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Insomnia, Short Sleep, And Snoring In Mid-To-Late Pregnancy: Disparities Related To Poverty, Race, And Obesity

Authors Kalmbach DA, Cheng P, Sangha R, O’Brien LM, Swanson LM, Palagini L, Bazan LF, Roth T, Drake CL

Received 7 August 2019

Accepted for publication 5 October 2019

Published 4 November 2019 Volume 2019:11 Pages 301—315


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Steven A Shea

David A Kalmbach,1 Philip Cheng,1 Roopina Sangha,2 Louise M O’Brien,3 Leslie M Swanson,4 Laura Palagini,5 Luisa F Bazan,6 Thomas Roth,1 Christopher L Drake1

1Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA; 2Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA; 3Departments of Obstetrics &Gynecology and Neurology, University of Michigan, Ann Arbor, MI, USA; 4Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; 5Departments of Neuroscience and Psychiatry, University of Pisa, Pisa, Italy; 6Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, USA

Correspondence: David A Kalmbach
Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Novi, MI, USA
Tel +1248 325 3938

Objective: To characterize sleep habits and parameters among women in mid-to-late pregnancy and to identify disparities associated with poverty, race, and obesity.
Design: Cross-sectional.
Setting: Large multi-site health system in Metro Detroit.
Participants: A total of 267 pregnant women (27.3% non-Hispanic black; gestational age: 27.99±1.20 weeks) completed online surveys on sleep quality, insomnia symptoms, sleep aid use, signs/symptoms of sleep-disordered breathing, and sociodemographics. Body mass index (BMI) and patient insurance were derived from medical records.
Results: As high as 76.2% of the women reported global sleep disturbance, 30.6% endorsed snoring, 24.3% sleep <6 hrs/night, and over half screened positive for clinical insomnia. Yet, only 3.4% of the women reported an insomnia diagnosis and 3.0% reported a sleep apnea diagnosis. In unadjusted models, poverty, Medicaid coverage, self-identifying as black, and obesity before and during pregnancy (BMI ≥ 35) were associated with a wide range of sleep problems. However, adjusted models revealed specificity. Poverty was uniquely related to increased insomnia symptoms and trouble sleeping due to bad dreams. Obesity before pregnancy was related to poor sleep quality, snoring, sleep aids, and short sleep. Black women reported shorter sleep duration than white women but differed on no other sleep parameters.
Conclusion: Clinical signs of insomnia and sleep-disordered breathing are common in mid-to-late pregnancy, but most cases go undetected. Problematic sleep disproportionately affects women in poverty, who self-identify as black, and who are obese before pregnancy. Poverty-related sleep issues are linked to insomnia, obesity-related disparities center on sleep-related breathing and medication use, and racial disparities relate to short sleep.

Keywords: sleep aids, sleep apnea, Medicaid, perinatal, prenatal

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