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Insomnia before and after childbirth: The risk of developing postpartum pain—A longitudinal population-based study

  • Børge Sivertsen
    Correspondence
    Corresponding author at: Domain for Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 973 Sentrum, 5808 Bergen, Norway.
    Affiliations
    Domain for Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 973 Sentrum, 5808 Bergen, Norway

    The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, P.O. Box 7810, N-5020 Bergen, Norway

    Department of Psychiatry, Helse Fonna HF, P.O. Box 2170, N-5504 Haugesund, Norway
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  • Keith J. Petrie
    Affiliations
    Department of Psychological Medicine, University of Auckland, Auckland 1142, New Zealand
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  • Jens Christoffer Skogen
    Affiliations
    Domain for Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 973 Sentrum, 5808 Bergen, Norway

    The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, P.O. Box 7810, N-5020 Bergen, Norway

    Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
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  • Mari Hysing
    Affiliations
    The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, P.O. Box 7810, N-5020 Bergen, Norway
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  • Malin Eberhard-Gran
    Affiliations
    Domain for Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 973 Sentrum, 5808 Bergen, Norway

    Health Services Research Center, Akershus University Hospital, Lørenskog, Norway

    Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
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Published:January 19, 2017DOI:https://doi.org/10.1016/j.ejogrb.2017.01.020

      Abstract

      Objective

      To examine if insomnia before and after childbirth predicts the development of postpartum bodily pain.

      Methods

      This study is part of a longitudinal cohort study, the Akershus Birth Cohort Study, which targeted all women giving birth at Akershus University Hospital in Norway. The current sample is comprised of 1480 women who participated at all three time points, yielding a participation rate of 32% of the 4662 women who originally consented to participate. The Bergen Insomnia Scale (BIS) was used to measure insomnia and a latent profile analysis (LPA) was used to identify subsets of women who shared a similar pattern of responses on the BIS-scale across the three time points. Pain was measured using the bodily pain scale, derived from the Primary Care Evaluation of Mental Disorders (PRIME-MD) and symptoms of depression were measured by the Edinburgh Postnatal Depression Scale (EPDS).

      Results

      Using a latent profile analysis a three class model showed the best fit and identified one major group (55.6%) with a low BIS scores across all three time points, one group with intermediate BIS scores (32.9%), and a smaller group (11.5%) with higher BIS scores across all three times. The chronic high insomnia group had a 2.8-fold increased risk of reporting high levels of bodily pain. The chronic intermediate group was associated with a 2.2-fold increased risk of bodily pain at two years postpartum. Adjusting for demographics and lifestyle behaviors did not reduce any of the associations, while adjusting for depression significantly attenuated the associations. Additional adjustment for pain at eight weeks postpartum further reduced the magnitude of the associations, but both chronic intermediate insomnia and chronic high insomnia remained strongly associated with the onset of bodily pain in the fully adjusted models (RR = 1.75, 95% CI: 1.37–2.23) and RR = 1.63, 95% CI: 1.15–2.32, respectively).

      Conclusions

      The high prevalence of insomnia among women during and after childbirth, in combination with the strong prospective association with impaired physical health, emphasizes the importance of adequately identifying, preventing and treating insomnia for this population.

      Keywords

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      References

        • Ohayon M.M.
        Prevalence of DSM-IV diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders.
        J Psychiatr Res. 1997; 31: 333-346
        • Pallesen S.
        • Sivertsen B.
        • Nordhus I.H.
        • Bjorvatn B.
        A 10-year trend of insomnia prevalence in the adult Norwegian population.
        Sleep Med. 2014; 15: 173-179
        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders: DSM-IV.
        4th ed. APA, Washington, D.C1994
        • Sivertsen B.
        • Krokstad S.
        • Overland S.
        • Mykletun A.
        The epidemiology of insomnia: associations with physical and mental health. The HUNT-2 study.
        J Psychosom Res. 2009; 67: 109-116
        • Hysing M.
        • Pallesen S.
        • Stormark K.M.
        • Lundervold A.J.
        • Sivertsen B.
        Sleep patterns and insomnia among adolescents: a population-based study.
        J Sleep Res. 2013; 22: 549-556
        • Sivertsen B.
        • Hysing M.
        • Dorheim S.K.
        • Eberhard-Gran M.
        Trajectories of maternal sleep problems before and after childbirth: a longitudinal population-based study.
        BMC Pregnancy Childbirth. 2015; 15: 129
        • Webb D.A.
        • Bloch J.R.
        • Coyne J.C.
        • Chung E.K.
        • Bennett I.M.
        • Culhane J.F.
        Postpartum physical symptoms in new mothers: their relationship to functional limitations and emotional well-being.
        Birth. 2008; 35: 179-187
        • McGovern P.
        • Dowd B.
        • Gjerdingen D.
        • Dagher R.
        • Ukestad L.
        • McCaffrey D.
        • et al.
        Mothers’ health and work-related factors at 11 weeks postpartum.
        Ann Fam Med. 2007; 5: 519-527
        • Ansara D.
        • Cohen M.M.
        • Gallop R.
        • Kung R.
        • Schei B.
        Predictors of women’s physical health problems after childbirth.
        J Psychosom Obstet Gynaecol. 2005; 26: 115-125
        • Sivertsen B.
        • Lallukka T.
        • Salo P.
        • Pallesen S.
        • Hysing M.
        • Krokstad S.
        • et al.
        Insomnia as a risk factor for ill health: results from the large population-based prospective HUNT Study in Norway.
        J. Sleep Res. 2014; 23: 124-132
        • Boardman H.F.
        • Thomas E.
        • Millson D.S.
        • Croft P.R.
        The natural history of headache: predictors of onset and recovery.
        Cephalalgia. 2006; 26: 1080-1088
        • Odegard S.S.
        • Sand T.
        • Engstrom M.
        • Stovner L.J.
        • Zwart J.A.
        • Hagen K.
        The long-term effect of insomnia on primary headaches: a prospective population-based cohort study (HUNT-2 and HUNT-3).
        Headache. 2011; 51: 570-580
        • Lyngberg A.C.
        • Rasmussen B.K.
        • Jorgensen T.
        • Jensen R.
        Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey.
        Eur J Epidemiol. 2005; 20: 243-249
        • Song J.E.
        • Chang S.B.
        • Park S.M.
        • Kim S.
        • Nam C.M.
        Empirical test of an explanatory theory of postpartum fatigue in Korea.
        J Adv Nurs. 2010; 66: 2627-2639
        • Song J.E.
        • Chae H.J.
        • Kim C.H.
        Changes in perceived health status, physical symptoms, and sleep satisfaction of postpartum women over time.
        Nurs Health Sci. 2014; 16: 335-342
        • Dennis C.
        • Ross L.
        Relationship among infant sleep patterns, maternal fatigue and development of depressive symptomatology.
        Birth. 2005; 32: 187-193
        • Dorheim S.K.
        • Bjorvatn B.
        • Eberhard-Gran M.
        Can insomnia in pregnancy predict postpartum depression? A longitudinal, population-based study.
        PLoS One. 2014; 9: e94674
        • Cheng C.Y.
        • Fowles E.R.
        • Walker L.O.
        Continuing education module: postpartum maternal health care in the United States: a critical review.
        J Perinatal Educ. 2006; 15: 34-42
        • Pallesen S.
        • Bjorvatn B.
        • Nordhus I.H.
        • Sivertsen B.
        • Hjornevik M.
        • Morin C.M.
        A new scale for measuring insomnia: the Bergen Insomnia Scale.
        Percept Mot Skills. 2008; 107: 691-706
        • Spitzer R.L.
        • Williams J.B.
        • Kroenke K.
        • Linzer M.
        • deGruy 3rd, F.V.
        • Hahn S.R.
        • et al.
        Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study.
        Jama. 1994; 272: 1749-1756
        • Cox J.L.
        • Holden J.M.
        • Sagovsky R.
        Detection of postnatal depression: development of the 10-item edinburgh postnatal depression scale.
        Br J Psychiatry: J Ment Sci. 1987; 150: 782-786
        • Eberhard-Gran M.
        • Eskild A.
        • Tambs K.
        • Schei B.
        • Opjordsmoen S.
        The edinburgh postnatal depression scale: validation in a norwegian community sample.
        Nordic J Psychiatry. 2001; 55: 113-117
        • Bunevicius A.
        • Kusminskas L.
        • Pop V.J.
        • Pedersen C.A.
        • Bunevicius R.
        Screening for antenatal depression with the Edinburgh Depression Scale.
        J Psychosom Obstet Gynaecol. 2009; 30: 238-243
        • Collins L.
        • Lanza S.
        Latent class latent transition analysis.
        2010
        • Davies H.T.
        • Crombie I.K.
        • Tavakoli M.
        When can odds ratios mislead?.
        BMJ. 1998; 316: 989-991
        • Morton S.M.
        • Bandara D.K.
        • Robinson E.M.
        • Carr P.E.
        In the 21st Century, what is an acceptable response rate?.
        Aust N Z J Public Health. 2012; 36: 106-108
        • Lauderdale D.S.
        • Knutson K.L.
        • Yan L.L.
        • Liu K.
        • Rathouz P.J.
        Self-reported and measured sleep duration: how similar are they?.
        Epidemiology. 2008; 19: 838-845
        • Zinkhan M.
        • Berger K.
        • Hense S.
        • Nagel M.
        • Obst A.
        • Koch B.
        • et al.
        Agreement of different methods for assessing sleep characteristics: a comparison of two actigraphs, wrist and hip placement, and self-report with polysomnography.
        Sleep Med. 2014; 15: 1107-1114
        • Green J.
        What is the EPDS measuring and how should we use it in research?.
        in: Henshaw C. Elliott S. Screening for perinatal depression. Jessica Kingsley Publishers, London2005: 141-147
        • Lallukka T.
        • Overland S.
        • Haaramo P.
        • Saastamoinen P.
        • Bjorvatn B.
        • Sivertsen B.
        The joint contribution of pain and insomnia to sickness absence and disability retirement: a register-linkage study among Norwegian and Finnish employees.
        Eur J Pain. 2014; 18: 883-892
        • Beaulieu P.
        • Walczak J.
        Pharmacological management of sleep and pain interactions.
        in: Lavigne G. Sessle B. Choiniere M. Soja P. Sleep and pain. WA: IASP Press, Seattle2007: 391-416
        • Tang N.K.
        Cognitive-behavioral therapy for sleep abnormalities of chronic pain patients.
        Curr Rheumatol Rep. 2009; 11: 451-460
      1. National Institute of Health, NIH State-of-the-Science Conference Statement on Manifestations and Management of Chronic Insomnia in Adults. NIH Consens State Sci Statements (2005), 1–30.

        • Ritterband L.M.
        • Bailey E.T.
        • Thorndike F.P.
        • Lord H.R.
        • Farrell-Carnahan L.
        • Baum L.D.
        Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia.
        Psycho-Oncol. 2012; 21: 695-705
        • Sivertsen B.
        • Vedaa Ø.
        • Nordgreen T.
        The future of insomnia treatment—the challenge of implementation.
        Sleep. 2013; 36
        • Buhrman M.
        • Fredriksson A.
        • Edstrom G.
        • Shafiei D.
        • Tarnqvist C.
        • Ljotsson B.
        • et al.
        Guided Internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation treatment: randomized controlled trial.
        Eur J Pain. 2013; 17: 753-765