Habitual Snoring and Depressive Symptoms During Pregnancy

Louise M O'Brien; Jocelynn T Owusu; Leslie M Swanson

BMC Pregnancy Childbirth. 2013;13(113)

Conclusions

In summary, maternal snoring appears to be independently associated with prenatal depressive symptoms as measured by the EPDS. These findings are important particularly since snoring affects a large number of pregnant women, increases in frequency as gestation progresses, and prenatal depressive symptoms remain one of the most common and consequential conditions during pregnancy. While the temporal relationship between snoring and depressive symptoms remains to be confirmed, these novel data suggest that routine screening for SDB symptoms during pregnancy may have clinical utility in early identification of women at risk for depressive symptoms and may provide an opportunity for intervention.

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Abbreviations
SDB: Sleep-Disordered Breathing; EPDS: Edinburgh Postnatal Depression Scale; GSDS: General Sleep Disturbance Scale; BMI: Body Mass Index; ICD: International Classification of Diseases.

Authors' contributions
LMO conceived and designed the study, assisted with data acquisition, analyzed and interpreted the data, drafted the manuscript, and approved the final version for submission. JTO assisted with study design, conducted data acquisition, managed, checked, and cleaned the data, assisted with manuscript editing, and approved the final version. LMS assisted with study design, analysis and interpretation as well as participated in manuscript drafting and revision, and provided approval for the final submitted version. All authors read and approved the final manuscript.

Acknowledgements
We thank the women for participating in this study. This project was supported in part by the Gene and Tubie Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research (MICHR) grant UL1RR024986, MICHR seed pilot grant F021024, and the National Heart, Lung, and Blood Institute (R21 HL089918). Dr. O'Brien was also supported by a career grant from the National Heart, Lung, and Blood Institute (K23 HL095739) and in part by R21 HL087819. No funding body had any role in design, data collection, analysis, data interpretation, manuscript preparation, or the decision to submit the manuscript for publication.

Table 1. Demographic data
	Total sample (n = 362)
Age (years)	30.1 ± 5.9
Pre-pregnancy BMI (kg/m²)	27.0 ± 7.3
Obesity (BMI ≥ 30;%)	27.1%
Racial Background:
Caucasian (%)	72.9%
African American (%)	12.2%
Asian (%)	8.9%
Multi-racial/Other (%)	6.1%
Educational Level:
High school or less (%)	24.5%
Marital Status:
Married (%)	67.7%
Partner (%)	3.9%
Single (%)	22.9%
Separated (%)	0.8%
Divorced (%)	0.6%
Unknown (%)	4.1%
Nulliparous (%)	32.0%
Pre-eclampsia (%)	7.8%
Diabetes Mellitus (%)	14.6%
Smoker (%)	14.5%

Data shown as mean ± standard deviation, or proportion as appropriate.
BMI = Body Mass Index.

Table 2. Comparison of demographics and sleep variables in women with and without EPDS scores ≥10
	EPDS < 10 (n = 256)	EPDS ≥ 10 (n = 106)
Age (years)	30.3 ± 5.8	29.5 ± 5.8
Pre-pregnancy BMI (kg/m²)	26.0 ± 6.6	29.1 ± 8.2**
Obesity (BMI ≥ 30;%)	22.0%	38.7%**
African American (%)	9.2%	18.3%*
High school or less (%)	20.6%	32.1%*
Married/partnered (%)	81.2%	59.2%**
Nulliparous (%)	36.1%	22.6%*
Pre-eclampsia (%)	5.2%	14.0%**
Diabetes Mellitus (%)	14.6%	15.0%
Smoker (%)	8.4%	25.0%**
Snoring (%)	26.2%	47.1%
Stopped breathing (%)	4.1%	3.8%
Mean Sleep Duration (hours)	8.7 ± 1.4	8.6 ± 1.8
Sleep duration ≤6 hours (%)	2.8%	7.3%
Sleep duration >10 hours (%)	13.3%	11.8%
Mean Sleep quality score	3.5 ± 1.2	4.1 ± 1.1**
Poor sleep quality (%)	67.8%	83.8%**

*p < 0.05; **p < 0.001.
BMI = Body Mass Index.
EPDS = Edinburgh Postnatal Depression Scale.

Table 3. Comparison of demographics, mean EPDS, sleep duration, and sleep quality scores between non-snoring and snoring women
	Non-snoring (n = 245)	Snoring (n = 116)
Age (years)	29.7 ± 5.8	30.8 ± 6.0
Pre-pregnancy BMI (kg/m²)	25.4 ± 6.1	30.4 ± 8.4**
Obesity (BMI ≥ 30;%)	19.7%	43.0%**
African American (%)	10.7%	14.8%
High school or less (%)	22.5%	25.2%
Married/partnered (%)	78.4%	67.3%*
Nulliparous (%)	35.4%	24.8%*
Pre-eclampsia (%)	6.2%	11.3%
Diabetes Mellitus (%)	11.6%	20.9%*
Smoker (%)	8.5%	21.9%**
Stopped breathing (%)	1.7%	9.6%**
Mean EPDS	5.4 ± 5.0	6.1 ± 4.9
EPDS ≥10 (%)	22.9%	42.7%**
EPDS ≥15 (%)	12.8%	18.3%
Mean Sleep Duration (hours)	8.7 ± 1.6	8.7 ± 1.6
Sleep duration ≤6 hours (%)	5.1%	1.9%
Sleep duration >10 hours (%)	12.6%	14.9%
Mean Sleep quality score	3.5 ± 1.2	3.9 ± 1.2*
Poor sleep quality (%)	72.5%	74.6%**

*p < 0.05; **p < 0.001.
BMI = Body Mass Index.
EPDS = Edinburgh Postnatal Depression Scale.

Table 4. Logistic regression of EPDS ≥ 10 onto snoring and other covariates
Variable	Beta	SE	p-value	Adjusted OR	95%CI
Explanatory variables
Snoring	0.666	0.293	0.023	2.00	1.13 – 3.46
Parity	0.273	0.122	0.025	1.38	1.04 – 1.67
Obesity	0.433	0.320	0.177	1.54	0.82 – 2.89
Sleep quality score	0.456	0.127	0.001	1.58	1.23 – 2.03
Partner	−0.802	0.348	0.021	0.45	0.23 – 0.89
African American	0.096	0.432	0.824	1.10	0.47 – 2.57
High school or less	−0.400	0.375	0.286	0.67	0.32 – 1.40
Pre-eclampsia (%)	1.552	0.478	0.001	4.72	1.85 – 12.05
Smoker (%)	0.969	0.427	0.017	2.64	1.19 – 5.83