Non-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis

OBJECTIVE  To investigate the effect of non-pharmacological interventions to improve sleep quality during pregnancy. DATA SOURCES  A search was made in the NCBI/PubMed, ClinicalTrials.gov, Embase, BVS, and Web of Science databases. There were no limitations regarding language, sample size, and type of non-pharmacological intervention. We have included prospective clinical trials between July 2014 and July 2019. SELECTION OF STUDIES  This study was registered in the Prospective International Registration of Systematic Reviews (PROSPERO) database was performed. Publication bias was also assessed with funnel plots. the primary outcome was the total score in the Pittsburgh Sleep Quality Index (PSQI) before and after intervention. Risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were used for assessing methodological quality. From the 28 retrieved studies, we have selected 8 for qualitative analysis and 6 for meta-analysis. DATA COLLECTION  Two independent reviewers performed the study selection. In the case of disagreement, a third senior reviewer was consulted. The study was initially assessed based on the title, followed by abstract. Lastly, the full text was assessed to be included. DATA SYNTHESIS  A significant improvement on the sleep quality (PSQI score) was observed when all interventions were grouped (MD = -3.03, 95%CI -4.15 to -1.92, n = 623, i2 = 84%, p < 0.001). Analysis by subgroup (music listening: MD = -1.96, 95% CI -3.27 to -0.65, n = 207, i2 = 67%, p = 0.003 and other interventions: MD = -3.66, 95% CI -4.93 to -2.40, n = 416, i2 = 80%, p < 0.001) showed an improvement, with high heterogeneity. Risk of bias has shown performance and detection bias for almost studies, and GRADE evidence was very low for all analyzed variables. CONCLUSION  Non-pharmacological interventions-listening to music, physical exercise, relaxation exercises, lettuce seed, sleep hygiene, and acupressure-are effective for improving sleep quality during pregnancy.

[1]  P. Lolekha,et al.  Restless Legs Syndrome in Pregnant Thai Women: Prevalence, Predictive Factors, and Natural Course , 2018, Journal of clinical neurology.

[2]  H. Shahraki,et al.  Double-blind randomized placebo-controlled trial on efficacy and safety of Lactuca sativa L. seeds on pregnancy-related insomnia. , 2018, Journal of ethnopharmacology.

[3]  S. Özkan,et al.  The effect of relaxation exercises on sleep quality in pregnant women in the third trimester: A randomized controlled trial. , 2018, Complementary therapies in clinical practice.

[4]  Ayşe Sönmez,et al.  Effects of sleep hygiene training given to pregnant women with restless leg syndrome on their sleep quality , 2018, Sleep and Breathing.

[5]  C. Parker,et al.  Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes , 2017, American journal of obstetrics and gynecology.

[6]  J. Sánchez-García,et al.  The influence of physical activity in water on sleep quality in pregnant women: A randomised trial. , 2017, Women and birth : journal of the Australian College of Midwives.

[7]  Sheri Madigan,et al.  Sleep quality during pregnancy: A meta-analysis. , 2017, Sleep medicine reviews.

[8]  P. Bech,et al.  Effect of supervised exercise in groups on psychological well-being among pregnant women at risk of depression (the EWE Study): study protocol for a randomized controlled trial , 2017, Trials.

[9]  A. Frigy,et al.  Effect of a gymnastics program on sleep characteristics in pregnant women. , 2017, Taiwanese journal of obstetrics & gynecology.

[10]  H. Sut,et al.  Sleep Quality and Health-Related Quality of Life in Pregnancy , 2016, The Journal of perinatal & neonatal nursing.

[11]  Chung-Hey Chen,et al.  Effects of music listening on stress, anxiety, and sleep quality for sleep-disturbed pregnant women , 2016, Women & health.

[12]  V. Sreenivas,et al.  Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study , 2016, Sleep and Breathing.

[13]  F. Facchinetti,et al.  Acupressure on Self-Reported Sleep Quality During Pregnancy. , 2016, Journal of acupuncture and meridian studies.

[14]  R. Manber,et al.  Objective and subjective sleep during pregnancy: links with depressive and anxiety symptoms , 2016, Archives of Women's Mental Health.

[15]  T. Campbell,et al.  Trajectories of Sleep Quality and Associations with Mood during the Perinatal Period. , 2015, Sleep.

[16]  K. Porter,et al.  Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans. , 2015, Sleep.

[17]  Bin Feng,et al.  Poor Sleep Quality of Third-Trimester Pregnancy is a Risk Factor for Postpartum Depression , 2014, Medical science monitor : international medical journal of experimental and clinical research.

[18]  J. Trinder,et al.  Mood and Objective and Subjective Measures of Sleep During Late Pregnancy and the Postpartum Period , 2014, Behavioral sleep medicine.

[19]  P. Boyce,et al.  Antenatal depression: an artefact of sleep disturbance? , 2014, Archives of Women's Mental Health.

[20]  M. Barnes,et al.  Subjective Reports Versus Objective Measurement of Sleep Latency and Sleep Duration in Pregnancy , 2013, Behavioral sleep medicine.

[21]  R. Stickgold,et al.  Poor sleep maintenance and subjective sleep quality are associated with postpartum maternal depression symptom severity , 2013, Archives of Women's Mental Health.

[22]  B. Hutchison,et al.  A postal survey of maternal sleep in late pregnancy , 2012, BMC Pregnancy and Childbirth.

[23]  A. Davati,et al.  The effects of sleep quality and duration in late pregnancy on labor and fetal outcome , 2012, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[24]  S. Wisniewski,et al.  Disturbed sleep, a novel risk factor for preterm birth? , 2012, Journal of women's health.

[25]  F. Facco.  Sleep-disordered breathing and pregnancy. , 2011, Seminars in perinatology.

[26]  L. Kuo,et al.  Factors Associated With Sleep Quality in Pregnant Women: A Prospective Observational Study , 2011, Nursing research.

[27]  J. Sterne,et al.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials , 2011, BMJ : British Medical Journal.

[28]  M. Khak,et al.  Sleep disturbance in late pregnancy and type and duration of labour , 2011, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.

[29]  G. Prado,et al.  Restless legs syndrome during pregnancy in Brazilian women. , 2010, Sleep medicine.

[30]  Y.‐H. Chen,et al.  Increased Risk of Adverse Pregnancy Outcomes in Women Receiving Zolpidem During Pregnancy , 2010, Clinical pharmacology and therapeutics.

[31]  Chung-Hey Chen,et al.  A comparative study of sleep quality between pregnant and nonpregnant Taiwanese women. , 2010, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[32]  E. Yokoyama,et al.  Prevalence of restless legs syndrome with pregnancy and the relationship with sleep disorders in the Japanese large population , 2008 .

[33]  M. Hosseini,et al.  The Teratogenic Effects of Flurazepam Intake during Organogenesis of the Rat Fetus , 2008, Toxicology mechanisms and methods.

[34]  M. Coussons‐Read,et al.  Sleep disruption during pregnancy: how does it influence serum cytokines? , 2007, Journal of reproductive immunology.

[35]  Kathryn A. Lee,et al.  Sleep in late pregnancy predicts length of labor and type of delivery. , 2004, American journal of obstetrics and gynecology.

[36]  R. Schwab,et al.  Sleep disorders during pregnancy. , 2004, Sleep.

[37]  P. Sahota,et al.  Sleep disorders in pregnancy , 2003, Current opinion in pulmonary medicine.

[38]  Daniel J Buysse,et al.  The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research , 1989, Psychiatry Research.

[39]  S. Masoumi,et al.  The effect of music therapy counseling on sleep quality in pregnant women , 2016 .

[40]  C. Bias.  The Cochrane Collaboration's tool for assessing risk of bias in randomised trials , 2011 .

[41]  J. Moutquin,et al.  Is sleep disturbed in pregnancy? , 2010, Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC.