INTRODUCTION:

Sleep is a physiological need of all human beings. The National Sleep Foundation has recommended that adults obtain 7-8 hours of sleep per 24 hours.⁵Pregnancy is one of the most important periods in a woman's life. Significant changes happen in hormonal level during pregnancy, which affects the function of different systems of mothers ^.Hormonal changes not only directly affect sleep-wake cycle and sleeping structure, but it also causes certain physical and mental changes that may lead to sleep disorder.⁶By causing changes in the immune system such as changes in the level of cytokine and C-reactive protein, sleep disorder can be associated with undesirable consequences such as anxiety, reduced tolerance against pain, premature delivery, low birth weight, blood pressure disorders, disorder in glucose tolerance and depression during and after pregnancy⁷. Though description of sleep patterns during pregnancy has great clinical importance, assessment of the quality and quantity of sleep has not been part of routine prenatal care. Considering the significant morbidity and health care costs, simple screening of pregnant women for sleep disorders using self report technique may have clinical utility⁸. As per above mentioned background the present study was aimed at assessing the sleep quality among antenatal women in third trimester.

MATERIAL AND METHODS:

A descriptive analytical study was conducted among 60 antenatal women above 37 weeks of gestation admitted in antenatal wards of MOSC Medical College Hospital, Kolenchery in the year 2018. A Standardized Pittsburgh Sleep Quality Index was used to assess the sleep quality. Data were analyzed using R software. The study was approved by the institutional ethics committee. After obtaining informed consent 60 antenatal women above 37 weeks of gestation were selected by Convenience sampling. Data were analyzed using R software.

RESULTS:

Section A : Description of subjects according to their demographic variables.

Socio demographic variables were described in terms of age, marital status, and educational qualification, type of family, work status and family income.

Table 1 shows that the majority of subjects (68.3%) were in the age group of 21-30yrs and 21.7% were in the age group of 31-40 yrs and a small percentage (10%) belonged to <20 yrs of age. All the subjects (100%) were married. Majority of subjects (35%) were undergraduates. Majority (93.3%) belonged to nuclear family. Most (60%) of them were homemakers and remaining were working mothers (40%). Nearly half of the subjects (53.3%) had monthly family income of ≥ 15000 Rs. and 46.7% had family income of <Rs.15000.

Table 1: Frequency and percentage distribution of subjects based on their demographic variables. n=60

	Variables	Frequency(f)	Percentage (%)
1	Age
	a) <20yrs	6	10
	b) 21-30yrs	41	68.3
	c) 31-40yrs	13	21.7
2	Marital status
	a) Married	60	100
3	Educational qualification
	a) Below 10th standard	17	28.3
	b) Higher secondary	15	25
	c) Undergraduate/diploma	21	35
	d) Post graduation and above	7	11.7
4	Type of family
	a) Nuclear	56	93.3
	b) Joint	4	6.7
5	Work status
	a) Working mothers	24	40
	b) Homemaker	36	60
6	Family income
	c) <Rs .15000	28	46.7
	d) > Rs.15000	32	53.3

Table 2: Frequency and percentage distribution of subjects according to their obstetric variables. n=60

Variables	Frequency (f)	Percentage (%)
Gravida
a) 1	32	53.3
b) >2	28	46.7
Gestation
a) 1	60	100
Number of children
a) 0	36	60
b) 1	16	26.7
c) >2	8	13.3
Birth spacing
a) <2	38	63.3
b) >2	22	36.7
Pregnancy complications
a) Yes	6	10
b) No	54	90
Worried about pregnancy outcome
a) Yes	23	38.3
b) No	37	61.7
Main support person
a) Mother & in-laws	6	10
b) Husband	54	90
Enlarged abdomen cause any discomfort
a) Yes	47	78.3
b) No	13	21.7
Worried about other persons in the bed
a) Yes	17	28.3
b) No	43	71.7
Worried about the dangers of using certain positions
a) Yes	19	31.6
b) No	41	4

Distribution of subjects according to their obstetric characteristics:

Obstetric variables were described in terms of gravida, gestation, number of children, spacing of children, pregnancy associated complications, main support person, worries about pregnancy outcomes, discomfort due to enlarged abdomen, worries about presence of other person in the bed and worries about dangers in changing positions.

The table 2 shows that majority of the subjects (53.3%) were primi gravida and all the subjects (100%) were with singleton gestation. Majority (60%) had no children and most of them (63.3%) had <2yrs of birth spacing between last and present pregnancy. 90% of subjects had no pregnancy complications where as 10% had pregnancy complications. Majority (61.6%) were worried about their pregnancy outcome. Most of the subject’s (90%) main support person was their husband. 78.3% women had discomfort while lying down due to enlarged abdomen. Majority of the women (71.7%) were not worried about the presence of other person sharing their bed. Most of the subjects (68.4%) were not worried about the dangers of using certain positions but more than a quarter (31.6%) was worried about the dangers of using certain positions.

SECTION B: Description based on objectives:

Objective 1: To assess the sleep quality among antenatal women in third trimester

Description of sleep quality among antenatal women in third trimester.

Table 3: Mean Pittsburgh Sleep Quality Index Score with sleep component scores in third trimester of pregnancy n=60

Sleep components	mean
Subjective sleep quality( 0-3)	1.167 ± 0.740
Sleep latency(0-3)	2.15 ±0.953
Sleep duration( 0-3)	2.233 ± 0.767
Habitual sleep efficiency (0-3)	1.983± 1.200
Sleep disturbances ( 0-3)	1.300 ± 0.497
Use of sleep medications (0-3)	0.000 ± 0.00
Day time dysfunction (0-3)	1.116 ±0.555
Total PSQI global score (0/21)	8.95 ±2.709

The above table shows that the mean Pittsburgh Sleep Quality Index Score was 8.95 with standard deviation of 2.709 which indicate poor sleep quality during 3^rd trimester of pregnancy.

Table 4: Frequency and percentage distribution of subjects according to the sleep quality. n=60

Grade	Frequency(f)	Percentage (%)
· Good (<5)	4	6.7
· Poor (≥5)	56	93.3

Figure1: Pie diagram showing sleep quality among antenatal women in third trimester

Table 4 depicts that almost all the subjects (93.3%) had poor sleep quality in the third trimester of pregnancy. Only 6.7% had good sleep quality in their third trimester.

The Fig. 1 explains that majority of the subjects (93.3%) had poor sleep quality in their third trimester of pregnancy.

Objective 2: To find out the association between sleep quality and various demographic and obstetric variables

Association between sleep quality and various demographic variables and obstetric variables:

Variables	Sleep Quality		Fisher^’s exact test	P value
	<5	≥5
Age
a) <20yrs	0	6	1.046	0.716
b) 21-30yrs	4	37
c) 31-40yrs	0	13
Educational qualifications
a) Below 10th std	1	16	-	-
b) Higher secondary	0	15
c) Undergraduate/diploma	2	19
d) Post graduate	1	6
Type of family
a) Nuclear	4	52	-	-
b) Joint	0	4
Work status
a) Homemaker	1	35
b) Working mothers	3	21
Family income
a) <15000	2	26		1
b) >15000	2	30
Gravida
a) 1	4	28	- -	0.116
b) >2	0	28
No. of children
a) 0	4	32	-	0.445
b) >1	0	24
Birth spacing
a) <2	4	40	-	0.565
b) >2	0	16
Pregnancy complications
a) Yes	0	6	-	1
b) No	4	50
Worried about pregnancy outcome
a) Yes	1	22	-	1
b) No	3	34
Gestation
a) 1	4	56	-	-
Main support person
a) Husband	4	50	-	1
b) Mother and in laws	0	6
Enlarged abdomen
a) Yes	4	43	-	0.568
b) No	0	13
Worried about other person in bed
a) Yes	2	15	-	0.317
b) No	2	41
Worried about the dangers of using certain positions while sleeping
a) Yes	0	19	-	0.297
b) No	4	37

Level of significance at p value <0.05

The above table depicts that was no significant association between sleep quality and selected socio demographic and obstetric variables.

SUMMARY:

The result showed that women in the third trimester had poor sleep quality. No significant association was found between sleep quality and various demographic and obstetric variables.

DISCUSSION:

In the present study it was observed that majority of the subjects (93.3%) had poor sleep quality in the third trimester of pregnancy. The mean Pittsburgh Sleep Quality Index Score was 8.95 with standard deviation of 2.70 which indicated poor sleep quality. A similar descriptive cross sectional study conducted in India also revealed that majority (95.5%) of women in third trimester had poor quality of sleep. The mean global PSQI score in third trimester was ≥ 5 (p value <0.05).¹On the contrary a study on physical activity and sleep among 1259 pregnant women in North Carolina using PSQI revealed that majority (44%) had good sleep quality where, as only 12.1% reported poor sleep quality.⁹

The present study revealed that there was no significant association between sleep quality and selected socio demographic and obstetric variables.A similar study conducted in turkey on sleep quality and related factors in pregnant women revealed that there was no statistically significant correlation was found between age and mean PSQI total score (r= 0.188, p=0.059).¹⁰On the contrary, a study conducted to measure the sleep quality of pregnant women and to determine and define the affecting factors among 100 pregnant women in Ahmet Necdet Sezer University revealed that 86% of pregnant women had bad sleep quality and also determined that sleep quality in pregnant women was in relation with age, obesity and presence of pregnancy affecting disease(p =0.036).

CONCLUSION:

The study concluded that majority of the antenatal women had poor sleep quality during their third trimester of pregnancy. No association was found between sleep quality and selected socio demographic and obstetric variables. Insufficient sleep duration and poor sleep quality during pregnancy may increase the risk of adverse pregnancy outcomes. Therefore the present study recommends that this study finding may help the nurse to plan for interventional strategy to improve the knowledge of antenatal women regarding prevention of complications due to poor sleep.

ACKNOWLEDGEMENT:

Here we extend our sincere thanks to all the antenatal women who participated in the study.

CONFLICT OF INTEREST:

The authors declare no conflict of interest in the study.

REFERENCES:

1. Gunduz S, Kosger H, Aldemir S, Akcal B, Tevrizci H, Hizli D, Celik HT. Sleep deprivation in the last trimester of pregnancy and inadequate vitamin D: Is there a relationship?. Journal of the Chinese Medical Association. 2016 Jan 1;79(1):34-8.

2. Cunningham, F., et al., Obstetrics.23rd ed. Tehran: golban; 2010. V1.409-414.}

3. Venugopal L, Rajendran P, Parghavi V. International Journal of Research in Medical sciences 2018 oct;6(10)3197- 3201. www.msjonline. Org

4. Alipour, Z., Sleep quality in late pregnancy and postpartum depression, Iran J Obstetrics, Gynecology & Infertility, 2011. (40): p. 39-47.)

5. Sharma SK, Nehra A, Sinha S, Soneja M, Sunesh K, Sreenivas V, Vedita D. Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study. Sleep and Breathing. 2016 Mar 1;20(1):87-93.

6. Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J rheumatol. 1991 May 1;18(5):728-33.

7. Williams, M., Associations of early pregnancy sleep duration with trimester-specific blood pressures and hypertensive disorders in pregnancy, Sleep, 2010. 33: p. 1363-1371

8. Wang H, Leng J, Li W, Wang L, Zhang C, Li W, Liu H, Zhang S, Chan J, Hu G, Yu Z. Sleep duration and quality, and risk of gestational diabetes mellitus in pregnant Chinese women. Diabetic Medicine. 2017 Jan;34(1):44-50.

9. Borodulin K, Even son KR, Monda K, Wen F, Herring AH, Dole N. Physical activity and sleep among pregnant women. Pediatric and perinatal epidemiology. 2010 Jan; 24(1):45-52.

10. Nobari BB, Taghizadeh A, Khorvash M, Alijani S, Shodja J, Khajeh-Dizaj FP. Available online at www. scholarsresearchlibrary. com. Annals of Biological Research. 2013; 4(1):213-

Received on 18.10.2019 Modified on 10.11.2019

Int. J. Nur. Edu. and Research. 2020; 8(1):49-52.

DOI: 10.5958/2454-2660.2020.00010.1