoms explain heightened depression risk in dementia caregivers.     

Changes in cytomegalovirus seroprevalence in pregnant Japanese women—A 10-year single center study

BackgroundHuman cytomegalovirus (CMV) causes congenital infections during pregnancy, and seroepidemiological data are important for estimating the risk of infection. However, only a few reports of CMV seroprevalence exist for pregnant Japanese women.ObjectivesThe purpose of this study was to assess CMV seroprevalence in pregnant Japanese women.Study designThis cross-sectional study involved pregnant Japanese women who delivered from 2003 to 2012 at our hospital (n = 15,616). Among these women, 14,099 (90.3%) underwent tests for the presence of CMV IgG. Those with an equivocal test result were excluded (n = 195) from this analysis, leaving a study sample of 13,904 Japanese pregnant women. The prevalence of CMV IgG was also assessed by calendar year, age, and parity.ResultsThe overall CMV IgG prevalence rate was 66.0%. CMV IgG prevalence significantly decreased over the course of 10 years from 2003 to 2012 (from 69.9% in 2003 to 65.2% in 2012) (p < 0.001). Adjusted odds ratios for CMV IgG positivity in women aged <25, 25–30, 35–40, and >40 years were 1.66 (95%CI: 1.25–2.20), 1.20 (95%CI: 1.07–1.35), 1.16 (95%CI: 1.07–1.26), and 1.44 (95%CI: 1.28–1.62), respectively, compared to women aged 30–35 years. Adjusted odds ratios for CMV IgG positivity for a parity of 1, 2, and ≥3 were 1.14 (95%CI: 1.06–1.23), 1.52 (95%CI: 1.32–1.77), and 2.54 (95%CI: 2.69–3.84), respectively, compared to nulliparous women.ConclusionWe found that 34% of pregnant Japanese women were susceptible to CMV infection. Calendar year, maternal age, and parity were significantly associated with changes in CMV seroprevalence among this population.     

Associations of early pregnancy sleep duration with trimester-specific blood pressures and hypertensive disorders in pregnancy

Study Objectives:

We evaluated the influence of maternal self-reported habitual sleep duration during early pregnancy on blood pressure (BP) levels and risk of hypertensive disorders of pregnancy.

Design:

Prospective cohort study.

Setting:

Clinic-based study.

Participants:

A cohort of 1,272 healthy, pregnant women.

Measurements and Results:

We abstracted maternal antenatal BP values from medical records and estimated mean BP differences across hours of sleep categories in regression models, using generalized estimating equations. Odds ratios (OR) and 95% confidence intervals (95% CIs) for pregnancy induced hypertension (PIH) and preeclampsia (PE) in relation to long and short sleep duration were estimated. Mean 1^st and 2^nd trimester systolic (S) and diastolic (D) BP values were similar among women reporting to be short sleepers (≤ 6 h) vs. women reporting to sleep 9 hours. However, both short and long sleep duration in early pregnancy were associated with increased mean 3^rd trimester SBP and DBP. For example, mean 3^rd trimester SBP was 3.72, and 2.43 mm Hg higher for women reporting ≤ 6 h and 7-8 h sleep, respectively, compared with women reporting 9 h of sleep. Mean 3^rd trimester SBP was 4.21 mm Hg higher for women reporting long sleep (≥ 10 h) vs. the reference group. Short and long sleep durations were associated with increased risks of PIH and PE. The ORs for very short (< 5 h) and long (≥ 10 h) sleepers were 9.52 (95% CI 1.83 to 49.40) and 2.45 (95% CI 0.74 to 8.15) for PE.

Conclusions:

Our findings are consistent with a larger literature that documents elevated blood pressure and increased risks of hypertension with short and long sleep duration.

Citation:

Williams MA; Miller RS; Qiu C; Cripe SM; Gelaye B; Enquobahrie D. Associations of early pregnancy sleep duration with trimester-specific blood pressures and hypertensive disorders in pregnancy. SLEEP 2010;33(10):1363-1371.     

Trajectories and stability of self‐reported short sleep duration from adolescence to adulthood

The trajectories and stability of self‐reported sleep duration recorded at ages 13, 15, and 23 years on reported sleep duration at age 30 years among 1105 students (55% male) who participated in the Norwegian Longitudinal Health and Behaviour Study were examined. Questionnaire data were used to obtain demographic and sleep variables. Dichotomised short sleep duration was based on normative values and set as ≤8.5 h (age 13 years), ≤8 h (age 15 years) and ≤7 h (ages 23 and 30 years). Results indicated a significant overall reduction in total sleep duration (h per night) across age groups. Sleep duration (continuous) at age 15 and 23 years (whole group) was moderately but positively correlated with sleep duration at age 30 years (P < 0.01). When split by sex, at age 15 years, this association was present among females only (P < 0.01); however, at age 23 years, this association was present in both male and females (both P < 0.001). Categorical short sleep at age 23 years (whole group) was associated with short sleep at age 30 years (unadjusted odds ratio = 3.67, 95% confidence interval 2.36–5.69). Following sex stratification, this effect was significant for both males (unadjusted odds ratio = 3.77, 95% confidence interval: 2.22–6.42) and females (unadjusted odds ratio = 2.71, 95% confidence interval: 1.46–5.04). No associations were noted for categorical short sleep at ages 13 or 15 years, and subsequent short sleep at 30 years. Habitual short sleep duration during middle adulthood is not sustained from the time of early adolescence. Rather, these trends appear to be formed during early adulthood.     

Characterization of obstructive sleep apnea–hypopnea syndrome (OSA) population by means of cluster analysis

Obstructive sleep apnea–hypopnea syndrome (OSA) is being identified increasingly as an important health issue. It is typified by repeated episodes of upper airway collapse during sleep leading to occasional hypoxaemia, sleep fragmentation and poor sleep quality. OSA is also being considered as an independent risk factor for hypertension, diabetes and cardiovascular diseases, leading to increased multi‐morbidity and mortality. Cluster analysis, a powerful statistical set of techniques, may help in investigating and classifying homogeneous groups of patients with similar OSA characteristics. This study aims to investigate the (possible) different groups of patients in an OSA population, and to analyse the relationships among the main clinical variables in each group to better understand the impact of OSA on patients. Starting from a well‐characterized OSA population of 198 subjects afferent to our sleep centre, we identified three different communities of OSA patients. The first has a very severe disease [apnea–hypopnea index (AHI) = 65.91 ± 22.47] and sleep disorder has a strong impact on daily life: a low level of diurnal partial pressure of oxygen (PaO₂) (77.39 ± 11.64 mmHg) and a high prevalence of hypertension (64%); the second, with less severe disease (AHI = 28.88 ± 17.13), in which sleep disorders seem to be less important for diurnal PaO₂ and have a minimum impact on comorbidity; and the last with very severe OSA (AHI = 57.26 ± 15.09) but with a low risk of nocturnal hypoxaemia (T90 = 11.58 ± 8.54) and less sleepy (Epworth Sleepiness Scale 10.00 ± 4.77).     

Association between obstructive sleep apnea severity and endothelial dysfunction in an increased background of cardiovascular burden

The objective of this study is to examine whether increasing obstructive sleep apnea (OSA) severity is associated with worsening endothelial function. The design is a cross‐sectional examination of the baseline assessment of a multi‐centre randomized controlled clinical trial examining the effects of oxygen, continuous positive airway pressure (CPAP) therapy or lifestyle modifications on cardiovascular biomarkers. Participants were recruited from cardiology clinics at four sites. Participants with an apnea–hypopnea index (AHI) of 15–50 and known cardio/cerebrovascular disease (CVD) or CVD risk factors were included. OSA severity indices [oxygen desaturation index (ODI), AHI and percentage of sleep time below 90% oxygen saturation (total sleep time <90)] and a measure of endothelium‐mediated vasodilatation [Framingham reactive hyperaemia index (F‐RHI) derived from peripheral arterial tonometry (PAT)] were assessed. The sample included 267 individuals with a mean AHI of 25.0 ± 8.5 SD and mean F‐RHI 0.44 ± 0.38. In adjusted models, the slope of the relationship between ODI and F‐RHI differed above and below an ODI of 24.6 (P = 0.04), such that above an ODI of 24.6 there was a marginally significant decline in the geometric mean of the PAT ratio by 3% [95% confidence interval (CI): 0%, 5%; P = 0.05], while below this point, there was a marginally significant incline in the geometric mean of the PAT ratio by 13% (95% CI: 0%, 27%; P = 0.05) per 5‐unit increase in ODI. A similar pattern was observed between AHI and F‐RHI. No relation was noted with total sleep time <90 and F‐RHI. There was evidence of a graded decline in endothelial function in association with higher levels of intermittent hypoxaemia.