[Sleep quality and sleep disturbances in Chinese pregnant women: a multicenter cross-sectional study].

Objective: This study aims to investigate the sleep quality of pregnant women in Xuhui District, Shanghai, and the related factors of sleep disturbances during pregnancy. Methods: From February 2019 to February 2021, we used online integrated sleep questionnaire (including PSQI, BQ, ESS, AIS) in Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, The International Peace Maternity and Child Health Hospitals of China Welfare Institution, and Shanghai Eighth People's Hospital, to investigate the sleep quality across pregnancy. We also collected maternal physical examination results, childbearing history, sociodemographic, and other clinical data. The prevalences and related factors of various sleep disturbances in pregnant women were analyzed, including insufficient/excessive nighttime sleep, low sleep efficiency, difficulty falling asleep, poor sleep quality, insomnia, daytime sleepiness, and high risk of sleep-disordered breathing (SDB). Results: This study includes 1 898 cases in the first trimester (T1), 3 099 cases in the second trimester (T2), and 1 539 cases in the third trimester (T3). Poor sleep quality (38.6%), daytime sleepiness (mild 41.9%, moderate 17.7%, severe 2.1%), and suspicious insomnia (32.3%) are most prevalent among women in T1 (P<0.01). In comparison, short sleep time (2.7%), long sleep time (8.6%), difficulty falling asleep (12.2%), poor sleep efficiency (35.4%), very poor sleep quality (6.7%), clinical insomnia (21.8%), and high-risk SDB (6.4%) are most prevalent among women in T3 (P<0.05). During pregnancy, late gestation (OR=1.016, 95%CI: 1.006-1.025) and multiple induced/drug abortions (OR=1.329, 95%CI: 1.043-1.692) are risk factors for poor sleep quality (PSQI>5), while multiple full-term deliveries (OR=0.800, 95%CI: 0.675-0.949) is its protective factor. Advanced maternal age (OR=0.976, 95%CI: 0.956-0.997), multiple full-term deliveries (OR=0.808, 95%CI: 0.680-0.959), late gestation (OR=0.983, 95%CI: 0.974-0.992) and hypertension (OR=0.572, 95%CI: 0.401-0.814) are protective factors for daytime sleepiness (ESS>6). The high-risk pregnancy category (OR=9.312, 95%CI: 1.156-74.978) is a risk factor for insomnia (AIS≥4), while multiple full-term deliveries (OR=0.815, 95%CI: 0.691-0.961) is its protective factor. High BMI (OR=1.334, 95%CI: 1.270-1.402) and hypertension (OR=4.427, 95%CI: 2.539-7.719) are risk factors for high-risk SDB in pregnant women. Conclusions: The prevalences of various sleep disturbances are high throughout pregnancy. Noticeably, symptoms of maternal SDB develop along with pregnancy. Different types of sleep disturbances are associated with different factors. Women of high-risk pregnancy category, in late gestation, with high BMI, hypertension, a history of induced/drug abortion, or without a history of full-term delivery can be at high risk of sleep disturbances during pregnancy.目的： 调查上海徐汇地区妊娠期女性睡眠质量，并分析睡眠呼吸障碍（sleep-disordered breathing，SDB）等睡眠疾病的相关因素。 方法： 研究采用国际标准化横断面临床研究设计，自2019年2月至2021年2月，在上海交通大学医学院附属第六人民医院、中国福利会国际和平妇幼保健院及上海市第八人民医院使用电子化的整合睡眠问卷［包括匹兹堡睡眠质量指数问卷（Pittsburgh sleep quality index，PSQI）、柏林问卷（Berlin questionnaire，BQ）、爱泼沃斯思睡量表（Epworth sleepiness scale，ESS）、雅典失眠量表（Athens insomnia scale，AIS）］调查妊娠期女性的睡眠质量，收集其人口学信息、生育史、体格检查结果等临床资料。统计夜间睡眠不足/过量、睡眠效率低下、入睡困难、睡眠质量差、失眠、日间过度思睡及睡眠呼吸障碍高风险等多种睡眠疾病在各孕期女性中的患病率，并分析不同睡眠疾病的相关因素。采用SPSS 22.0及OriginLab 2019b软件进行统计学分析与制图。 结果： 研究纳入孕早期女性1 898例，孕中期女性3 099例，孕晚期女性1 539例。夜间睡眠不足（42例，2.7%），夜间睡眠过量（132例，8.6%），入睡困难（187例，12.2%），睡眠效率低下（542例，35.4%），睡眠质量极差（102例，6.7%），临床失眠（335例，21.8%），SDB高风险（44例，6.4%）的患病率在孕晚期女性中最高（χ2值分别是20.455、6.027、35.565、38.046、15.376、6.782，P值均<0.05）。睡眠质量较差（724例，38.6%），不同程度日间思睡（日间思睡794例，41.9%，日间过度思睡336例，17.7%，有危险性的日间思睡40例，2.1%），可疑失眠（612例，32.3%）的患病率在孕早期女性中最高（χ2值分别是38.046、33.875、15.376，P值均<0.01）。对妊娠期女性而言，较大孕周（OR=1.016）、多次人流或药流史（OR=1.329）是睡眠质量差（PSQI>5）的风险因素，而多次足月产史（OR=0.800）是其保护因素。大龄孕妇（OR=0.976）、多次足月产史（OR=0.808）、较大孕周（OR=0.983）、高血压（OR=0.572）是日间思睡（ESS>6）的保护因素。妊娠高风险预警评级（OR=9.312）是失眠（AIS≥4）的风险因素，而多次足月产史（OR=0.815）是其保护因素。高体质量指数（OR=1.334）、高血压（OR=4.427）是SDB高风险的影响因素。 结论： 多种睡眠疾病在妊娠期女性中患病率较高，其中睡眠呼吸障碍症状随妊娠进程的发展而明显加重。不同类型睡眠疾病的相关因素各异。妊娠高风险预警评级、高体质量指数、较大孕周、高血压、有人流或药流史、无足月产史的孕妇是妊娠期睡眠疾病的高危人群。.