DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection. Issue 1 (11th March 2022)

• Record Type: Journal Article
• Authors: Kalmbach, David A; Cheng, Philip; Roth, Andrea; Roth, Thomas; Swanson, Leslie M; O'Brien, Louise M; Fresco, David M; Harb, Nicholas C; Cuamatzi-Castelan, Andrea S; Reffi, Anthony N; Drake, Christopher L
• Is Part Of: Sleep advances. Volume 3:Issue 1(2022)
• Publication Date: 2022-03-11
• Subjects: ICSD-3 -- perinatal -- Presleep Arousal Scale -- Insomnia Severity Index -- Pittsburgh Sleep Quality Index -- Epworth Sleepiness Scale -- daytime sleepiness; Sleep disorders -- Periodicals; Circadian rhythms -- Periodicals; 616.8498
• DOI: 10.1093/sleepadvances/zpac006
• Languages: English
• ISSNs: 2632-5012

Abstract

Abstract: Study Objectives: The study had three primary goals. First, we estimated survey-assessed DSM-5 insomnia disorder rates in pregnancy, and described associated sociodemographics, and sleep-wake and mental health symptoms. Second, we derived cutoffs for detecting DSM-5 insomnia disorder using common self-report measures of sleep symptoms. Third, we identified clinically relevant cut-points on measures of nocturnal cognitive and somatic arousal. Methods: Ninety-nine women (85.9% in the 2 nd trimester) completed online surveys including DSM-5 insomnia disorder criteria, the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Presleep Arousal Scale's Cognitive (PSASC) and Somatic (PSASS) factors, and Edinburgh Postnatal Depression Scale. Results: DSM-5 insomnia disorder rate was 19.2%. Insomnia was associated with depression, suicidality, nocturnal cognitive and somatic arousal, and daytime sleepiness. An ISI scoring method that aligns with DSM-5 criteria yielded excellent metrics for detecting insomnia disorder and good sleep. Regarding quantitative cutoffs, ISI ≥ 10 and ISI ≥ 11 (but not ISI ≥ 15) were supported for detecting DSM-5 insomnia, whereas ISI ≤ 7 and ISI ≤ 9 performed well for detecting good sleep. PSQI cutoff of 5 was supported for detecting insomnia and good sleep. The optimal cutoff for nocturnal cognitive arousal was PSASC ≥ 18, whereas the optimal cutoff for somatic arousal was PSASS ≥ 13. Conclusions: Insomnia disorder affects a large segment of pregnant women. Empirically derived cutoffs for insomnia, good sleep, cognitive arousal, and somatic arousal may inform case identification and future perinatal sleep research methodology.