ABSTRACT

Objective

Insomnia affects over half of pregnant and postpartum women. Early evidence indicates that cognitive-behavioral therapy for insomnia (CBTI) improves maternal sleep and mood. However, standard CBTI may be less efficacious in perinatal women than the broader insomnia population. This study sought to identify patient characteristics in a perinatal sample associated with poor response to CBTI, and characterize patient feedback to identify areas of insomnia therapy to tailor for the perinatal experience.

Participants

Secondary analysis of 46 pregnant women with insomnia symptoms who were treated with digital CBTI in a randomized controlled trial.

Methods

We assessed insomnia, cognitive arousal, and depression before and after prenatal treatment, then 6 weeks postpartum. Patients provided feedback on digital CBTI.

Results

Residual cognitive arousal after treatment was the most robust factor associated with treatment non-response. Critically, CBTI responders and non-responders differed on no other sociodemographic or pretreatment metrics. After childbirth, short sleep (<6 hrs/night) was associated with maternal reports of poor infant sleep quality. Patient feedback indicated that most patients preferred online treatment to in-person treatment. Although women described digital CBTI as convenient and helpful, many patients indicated that insomnia therapy would be improved if it addressed sleep challenges unique to pregnancy and postpartum. Patients requested education on maternal and infant sleep, flexibility in behavioral sleep strategies, and guidance to manage infant sleep.

Conclusions

Modifying insomnia therapy to better alleviate refractory cognitive arousal and address the changing needs of women as they progress through pregnancy and early parenting may increase efficacy for perinatal insomnia.

Name: Insomnia and Rumination in Late Pregnancy and the Risk for Postpartum Depression

URL: clinicaltrials.gov

Registration: NCT03596879

中文翻译：

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检查患者反馈以及认知唤醒在妊娠期失眠数字认知行为疗法无反应中的作用

摘要

客观的

失眠影响超过一半的孕妇和产后妇女。早期证据表明，失眠认知行为疗法 (CBTI) 可改善母亲的睡眠和情绪。然而，与更广泛的失眠人群相比，标准 CBTI 对围产期妇女的效果可能较差。本研究旨在确定围产期样本中与 CBTI 反应不佳相关的患者特征，并描述患者反馈的特征，以确定失眠治疗的领域，以适应围产期经历。

参加者

在一项随机对照试验中，对 46 名有失眠症状且接受数字 CBTI 治疗的孕妇进行了二次分析。

方法

我们在产前治疗前后以及产后 6 周评估了失眠、认知唤醒和抑郁情况。患者提供了有关数字 CBTI 的反馈。

结果

治疗后残留的认知唤醒是与治疗无反应相关的最强有力的因素。至关重要的是，CBTI 应答者和非应答者在其他社会人口统计学或治疗前指标上没有差异。分娩后，睡眠时间短（<6 小时/晚）与母亲报告的婴儿睡眠质量差有关。患者反馈表明，大多数患者更喜欢在线治疗而不是面对面治疗。尽管女性认为数字 CBTI 方便且有帮助，但许多患者表示，如果它能解决怀孕和产后特有的睡眠挑战，失眠治疗将会得到改善。患者请求有关母婴睡眠的教育、行为睡眠策略的灵活性以及管理婴儿睡眠的指导。

结论

修改失眠疗法以更好地缓解难治性认知唤醒并满足女性在怀孕和早期育儿过程中不断变化的需求，可能会提高围产期失眠的疗效。

名称： 妊娠晚期失眠和沉思以及产后抑郁症的风险

网址：clinicaltrials.gov

注册号：NCT03596879