ABSTRACT
Conclusion:
It is shown that night sleep quality is deteriorated in pregnant women, especially in the last trimester. The fact that the frequency of RLS/WEH is not different in pregnant women with poor sleep quality suggests the existence of other factors underlying poor sleep quality.
Results:
The mean age was 28.8±6.0 years. PSQI values were significantly higher in the third trimester (p=0.044), and ESS values were similar between trimesters (p=0.524). RLS/WEH was detected in 34% of the pregnant women; there was no difference between trimesters (p=0.188). The PSQI score was significantly higher in RLS/WEH patients (p=0.013). There was no significant difference in clinical and biochemical parameters between pregnant women with and without subjective poor sleep quality at night (PSQI >5 points).
Materials and Methods:
Hundred pregnant women were included in the study prospectively and consecutively. Pregnant women were evaluated to determine their clinical characteristics, including demographic data, habits, and medical backgrounds by using a questionnaire. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), disease duration, severity, triggering factors, and family history for RLS/WEH were recorded. Complete blood count, fasting blood glucose, kidney function tests, ferritin, iron and iron binding capacity were also analyzed.
Objective:
Pregnancy causes changes in the duration and quality of sleep. Insomnia, insufficient sleep time, and symptoms associated with restless legs syndrome/Willis-Ekbom disease (RLS/WED) are frequently described during pregnancy. We aimed to evaluate the deterioration in sleep quality during pregnancy according to trimesters and to examine the effect of RLS/WEH and its correlation with clinical and biochemical markers.
Keywords:
Pregnancy, sleep quality, restless leg disease
References
1World Health Organization (WHO). Target of Health for All. Available from: https://www.euro.who.int/__data/assets/pdf_file/0008/149282/RC61_InfDoc7.pdf
2Rasch B, Born J. About sleep's role in memory. Physiol Rev 2013;93:681-766.
3Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: a meta-analysis. Sleep 1996;19:318-26.
4Ismailogullari S, Ozturk A, Mazicioglu MM, Serin S, Gültekin M, Aksu M. Restless legs syndrome and pregnancy in Kayseri, Turkey: A hospital based survey. Sleep Biol. Rhythms 2010;8:137-43.
5Lee KA. Alterations in sleep during pregnancy and postpartum: a review of 30 years of research. Sleep Med Rev 1998;2:231-42.
6Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol (1985) 1998;84:1055-62.
7Okun ML, Hanusa BH, Hall M, Wisner KL. Sleep complaints in late pregnancy and the recurrence of postpartum depression. Behav Sleep Med 2009;7:106-17.
8Taşkıran N. Pregnancy and sleep quality. Journal of Turkish Society of Obstetrics and Gynecology 2011;8:181-7.
9Yucel SC, Yucel U, Gulhan I, Ozeren M. Sleep quality and related factors in pregnant women. J Med Sci 2012;3:459-63.
10Steinweg K, Nippita T, Cistulli PA, Bin YS. Maternal and neonatal outcomes associated with restless legs syndrome in pregnancy: A systematic review. Sleep Med Rev 2020;54:101359.
11Manconi M, Ulfberg J, Berger K, Ghorayeb I, Wesström J, Fulda S, Allen RP, Pollmächer T. When gender matters: restless legs syndrome. Report of the "RLS and woman" workshop endorsed by the European RLS Study Group. Sleep Med Rev 2012;16:297-307.
12Neyal A, Senel GB, Aslan R, Nalbantoglu M, Acikgoz S, Yilmaz N, Tumay FB, Neyal M, Karadeniz D. A prospective study of Willis-Ekbom disease/restless legs syndrome during and after pregnancy. Sleep Med 2015;16:1036-40.
13Tunç T, Karadağ YS, Doğulu F, Inan LE. Predisposing factors of restless legs syndrome in pregnancy. Mov Disord 2007;22:627-31.
14Yıldırım E, Apaydın H. Zinc and Magnesium Levels of Pregnant Women with Restless Leg Syndrome and Their Relationship with Anxiety: A Case-Control Study. Biol Trace Elem Res 2021;199:1674-85
15Balaban H, Yıldız ÖK, Çil G, Şentürk İA, Erselcan T, Bolayır E, Topaktaş S. Serum 25-hydroxyvitamin D levels in restless legs syndrome patients. Sleep Med 2012;13:953-7.
16Dunietz GL, Lisabeth LD, Shedden K, Shamim-Uzzaman QA, Bullough AS, Chames MC, Bowden MF, O'Brien LM. Restless Legs Syndrome and Sleep-Wake Disturbances in Pregnancy. J Clin Sleep Med 2017;13:863-70.
17Terzi H, Terzi R, Zeybek B, Ergenoglu M, Hacivelioglu S, Akdemir A, Yeniel O. Restless legs syndrome is related to obstructive sleep apnea symptoms during pregnancy. Sleep Breath 2015;19:73-8.
18Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J; Restless Legs Syndrome Diagnosis and Epidemiology workshop at the National Institutes of Health; International Restless Legs Syndrome Study Group. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003;4:101-19.
19Walters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP, Trenkwalder C; International Restless Legs Syndrome Study Group. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 2003;4:121-32.
20Mindell JA, Cook RA, Nikolovski J. Sleep patterns and sleep disturbances across pregnancy. Sleep Med 2015;16:483-8.
21Blair LM, Porter K, Leblebicioglu B, Christian LM. Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans. Sleep 2015;38:1259-67.
22Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
23Lee H, Kim KE, Kim MY, Park CG. Comparison of factor structures of the Pittsburgh sleep quality index between mid- and late pregnancy among Korean women: a cross-sectional study. BMC Pregnancy Childbirth 2022;22:694.
24Jomeen J, Martin CR. The impact of choice of maternity care on psychological health outcomes for women during pregnancy and the postnatal period. J Eval Clin Pract 2008;14:391-8.
25Okun ML, Coussons-Read ME. Sleep disruption during pregnancy: how does it influence serum cytokines? J Reprod Immunol 2007;73:158-65.
26Skouteris H, Germano C, Wertheim EH, Paxton SJ, Milgrom J. Sleep quality and depression during pregnancy: a prospective study. J Sleep Res 2008;17:217-20.
27Kızılırmak A, Timur S, Kartal B. Insomnia in pregnancy and factors related to insomnia. ScientificWorldJournal 2012;2012:197093.
28Manconi M, Govoni V, De Vito A, Economou NT, Cesnik E, Casetta I, Mollica G, Ferini-Strambi L, Granieri E. Restless legs syndrome and pregnancy. Neurology 2004;63:1065-9.
29Dzaja A, Wehrle R, Lancel M, Pollmächer T. Elevated estradiol plasma levels in women with restless legs during pregnancy. Sleep 2009;32:169-74.
30Tuna Oran N, Yuksel E, Ruzgar S. Prevalence of restless leg syndrome and effects on quality of life during pregnancy. Sleep Breath 2021;25:2127-34.
31Akbaş P, Sözbir ŞY. Restless legs syndrome and quality of life in pregnant women. Rev Assoc Med Bras (1992) 2019;65:618-24.
32Patton SM, Ponnuru P, Snyder AM, Podskalny GD, Connor JR. Hypoxia-inducible factor pathway activation in restless legs syndrome patients. Eur J Neurol 2011;18:1329-35.
33Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM. Sleep quality during pregnancy: A meta-analysis. Sleep Med Rev 2018;38:168-76.
34Gupta R, Dhyani M, Kendzerska T, Pandi-Perumal SR, BaHammam AS, Srivanitchapoom P, Pandey S, Hallett M. Restless legs syndrome and pregnancy: prevalence, possible pathophysiological mechanisms and treatment. Acta Neurol Scand 2016;133:320-9.
35Lee KA, Zaffke ME, Baratte-Beebe K. Restless legs syndrome and sleep disturbance during pregnancy: the role of folate and iron. J Womens Health Gend Based Med 2001;10:335-41.
36Innes KE, Kandati S, Flack KL, Agarwal P, Selfe TK. The Association of Restless Legs Syndrome to History of Gestational Diabetes in an Appalachian Primary Care Population. J Clin Sleep Med 2015;11:1121-30.
