Exploring the longitudinal relationships between poor sleep, sleep apnoea, and depression during pregnancy

This study investigated relationships between sleep quality, sleep apnoea and depression during pregnancy, focusing on their associations and potential bidirectional effects.

Data from 193 pregnant women enrolled in a longitudinal study across pregnancy and postpartum were included. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Sleep apnoea was measured using home sleep studies (Apnoea-Hypopnoea Index, AHI ≥ 5). Depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS ≥ 13). Repeat assessments of sleep quality, apnoea and depressive symptoms were undertaken in early and late pregnancy. Clinical depression was diagnosed using the Structured Clinical Interview for DSM in early pregnancy and six months postpartum.

Women with depression diagnosed in early-mid pregnancy had poorer self-reported sleep quality, higher self-reported depressive symptoms and increased incidence of postnatal depression. Depression in early pregnancy was associated with poorer sleep quality concurrently (OR: 1.25 [1.10-1.41]) and in late pregnancy (OR: 1.19 [1.04-1.36]). Cross-lagged panel modelling showed early depressive symptoms predicted poorer sleep in late pregnancy, but not vice versa. Sleep apnoea (severity or diagnosis) was not associated with depression or depressive symptoms.

Depressive symptoms in early pregnancy predicted poorer self-reported sleep quality in later pregnancy, but not the reverse. Treating depression early in pregnancy may improve subsequent sleep. Sleep apnoea and depression may require distinct management approaches. Persistent sleep issues in pregnant women with depression or depressive symptoms should prompt screening for underlying sleep disorders, with sleep-focused interventions or medication adjustments considered if none are identified.