Repeated Measures Examination of Pre-Sleep Arousal, Sleep Quality, and Emotion Dysregulation During the Perinatal Period

• In Event: The Importance of Sleep Across the Perinatal Period: Implications for Maternal and Infant Well-being

Abstract

Background. Poor maternal sleep has been associated with perinatal psychopathology, negative maternal perceptions of the mother-infant relationship, and ineffective maternal feeding (González-Mesa et al., 2019; Leerkes et al., 2022; Tikotzky, 2016). Given these implications for maternal and infant health, there is a critical need to identify intervention targets, such as pre-sleep arousal (Dietch & Manber, 2021) and emotion dysregulation. Thus, we examined if the association between pre-sleep arousal and sleep quality during pregnancy and postpartum differed based on difficulties with emotion regulation during pregnancy.

Methods. Participants (aged 19-38) completed 7 days of daily surveys during their 3rd trimester of pregnancy (N = 86), and 14 days of surveys between 6 and 16 weeks postpartum (N = 81). Daily surveys included the Pre-Sleep Arousal Scale (PSAS; Nicassio et al., 1985) and Consensus Sleep Diary (CSD; Carney et al., 2012). Emotion dysregulation was measured via the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) during their 3rd trimester of pregnancy. Multilevel models were run in HLM8.

Results. Prenatally, within-person variance accounted for 75% of the variability in nightly subjective sleep quality (ICC = .25). On a nightly basis, higher pre-sleep arousal predicted poorer sleep quality (B = -.07, p < .001), and this association varied significantly across levels of prenatal emotion dysregulation (B = .001, p = .01). Specifically, the negative association between pre-sleep arousal and sleep quality was significantly stronger for participants who reported lower emotion dysregulation during pregnancy. Postnatally, within-person variance accounted for 63% of the variability in nightly subjective sleep quality (ICC = .37). Again, higher pre-sleep arousal predicted poorer subjective sleep quality on a nightly basis (B = -.06, p < .001); however, prenatal emotion dysregulation did not moderate this association. Instead, it exhibited a conditional main effect such that at the average level of pre-sleep arousal, more difficulties with emotion regulation predicted poorer postnatal sleep quality (B = -.01, p = .03). Exploratory analyses revealed a significant interaction between the DERS-Impulsivity subscale and Somatic pre-sleep arousal on sleep quality (B = .01, p = .05). Specifically, participants who reported having less difficulty controlling their behaviors when upset during pregnancy exhibited a significantly stronger relation between somatic pre-sleep arousal and poor sleep quality.

Discussion. It was unexpected that the nightly relation between pre-sleep arousal and sleep quality would be stronger for pregnant women who reported fewer difficulties with emotion regulation. It may be that these women were especially susceptible to the impacts of new-onset pre-sleep arousal, or that sleep quality among highly emotionally dysregulated women was already poor and therefore less affected by pre-sleep arousal (e.g., a floor effect). Regardless, the relation between pre-sleep arousal and sleep quality was significant across all levels of emotion dysregulation. This finding highlights pre-sleep arousal as a critical and distinct intervention target during pregnancy, as one recent study indicated that prenatal sleep intervention improved sleep duration and maintenance but not pre-sleep arousal (Kalmbach et al., 2020). Results will be discussed further in the context of infant development.

Authors

• Parisa R. Kaliush, University of Utah
  Presenting Author

• Paula G. Williams, University of Utah

• Liz Conradt, Duke University

• Sheila E Crowell, University of Utah