Insomnia phenotypes and their impact on maternal and infant health

失眠表型及其对母婴健康的影响

• 批准号: 10201235
• 负责人: MICHELE L OKUN
• 金额: $ 43.47万
• 依托单位: UNIVERSITY OF COLORADO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-06 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10201235
• 关键词: Address; Affect; Age-Years; Biological; Biological Assay; Biological Markers; Biomedical Research; Clinical assessments; Comorbid Insomnia; Data; Data Collection; Development; Disease; Encapsulated; Evaluation; Exacerbated Insomnia; Exhibits; Exposure to; Frequencies; Future; General Population; Gestational Diabetes; Health; Health Status; Health behavior; Hour; Hydrocortisone; Hypertension; IL8 gene; Immune; Immunologic Markers; Incidence; Individual; Infant; Infant Health; Inflammation; Interleukin-10; Interleukin-4; Interleukin-6; Knowledge; Link; Maternal Health; Mediating; Medical; Mental Depression; Mental Health; Mood Disorders; Nausea; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Participant; Pathway interactions; Patient Recruitments; Perinatal; Personal Satisfaction; Phenotype; Physiological; Plague; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Premature Birth; Primary Insomnia; Recording of previous events; Recurrence; Reporting; Research; Research Personnel; Risk; Role; Salivary; Sampling; Severities; Sleep; Sleep Disorders; Sleep State Misperceptions; Sleep disturbances; Sleeplessness; Symptoms; TNF gene; Thinking; Third Pregnancy Trimester; Translating; Uncertainty; Urination; Variant; Woman; actigraphy; adverse outcome; child bearing; depressive symptoms; disorder risk; experience; falls; fetal; graduate student; hypothalamic-pituitary-adrenal axis; implementation intervention; indexing; infancy; infant outcome; inflammatory marker; laboratory experience; maternal morbidity; maternal outcome; novel; obstetric outcomes; perinatal period; perinatal women; physical conditioning; pregnancy hypertension; recruit; screening; sex; sleep difficulty; sleep health; stress reactivity; symptomatology; systemic inflammatory response; undergraduate research; undergraduate student

Of the ~4 million pregnant women each year, insomnia and pregnancy-related sleep disturbances plague upwards of 50-60% (> 2 million women) by the third trimester. Pregnancy can initiate and exacerbate insomnia symptoms that often extend into the postpartum period. In fact, rates as high as 41% have been reported up to 2 years postpartum. Despite this pervasiveness, insomnia is often considered a transient symptom of childbearing with few consequences for mental or physical health. As a result of this thinking, there have been few studies examining the impact of insomnia on pregnancy/postpartum maternal mental or physical health, well-being or infant outcomes. This is in spite of the fact that insomnia and emerging phenotypes (i.e., with short sleep duration) appear to increase depressive symptomatology and dysregulate immune and hypothalamic-pituitary- adrenal axis (HPA) activity. Each of which may subsequently translate into adverse maternal morbidities, such as gestational hypertension or diabetes, or poor outcomes, including preterm birth. Moreover, given the known long-term consequences of maternal morbidity on infant mental and physical health, the need to examine these associations longitudinally is sorely needed. So, one objective of this R15 proposal is to obtain preliminary data regarding the frequency of various insomnia phenotypes, and examine how they are correlated with recurrent depressive symptomology, immune, and HPA axis activity among perinatal women with a history of PPD. We will also explore the role of fetal sex on infant HPA activity and how it is modified by insomnia (phenotypes). The second objective of this AREA proposal is to expose both graduate and undergraduate students to biomedical research. A sample of 100 pregnant women (18-45 years of age) between 16-20 weeks gestation will be recruited, with reassessment at 28-31 weeks and at 3 months postpartum (along with their infant) to address the following aims. AIM 1: To assess the degree of recurrent depressive symptomatology and physiological dysregulation among four groups of pregnant and postpartum women. 1) insomnia with short sleep duration (ISQ+ + < 6 hours via actigraphy); 2) insomnia with normal sleep duration (ISQ+ + ≥ 6 hours); 3) short sleepers & no insomnia (ISQ- and ≥ 6 hours); and 4) healthy sleepers (ISQ- and normal sleep duration ≥ 6 hours). AIM 2: To assess the extent that physiological dysregulation mediates the association between insomnia and depressive symptomatology during pregnancy and postpartum. Physiological dysregulation will be assessed by immune markers (IL-4, IL-6, IL-8, IL-10 and TNF-α) and HPA axis activity (diurnal release of cortisol, CAR, and slope). Exploratory Aims: (1) To assess whether insomnia, depression and physiological dysregulation during pregnancy is modified by fetal sex. (2) Explore the amount of infant HPA axis dysregulation among the four maternal insomnia groups. We anticipate that perinatal women with insomnia and short sleep duration will have greater depressive symptoms and physiological dysregulation than the other three groups. Also, we expect physiological dysregulation will mediate the association between insomnia and depression.

每年约有 400 万孕妇遭受失眠和与怀孕相关的睡眠障碍困扰 超过 50-60%（> 200 万女性）在妊娠晚期可能会引发失眠并使其恶化。 事实上，据报道，这种症状的发生率高达 41%，高达 2。 尽管失眠很普遍，但它通常被认为是生育的短暂症状。 由于这种想法，很少有研究对心理或身体健康造成影响。 检查失眠对怀孕/产后母亲心理或身体健康、福祉或 尽管存在失眠和新出现的表型（即睡眠不足），但婴儿的结局仍然如此。 持续时间）似乎会增加抑郁症状并导致免疫和下丘脑-垂体失调 肾上腺轴（HPA）活动中的每一个都可能随后转化为不良的孕产妇疾病，例如 如妊娠高血压或糖尿病，或不良结局，包括早产。 孕产妇发病对婴儿身心健康的长期影响，需要检查这些 因此，R15 提案的目标之一就是获得初步数据。 关于各种失眠表型的频率，并检查它们与复发性失眠的关系 有 PPD 病史的围产期妇女的抑郁症状、免疫和 HPA 轴活动。 还将探讨胎儿性别对婴儿 HPA 活性的作用以及失眠（表型）如何改变它。 该 AREA 提案的第二个目标是让研究生和本科生接触生物医学 研究将招募 100 名妊娠 16-20 周的孕妇（18-45 岁）作为样本， 在 28-31 周和产后 3 个月（连同婴儿）进行重新评估，以解决以下问题 目标 1：评估复发性抑郁症状和生理失调的程度。 四组孕妇和产后妇女中 1）睡眠时间短的失眠（ISQ+ + < 6）。 2) 睡眠时间正常的失眠者（ISQ+ + ≥ 6 小时）；3) 睡眠时间短且无失眠症的人； （ISQ- 和 ≥ 6 小时）；和 4) 健康睡眠者（ISQ- 和正常睡眠持续时间 ≥ 6 小时）：评估 生理失调在多大程度上介导失眠和抑郁之间的关联 怀孕期间和产后的症状将通过免疫进行评估。 标记物（IL-4、IL-6、IL-8、IL-10 和 TNF-α）和 HPA 轴活性（皮质醇的昼夜释放、CAR 和斜率）。 探索性目的：（1）评估妊娠期间是否存在失眠、抑郁和生理失调 (2)探讨四种母体中婴儿HPA轴失调的程度。 我们预计，失眠和睡眠时间短的围产期女性比例会更高。 抑郁症状和生理失调比其他三组还要多，我们预计生理。 调节失调会介导失眠和抑郁之间的关联。