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
- Prevalence of DSM-IV diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders.J Psychiatr Res. 1997; 31: 333-346
- A 10-year trend of insomnia prevalence in the adult Norwegian population.Sleep Med. 2014; 15: 173-179
- Diagnostic and statistical manual of mental disorders: DSM-IV.4th ed. APA, Washington, D.C1994
- The epidemiology of insomnia: associations with physical and mental health. The HUNT-2 study.J Psychosom Res. 2009; 67: 109-116
- Sleep patterns and insomnia among adolescents: a population-based study.J Sleep Res. 2013; 22: 549-556
- Trajectories of maternal sleep problems before and after childbirth: a longitudinal population-based study.BMC Pregnancy Childbirth. 2015; 15: 129
- Postpartum physical symptoms in new mothers: their relationship to functional limitations and emotional well-being.Birth. 2008; 35: 179-187
- Mothers’ health and work-related factors at 11 weeks postpartum.Ann Fam Med. 2007; 5: 519-527
- Predictors of women’s physical health problems after childbirth.J Psychosom Obstet Gynaecol. 2005; 26: 115-125
- 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
- The natural history of headache: predictors of onset and recovery.Cephalalgia. 2006; 26: 1080-1088
- 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
- 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
- Empirical test of an explanatory theory of postpartum fatigue in Korea.J Adv Nurs. 2010; 66: 2627-2639
- Changes in perceived health status, physical symptoms, and sleep satisfaction of postpartum women over time.Nurs Health Sci. 2014; 16: 335-342
- Relationship among infant sleep patterns, maternal fatigue and development of depressive symptomatology.Birth. 2005; 32: 187-193
- Can insomnia in pregnancy predict postpartum depression? A longitudinal, population-based study.PLoS One. 2014; 9: e94674
- Continuing education module: postpartum maternal health care in the United States: a critical review.J Perinatal Educ. 2006; 15: 34-42
- A new scale for measuring insomnia: the Bergen Insomnia Scale.Percept Mot Skills. 2008; 107: 691-706
- Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study.Jama. 1994; 272: 1749-1756
- Detection of postnatal depression: development of the 10-item edinburgh postnatal depression scale.Br J Psychiatry: J Ment Sci. 1987; 150: 782-786
- The edinburgh postnatal depression scale: validation in a norwegian community sample.Nordic J Psychiatry. 2001; 55: 113-117
- Screening for antenatal depression with the Edinburgh Depression Scale.J Psychosom Obstet Gynaecol. 2009; 30: 238-243
- Latent class latent transition analysis.2010
- When can odds ratios mislead?.BMJ. 1998; 316: 989-991
- In the 21st Century, what is an acceptable response rate?.Aust N Z J Public Health. 2012; 36: 106-108
- Self-reported and measured sleep duration: how similar are they?.Epidemiology. 2008; 19: 838-845
- 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
- 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
- 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
- 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
- Cognitive-behavioral therapy for sleep abnormalities of chronic pain patients.Curr Rheumatol Rep. 2009; 11: 451-460
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.
- Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia.Psycho-Oncol. 2012; 21: 695-705
- The future of insomnia treatment—the challenge of implementation.Sleep. 2013; 36
- 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
Article info
Publication history
Published online: January 19, 2017
Accepted:
January 16,
2017
Received:
October 28,
2016
Footnotes
☆Condensation: Chronic insomnia during and after pregnancy is a risk factor for later onset of bodily pain.
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
