Prevalence and predictors for postpartum sleep disorders: a nationwide analysis

Figures & data

Table 1. Maternal characteristics among women with and without a sleep disorder.

Variable	Any sleep disorder (n = 3535)	No sleep disorder (n = 185,512)	p Value
Maternal age (years)			<.001
<20	67 (1.9%)	3812 (2%)
20–34	2405 (68%)	134,093 (72.3%)
≥35	1063 (30.1%)	47,607 (25.7%)
Highest educational level			<.001
Less than 12th grade	<20	596 (0.3%)
High school diploma	726 (20.5%)	36,943 (19.9%)
Less than bachelor degree	2008 (56.8%)	99,369 (53.6%)
Bachelor degree or higher	776 (21.9%)	47,575 (25.6%)
Unknown	<20	1029 (0.6%)
Annual household income ($)			.001
<40,000	406 (11.5%)	18,748 (10.1%)
40,000–49,000	189 (5.4%)	9107 (4.9%)
50,000–59,000	207 (5.9%)	9855 (5.3%)
60,000–74,000	274 (7.8%)	14,655 (7.9%)
75,000–99,000	446 (12.6%)	21,994 (11.9%)
≥100,000	1118 (33.6%)	68,641 (37%)
Unknown	825 (23.3%)	42,512 (22.9%)
Race			<.001
White	1906 (53.9%)	92,951 (50.1%)
African-American	219 (6.2%)	12,373 (6.7%)
Hispanic	273 (7.7%)	16,738 (9%)
Asian	112 (3.2%)	12,325 (6.6%)
Unknown	1025 (29%)	51,125 (27.6%)
Obesity	276 (7.8%)	7198 (3.9%)	<.001
Chronic hypertension	212 (6%)	5049 (2.7%)	<.001
Diabetes (pre-existing or gestational)	344 (9.7%)	13,853 (7.5%)	<.001
Alcohol abuse	<20	43 (0.02%)	.202
Drug abuse	25 (0.7%)	397 (0.2%)	<.001
Tobacco use disorder	107 (3%)	3074 (1.7%)	<.001
Multiple gestation	110 (3.1%)	4247 (2.3%)	.001
Hypertensive disorder of pregnancy	371 (10.5%)	13,758 (7.4%)	<.001
Mode of delivery			<.001
Vaginal	2001 (56.6%)	119,800 (64.6%)
Cesarean without labor	941 (26.6%)	38,603 (20.8%)
Cesarean with labor	593 (16.8%)	27,109 (14.6%)
Preterm delivery	312 (8.8%)	10,736 (5.8%)	<.001
Stillbirth	36 (1%)	844 (0.4%)	<.001
Year			.111
2011	1103 (31.2%)	54,793 (29.5%)
2012	1056 (29.9%)	55,449 (29.9%)
2013	944 (26.7%)	50,998 (27.5%)
2014	432 (12.2%)	24,272 (13.1%)

Data presented as n (%). Due to data restrictions and to avoid potential identification of subjects, cells with numbers less 20 are reported as <20.

Table 2. Maternal predictors of a sleep disorder.

Variable	Unadjusted odds ratios (95% CI)	Adjusted odds ratios (95% CI)
Maternal age (years)
<20	0.98 (0.77–1.25)	0.97 (0.76–1.24)
20–34	Reference	Reference
≥35	1.24 (1.16–1.34)	1.22 (1.13–1.32)
Highest educational level
Less than 12th grade	Reference	Reference
High school diploma	1.46 (0.73–2.95)	1.39 (0.69–2.81)
Less than bachelor degree	1.51 (0.75–3.03)	1.53 (0.75–3.08)
Bachelor degree or higher	1.22 (0.60–2.45)	1.34 (0.66–2.73)
Unknown	1.23 (0.53–2.87)	1.17 (0.50–2.75)
Annual household income ($)
<40,000	Reference	Reference
40,000–49,000	0.96 (0.80–1.01)	0.96 (0.81–1.15)
50,000–59,000	0.97 (0.82–1.15)	0.97 (0.82–1.15)
60,000–74,000	0.86 (0.74–1.01)	0.86 (0.73–1.01)
75,000–99,000	0.94 (0.82–1.07)	0.93 (0.80–1.06)
≥100,000	0.80 (0.71–0.90)	0.80 (0.71–0.91)
Unknown	0.90 (0.79–1.01)	0.94 (0.83–1.07)
Race
White	Reference	Reference
African-American	0.86 (0.37–0.54)	0.75 (0.65–0.87)
Hispanic	0.80 (0.70–0.90)	0.75 (0.66–0.86)
Asian	0.44 (0.37–0.54)	0.46 (0.38–0.56)
Unknown	0.98 (0.91–1.06)	0.92 (0.85–1.00)
Obesity	2.10 (1.85–2.38)	1.68 (1.47–1.91)
Chronic hypertension	2.28 (1.98–2.63)	1.82 (1.57–2.11)
Diabetes (pre-existing or gestational)	1.34 (1.19–1.49)	1.14 (1.01–1.28)
Alcohol abuse	2.44 (0.59–10.08)	–
Drug abuse	3.32 (2.21–4.98)	2.70 (1.79–4.09)
Tobacco use disorder	1.85 (1.52–2.25)	1.54 (1.26–1.88)
Multiple gestation	1.37 (1.13–1.66)	1.03 (0.84–1.26)
Hypertensive disorder of pregnancy	1.46 (1.31–1.63)	1.31 (1.17–1.46)
Mode of delivery
Vaginal	Reference	Reference
Cesarean without labor	1.46 (1.35–1.58)	1.31 (1.21–1.42)
Cesarean with labor	1.31 (1.19–1.44)	1.22 (1.11–1.34)
Preterm delivery	1.58 (1.40–1.77)	1.38 (1.22–1.56)
Stillbirth	2.25 (1.61–3.15)	2.15 (1.53–3.01)

Data presented as n (%).

Figure 1. Flowchart.

Table 3. Maternal characteristics among women with and without a comorbid diagnosis of sleep disorder and postnatal depression.

Variable	Comorbid sleep disorder and depression (n = 1182)	No comorbid sleep disorder and depression^a (n = 172,391)	p Value
Maternal age (years)			.04
<20	34 (2.9%)	3383 (2.0%)
20–34	832 (70.4%)	124,913 (72.5%)
≥35	316 (26.7%)	44,095 (25.6%)
Highest educational level			<.001
Less than 12th grade	<20	559 (0.3%)
High school diploma	259 (21.9%)	34,211 (19.9%)
Less than bachelor degree	696 (58.9%)	91,974 (53.4%)
Bachelor degree or higher	222 (18.8%)	44,696 (25.9%)
Unknown	<20	951 (0.6%)
Annual household income ($)			<.001
<40,000	152 (12.9%)	12,237 (10.0%)
40,000–49,000	65 (12.9%)	8441 (4.9%)
50,000–59,000	66 (5.6%)	9055 (5.3%)
60,000–74,000	100 (8.5%)	13,592 (7.9%)
75,000–99,000	166 (14.0%)	20,393 (11.8%)
≥100,000	359 (30.4%)	64,218 (37.3%)
Unknown	274 (23.2%)	39,455 (22.9%)
Race			<.001
White	667 (56.4%)	85,664 (49.7%)
African-American	65 (5.5%)	11,661 (6.8%)
Hispanic	98 (8.3%)	15,818 (9.2%)
Asian	23 (2.0%)	12,004 (7.0%)
Unknown	329 (27.8%)	47,243 (27.4%)
Obesity	104 (8.8%)	6488 (3.8%)	<.001
Chronic hypertension	66 (5.6%)	4526 (2.6%)	<.001
Diabetes (pre-existing or gestational)	104 (8.8%)	12,792 (7.4%)	.07
Alcohol abuse	<20	35 (0.02)	.62
Drug abuse	<20	326 (0.2%)	<.001
Tobacco use disorder	51 (4.3%)	2620 (1.5%)	<.001
Multiple gestation	30 (2.5%)	3891 (2.3%)	.52
Hypertensive disorder of pregnancy	122 (10.3%)	12,554 (7.3%)	<.001
Mode of delivery			<.001
Vaginal	686 (58.0%)	111,640 (64.8%)
Cesarean without labor	284 (24.0%)	35,637 (20.7%)
Cesarean with labor	212 (17.9%)	25,114 (14.6%)
Preterm delivery	113 (9.6%)	9678 (5.6%)	<.001
Stillbirth	<20	693 (0.4%)	<.001
Year			.26
2011	359 (30.4%)	50,935 (29.6%)
2012	366 (31.0%)	51,514 (29.9%)
2013	325 (27.5%)	47,374 (27.5%)
2014	132 (11.2%)	22,568 (13.1%)

Data presented as n (%). Due to data restrictions and to avoid potential identification of subjects, cells with numbers less 20 are reported as <20.

^a Defined as women who have a sleep disorder and depression.

Table 4. Maternal predictors of a comorbid diagnosis of a sleep disorder and postpartum depression.

Variable	Unadjusted odds ratios (95% CI)	Adjusted odds ratios (95% CI)
Maternal age (years)
<20	1.51 (1.07–2.13)	1.40 (0.99–1.98)
20–34	Reference	Reference
≥35	1.08 (0.94–1.23)	1.11 (0.97–1.27)
Highest educational level
Less than 12th grade	Reference	Reference
High school diploma	4.23 (0.59–30.21)	4.14 (0.58–29.64)
Less than bachelor degree	4.23 (0.59–30.13)	4.67 (0.65–33.46)
Bachelor degree or higher	2.78 (0.39–19.93	3.66 (0.51–26.30)
Unknown	4.60 (0.51–41.30)	4.68 (0.52–42.26)
Annual household income ($)
<40,000	Reference	Reference
40,000–49,000	0.87 (0.65–1.17)	0.88 (0.65–1.18)
50,000–59,000	0.83 (0.62–1.10)	0.83 (0.62–1.11)
60,000–74,000	0.83 (0.65–1.07)	0.83 (0.64–1.07)
75,000–99,000	0.92 (0.74–1.15)	0.92 (0.73–1.15)
≥100,000	0.63 (0.52–0.77)	0.67 (0.54–0.82)
Unknown	0.80 (0.65–0.97)	0.88 (0.71–1.08)
Race
White	Reference	Reference
African-American	0.72 (0.55–0.92)	0.58 (0.45–0.75)
Hispanic	0.80 (0.64–0.98)	0.73 (0.59–0.91)
Asian	0.25 (0.16–0.37)	0.27 (0.17–0.41)
Unknown	0.89 (0.78–1.02)	0.83 (0.72–0.95)
Obesity	2.47 (2.01–3.02)	1.98 (1.61–2.45)
Chronic hypertension	2.19 (1.71–2.82)	1.71 (1.32–2.22)
Diabetes (pre-existing or gestational)	1.20 (0.98–1.47)	1.04 (0.85–1.29)
Drug abuse	6.33 (3.69–10.83)	4.13 (2.37–7.21)
Tobacco use disorder	2.92 (2.20–3.88)	2.12 (1.58–2.85)
Multiple gestation	1.13 (0.78–1.62)	0.86 (0.59–1.25)
Hypertensive disorder of pregnancy	1.47 (1.21–1.77)	1.25 (1.03–1.51)
Mode of delivery
Vaginal	Reference	Reference
Cesarean without labor	1.30 (1.13–1.49)	1.19 (1.03–1.38)
Cesarean with labor	1.37 (1.18–1.60)	1.30 (1.11–1.53)
Preterm delivery	1.78 (1.46–2.16)	1.62 (1.33–1.99)
Stillbirth	3.18 (1.90–5.33)	2.93 (1.74–4.92)

Data availability statement

Study data available upon reasonable request.