Shao Yu Tsai

Sleep disturbances and depressive symptoms in healthy postpartum women: A pilot study†

In this pilot study we examined the relationship between objective and subjective sleep disturbances and depressive symptoms in 22 healthy primiparous postpartum women within 3 months after delivery. We found that none of the women in our study had clinically significant depression scores on the Edinburgh Postnatal Depression Scale; nonetheless, a variable duration of night-time sleep from night to night during the 7-day monitoring period and reported awakening too early were significantly correlated with increased depressive symptoms. Results suggest that first-time mothers who complain of irregular night-time sleep duration and waking up too early should be screened and evaluated for potential postpartum depressive symptoms.

Nighttime sleep and daytime nap patterns in school age children with and without asthma

Objective: This research examines subjective and objective report of naps and nighttime sleep in 9- to 11-year-old children with and without asthma. Methods: This between subjects study collected prospective self-report diary and objective actigraphy measures of sleep from 27 children with and 27 without asthma during a 7-day/6-night at-home monitoring period. Results: Thirty-two percent of participants reported daytime naps. Nappers were more likely to be children with asthma (12/27 vs. 5/27, p = 0.04) even though the children with asthma did not report being more tired, sleepy, or less alert in the morning. Nappers did not differ from non-nappers on self-report measures of overall sleep quality or number of awakenings but were documented, via objective measures, to have later (clock time: 23:05 vs. 22:21, p = 0.04) and more variable (Levine’s Test for Equality of Variances: F = 10.68, p = 0.002) sleep onset times than non-nappers. Sleep offset times did not differ between the nappers vs. non-nappers, therefore, nappers had fewer total minutes of nighttime sleep than did the non-nappers (437 vs. 465, p = 0.04). Later (clock time: 23:01 vs. 22:15, p = 0.01) sleep onset times were also documented in minority vs. Caucasian children. Conclusions: Napping appears a more common behavior than expected especially in children with asthma or of minority ethnicity but the reasons are unclear. Self-report measures may not capture important sleep characteristics that objective measures can identify. Strategies to reduce late and variable bedtimes of all children are needed given our awareness of the negative cognitive, emotional, and behavioral consequences of poor sleep in children.

Daytime Physical Activity Levels in School-Age Children With and Without Asthma

Background:Physical activity (PA) is a significant predictor of health outcomes in children with and without chronic conditions. Few researchers have used actigraphy as an objective measure of PA during the child’s normal daily routines, and the findings have been inconsistent. It is unclear if asthma can contribute to low PA levels. Objectives:The aim of this study was to compare daytime PA levels in children with and without asthma and examine the relationships among asthma, PA, body mass index (BMI), and child reports of symptoms. Methods:Physical activity as measured by actigraphy and self-report symptoms of coughing, wheezing, chest tightness, perceived tiredness, sleepiness, and alertness were obtained in 54 children aged 9–11 years with and without asthma for 7 consecutive days. Activity variables derived from actigraphy included (a) mean daytime activity level; (b) peak daytime activity level; and (c) time duration spent in sedentary, light, moderate, vigorous, and total moderate plus vigorous PA (MVPA). Results:Children with and without asthma did not differ on BMI or activity levels. Children with asthma reported more activity limitations due to breathing problems than children without asthma (p < .01). In multivariate analyses, asthma predicted reduced mean, peak, and total time spent in MVPA level after controlling for gender, BMI, and self-report of symptoms. A significant interaction was found between asthma and BMI on mean, peak, and total time spent in MVPA. Discussion:The association between asthma and PA is complex when the child’s BMI is considered. Results suggest that reduced PAs with respect to respiratory symptom severity, childhood obesity, and functional impairment are important areas for future studies.

Parent-Child Agreement in Report of Nighttime Respiratory Symptoms and Sleep Disruptions and Quality

INTRODUCTION Asthma control requires assessment of nighttime symptoms and sleep disruption. Cognitive and emotional development enables most school-aged children to report nocturnal problems, but providers often rely only on parental report, potentially limiting the comprehensiveness of their assessments and their ability to support the childs emerging efforts at shared management of their illness. This study investigated parent-child concordance in report of nighttime respiratory symptoms, sleep disruption, and quality of sleep in a sample of 9- to 11-year-old children with asthma. Secondarily, similar concordance patterns in an equal number of dyads where the child was asthma free were examined to illustrate the potential influence of asthma. METHOD Parents and children completed 1-week diaries in their homes without confiding in one another. The probability of knowing the childs report on a specific item if the parents report was known was assessed using contingency tables. RESULTS Within the asthma group, parent-child reports differed significantly across all symptoms and sleep parameters. Parents most often reported fewer symptoms and awakenings and better quality of sleep than did their child. Concordance rates were lowest for morning perceptions of tiredness, sleepiness, and alertness in both asthma and non-asthma groups. DISCUSSION Both parents and school-aged children with asthma need to be asked about nighttime asthma symptoms, sleep, and morning perceptions when attempting to evaluate asthma control. Assessment of sleep in all children should include parent and child reports and would benefit by the addition of objective measures.

Nighttime Sleep, Daytime Napping, and Labor Outcomes in Healthy Pregnant Women in Taiwan

We prospectively examined the associations of nighttime and daytime sleep during the third trimester of pregnancy with labor duration and risk of cesarean deliveries in a convenience sample of 120 nulliparous women who completed sleep-related questionnaires and wore wrist actigraphs for up to 7 days. Nap duration and 24-hour sleep duration were inversely associated with labor duration in women with vaginal delivery. Neither actigraphy-derived nor self-reported sleep variables were associated with type of delivery (e.g., vaginal, cesarean). Results showed a beneficial effect of sleep on labor duration and suggest that studies of sleep duration effects on labor and pregnancy outcomes require a consideration of the amount of both daytime and nighttime sleep.

Light is beneficial for infant circadian entrainment: an actigraphic study

AIM This article is a report of an exploratory study of the relation between light exposure and circadian rest-activity patterns in infants. BACKGROUND Ambient light is a major environmental stimulus for regulation of circadian rhythm of sleep and wake in adults, but few studies have been conducted to examine environmental light exposure in relation to rest-activity circadian rhythm parameters of infants. METHODS An intensive within-subject design was used with a convenience sample of 22 infants (mean postnatal age 49·8 days) who wore a combined light and activity monitoring device for seven consecutive days at home. For each infant, light data (lux) were aggregated over the 7 days into categories of illumination and expressed in mean minutes/day. Circadian light and activity parameters, including mesor, amplitude, acrophase and R(2) cosinor fit, were determined using cosinor analysis. Associations between light exposure and circadian rest-activity rhythm parameters were examined using correlation and regression analyses. Data were collected between 2006 and 2007. RESULTS Infants spent only one-eighth of their daytime hours in an environment with >100 lux light level. There was a relatively large statistically significant relation between the acrophase of light exposure and the acrophase of activity. Increased duration of daily exposure to >100 lux of illumination, and increased amplitude of circadian rhythm of light were associated with stronger circadian patterns of infant activity. CONCLUSION Results suggest an association between light and activity patterns and that increasing duration of exposure to moderate light levels may be a simple and economical nursing intervention during the early postnatal weeks.

Effect of external motion on correspondence between infant actigraphy and maternal diary

Correspondence between infant actigraphy and mother-recorded diary differed significantly when receiver-operator function area under the curve, correlation, and logistic regression was calculated with and without excluding periods of external motion. External motion occurred in 40% of recording time and significantly changed activity count per epoch.

Mother–Infant Activity Synchrony as a Correlate of the Emergence of Circadian Rhythm

Objective: Entrainment to the day—night cycle is critical for infant sleep and social development. Synchronization of infant circadian systems with the social 24-hr day may require maternal activity signals as an entraining cue. This descriptive and exploratory research examines the activity level and circadian pattern in mothers and infants. Method: Twenty-two healthy mothers and their infants (postnatal age 49.8 ± 17.1 days) wore actigraph monitors for seven days. Daytime (06:00—21:59) and nighttime (22:00—05:59) activity levels and circadian parameters of rest—activity patterns (i.e., mesor, amplitude, acrophase, and 24-hr cosinor fit) were calculated. Results: Mothers and infants were significantly more active during the day than at night. The goodness-of-fit index for the model (R2) indicates that circadian rhythm accounted for a mean of 29 ± 10% and 12 ± 8% of the variability in maternal and infant activity, respectively. Acrophase of activity occurred at 15:46 ± 1:07 for the mothers and 15:20 ± 1:21 for the infants. The mean within-dyad correlation of activity counts was r = .46 ± .11, and the within-dyad correlation was associated with the amplitude (r = .66, p < .01) and 24-hr cosinor fit of infant activity (r = .67, p < .01). Conclusions: Our findings suggest maternal rhythms as a possible exogenous influence on shaping an infant’s emerging rhythms and synchronizing them with the external light—dark cycle. Strong pattern synchrony between maternal and infant activity may support infant circadian entrainment and enhance a regular 24-hr sleep—wake schedule during the early postnatal weeks.

Psychometric evaluation of a Chinese version of the Lee Fatigue Scale-Short Form in women during pregnancy and postpartum.

BACKGROUND Fatigue is among the most prevalent and distressing symptoms in pregnant and postpartum women. Estimating fatigue severity with a psychometrically sound instrument provides the most fundamental information for understanding womens fatigue experience and assessing the need for intervention to improve maternal and infant health outcomes. OBJECTIVES To evaluate the psychometric properties of a Chinese version of the 7-item Lee Fatigue Scale-Short Form (C-LFS-SF) in pregnant and postpartum women. METHODS The study was composed of two phases: translation of the scale into Chinese and examination of content validity, and testing to establish the reliability and validity. A convenience sample of 124 women completed health-related questionnaires, kept a fatigue diary and wore a wrist actigraph for 7 days during the third trimester of pregnancy and within three months postpartum. RESULTS The C-LFS-SF showed satisfactory internal consistency (Cronbachs alpha≥.97) and stability over the 7 days at each time point (intraclass correlation coefficient>.87). Exploratory factor analysis showed that 88-94% of the total variance was explained by the one-factor fatigue model. Significant associations among the C-LFS-SF and actigraphic sleep quantity and quality variables supported adequate construct validity. CONCLUSIONS The C-LFS-SF has satisfactory psychometric properties and is an easy and promising tool for assessing maternal fatigue during routine prenatal and postpartum care. This scale needs to be further tested in a more diverse population of pregnant and postpartum women, like women with high risk pregnancies or with medical conditions.

Reduced sleep duration and daytime naps in pregnant women in Taiwan.

Background:Napping is highly prevalent in pregnant women, but the relation between nighttime sleep and daytime naps in pregnant women is poorly understood. Objectives:The aim of this study was to examine the temporal association of nighttime sleep quality and quantity with subsequent daytime naps and the temporal association of daytime naps with sleep quality and quantity the following night in women during the third trimester of pregnancy in Taiwan. Methods:Sleep was assessed in 80 Taiwanese nulliparous women aged 31.70 years (SD = 4.58 years) using actigraphy and diaries for 7 consecutive days. Subjective sleep quality was examined using the Pittsburgh Sleep Quality Index. Multiple linear regressions with generalized estimating equations were used to examine the temporal associations of nighttime sleep and daytime naps. Results:All women napped sometime during the study week, and mean Pittsburgh Sleep Quality Index global score was 6.6, indicating poor sleep quality. Fewer weekly work hours and shorter sleep duration the preceding night were associated with longer nap duration the next day. More work hours, longer nap duration, and more intense fatigue were associated with shorter sleep duration the following night. Discussion:Naps during pregnancy might indicate insufficient nighttime sleep, and longer daytime naps could compromise subsequent nighttime sleep. Further research is needed to determine if short sleep duration and longer daytime naps are associated with negative pregnancy outcomes.