1093 Know Thyself: How Much Does What We Think About Sleep Matter? Interventional Targets for Treating Perinatal Sleep Concerns

Abstract Introduction Sleep disturbance affects 60-80% of postpartum women and increases risk for depression and anxiety but continues to be regarded as a “normal” experience the postpartum period. Maladaptive sleep-related cognitions—including dysfunctional beliefs and catastrophizing about sleep—predict insomnia severity and treatment outcomes in general populations. However, the extent to which normative expectations around perinatal sleep (attitudes and beliefs assessed at pregnancy) predict postpartum sleep quality and interact with postpartum mood remains unknown. Such information could inform preventive interventional targets. Methods 432 pregnant women (24 weeks gestation +/- 5 weeks) completed measures on their attitudes and beliefs on postpartum sleep, alongside their current sleep quality (Pittsburgh Sleep Quality Index), and affect (Edinburgh Postnatal Depression Scale; Generalized Anxiety Disorder 7-item scale). They repeated these assessments at postpartum week-6, 12, 24. Among these, 49 women also completed wrist actigraphy at 6-8 weeks postpartum. Results Seventy percent (301/432) of all pregnant women expected poor sleep in the postpartum as rated as anything above “sometimes” on a 5 point-Likert scale. Level of predicted sleep disruption during pregnancy predicted postpartum sleep concerns above and beyond parity, past history of sleep disorders, and past psychiatric history. Notably, in healthy, first-time pregnant women, those who predicted greater sleep disturbance had significantly more disrupted sleep by both actigraphy and self-report measures (Beta = .42, p<.01, R^2 = .14. Among those women who predicted the worst sleep quality, level of postpartum anxiety significantly modified the effect of predictions on poor sleep quality: in other words, the greater one’s anxiety in the postpartum, the poorer their objective and subjective sleep quality, independent of antenatal anxiety levels. Conclusion Pregnancy-rated attitudes and beliefs about sleep may serve as a modifiable risk factor of postpartum sleep concerns. In the postpartum, treating underlying postpartum anxiety may also help with sleep quality. The relationship between postpartum anxiety and postpartum sleep disruption apart from insomnia merits further evaluation to elucidate common etiological pathways. Support (if any) NIH 1R36MH118000-01, 1T32HL170968-01; U24HD113146