Background
Methods
Search terms and search strategies
Search outcome
Quality appraisal
Data abstraction
Author, Country | Purpose | Study design | Sample | Key findings |
---|---|---|---|---|
Lee & Kimble (2009), USA | Explore relationships between impaired sleep and wellbeing in mothers with low birth weight infants (LBW) in the NICU. | Cross sectional | 20 mothers of preterm LBW infants in the NICU | Poor sleep quality and disturbed daytime function, night-time TST was ≤7 h. The mothers took more time to fall asleep compared to normal adults. Daytime sleep was < 1 h. Mothers reported moderate depressive symptoms. HRQoL was 1 SD below the normative score for age-matched females in the US. Mothers with more sleep debt reported more fatigue severity, depression and poorer HRQoL. |
Lee & Hsu (2012a), USA | Examine the relationship among sleep, stress, depression, fatigue and H- QoL among mothers with a LBW infant in the NICU early postpartum. | Cross sectional | 55 mothers of preterm LBW infants in the NICU | Poor sleep quality in mothers was associated with stress, fatigue, depression and poor HRQoL. Maternal stress contributed to poor sleep quality and depression, which in turn contributed to poor HRQoL. |
Lee et al. (2012b), USA | Describe daytime activity levels and their associations with sleep, fatigue, depressive symptoms and quality of life. | Cross sectional | 51 mothers of preterm infants in the NICU | Compared to high activity mothers, mothers with low activity levels slept less at night-time and napped more during the daytime, and they reported more postpartum depressive symptoms. Higher daytime activity was associated with fewer depressive symptoms. More sleep was associated with less severe fatigue. |
Lee & Hsu (2016), USA | Examine whether depressive symptoms and sleep disturbance in black mothers would vary as a function of the 5-HTTLPR when they faced the stress of infant hospitalization after preterm birth early postpartum. | Cross sectional | 30 mothers of preterm LBW infants in the NICU | Mothers with the L/L allele reported greater sleep disturbances than those with the S/L allele. Mothers’ perceived global stress, depressive symptoms, and circadian activity rhythms did not vary with their 5- HTTLPR genotype. |
Shelton et al. (2014), USA | Compare the levels of self-reported perceived global and situational stress, sleep disturbance and the level of wellness between mothers with an infant in the NICU who are categorized as having high or low depressive symptoms. | Cross sectional | 55 mothers of preterm infants in the NICU | All the mothers in this study experienced poor sleep. Mothers reported a moderate level of morning fatigue, and their HRQoL for physical and mental components were below the norm. Mothers with higher depressive symptoms reported greater stress and experienced poorer sleep. |
Schaffer (2012), USA | Describe maternal and infant factors that influence sleep quality; examine the relationships between depression, anxiety, stress, social support and sleep quality, and describe the influence of a RGI intervention on sleep quality among a sample of mothers whose preterm babies were admitted to the NICU. | Prospective descriptive data analysis. Clinical trial. | 20 mothers of preterm infants in the NICU | Anxiety, depression, stress and lower income were related to poor sleep quality; social support and increased age were related to better sleep quality. With cumulative R-GI use, sleep quality improved. The participants reported that the intervention of R-GI assisted them in falling asleep and in reducing stress. |
Lee et al. (2013), USA | Examine the effectiveness of a 3-week bright light therapy RCT intervention on sleep and health outcomes of mothers with LBW infants in the NICU. | Clinical trial | 30 mothers of preterm LBW in the NICU | Mothers in the treatment group improved in nocturnal TST, CAR, morning fatigue, depressive symptoms, and HRQoL compared to the control group. The 3-week bright light intervention combined with sleep hygiene materials appeared promising for maternal sleep early postpartum. |
Williams & Williams (1997), USA | To assess simultaneous interactions among variables in a path diagram. The variables assessed were caregiver fatigue, sleep effectiveness, perception of stress, reframing capacity within the family, family cohesion, family income, and the placement of a preterm on an apnea monitor. | Cohort | 74 mothers of preterm infants in the NICU and at home | Path diagrams increased in complexity over time. At all measure points, sleep effectiveness tended to decrease fatigue. When sleep effectiveness increased, the levels of fatigue decreased. |
Gennaro & Fehder (2000), USA | Examine the difference in health behaviours among mothers of preterm, VLBW infants and mothers of healthy term infants. | Cohort | 64 mothers of VLBW preterm infants and 60 mothers of full-term infants in the NICU and at home | No differences were noted in sleep between mothers of preterm infants and term infants. The amount of sleep per night did not change significantly over time; the mothers were successful in managing sleep. |
McMillen et al. (1993), Australia | Compare the effects of the demands of term and preterm infants on the daily rhythms of sleep and wakefulness and salivary melatonin and cortisol concentrations in mothers. | Cohort | 23 mothers of term infants and 22 mothers of preterm infants at home. | Mothers of preterm infants slept less, were more awake, had less time asleep and fewer sleep bouts per 24 h compared to the mothers of full-term infants. Cortisol and melatonin salivary tests varied between the groups, maybe because of greater physiological disruption in mothers of preterm infants. |
Wollenhaupt (2010), USA | Explore the experience of mothers and fathers as they integrate their premature infant into the family at home. | Naturalistic inquiry | Parents of 10 preterm infants at home | After coming home with the baby, most of the parents described their sleeping experiences like soldiers in combat. Parents had a heightened awareness of sounds in the night, stood guard over and wakened to check on the baby. The best nights of sleep consisted of 3–5 h of interrupted sleep. Fathers described their inability to catch up on sleep; they went to work early or awakened to take care of the baby, so the mother could sleep; and they had less opportunity to take naps during the daytime compared to mothers. |
Author Year Country | Design | Sample | Context | Time data collection | Instruments used to study sleep | Instruments used to study health |
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Lee & Kimble (2009), USA | Quantitative, cross sectional | 20 mothers of LBW infants | NICU | Second week postpartum | Self-report: Sleep rated for the past week (GSDS), sleep diary (2 days) Objective: actigraphy for 2 days. | Fatigue: NRS-F Depression: EPDS Health related quality of life: SF36v2 |
Lee & Hsu (2012a), USA | Quantitative, cross sectional | 55 mothers of LBW infants | NICU | Second week postpartum | Self-report: Sleep rated for the past week (GSDS), SDI, sleep diary. Objective: Actigraphy 2 days (N = 20) and 3 days (N = 35) | Fatigue: LFS Depression: EPDS Stress: PSS and IES Health related quality of life: SF36v2 |
Lee et al. (2012b), USA | Quantitative, cross sectional, comparative | 51 mothers of preterm infants | NICU | Second week postpartum | Self-report: Sleep rated for the past week (GSDS), sleep diary. Objective: Actigraphy 2–3 days | Fatigue: LFS Depression: EPDS Health related quality of life: SF36v2 Activity: actigraphy to measure rest/activity pattern |
Lee & Hsu (2016), USA | Quantitative, cross sectional, comparative | 30 mothers of LBW infants | NICU | Second week postpartum | Subjective: Sleep rated for the past week (GSDS), sleep diary. Objective: Actigraphy 3 days | Depression: EPDS Stress: PSS Serum: Test serotonin transporter polymorphism (5 HTTLPR) genotype. |
Shelton et al. (2014), USA | Quantitative, cross sectional comparative design | 55 mothers of preterm infants | NICU | Second week postpartum | Self-report: Sleep rated for the past week (GSDS), sleep diary (2–3 days). Objective: Actigraphy 2–3 days | Fatigue: LFS Depression: EPDS Stress: PSS Health related quality of life: SF36v2 |
Schaffer (2012), USA | Quantitative Prospective descriptive data analysis Clinical trial | 20 mothers of preterm infants | NICU | Repeated measures over eight weeks postpartum | Self-report: PSQI | Anxiety: STAI Depression: CES-D Stress: PSS Social support: FSSQ + A brief semi structured interview on the acceptability of the R-GI intervention. |
Lee et al. (2013), USA | Quantitative, clinical trial | 30 mothers of LBW infants randomized to a treatment or control group. | NICU | Data collected at pretreatment (second week postpartum) and after 3-week intervention. | Self-report: Sleep rated for the past week (GSDS), sleep diary for 3 days Objective: Actigraphy 3 days | Fatigue: LFS Depression: EPDS Stress: PSS Health related quality of life: SF36v2 Maternal perceived support: FSS |
Williams & Williams (1997), USA | Quantitative, cohort, comparative | 74 mothers of preterm infants | NICU and home T1/Baseline = NICU T2 = one-week post-discharge T3 = one-month post-discharge. | Data were collected at three-time periods; baseline, one-week post discharge and one-month post discharge | Self-report: Subscale of the VHS Sleep Scale. | Stress: PSS Fatigue: MAF, Reframe: FCOPES, Cohesion: FACES II |
Gennaro & Fehder (2000), USA | Quantitative, longitudinal, comparative | 124 mothers, 64 with a VLBW preterm infant and 60 with a full-term infant | NICU and home | Data collected within 24 h after birth, + home (1 month, 2 months, and 4 months postpartum) | Self-report: SWAI and SSS. | Maternal weight loss, Nutritional intake: 24-h diet recall, Exercise: FWPA |
McMillen et al. (1993), Australia | Quantitative, cohort, comparative | Mothers of 23 term infants and 22 preterm infants | Home | Up to 5 months after either birth (term group) or arrival of the infant home (preterm group). | Self-report: 24-h sleep/wake chart for infant and mother (completed by mother). | Saliva: Melatonin and cortisol tests. |
Wollenhaupt (2010), USA | Qualitative, Natural inqury design | Mothers and fathers in 10 families. | Home | 3–5 weeks following discharge from NICU | Semi-structured interviews |
Synthesis
Author, year of publication, country of origin | N= | Sleep | Mental health | Wellbeing | Social health | |||||
---|---|---|---|---|---|---|---|---|---|---|
Fatigue | Anxiety | Stress | Depression | HRQOL | Social support | |||||
Morning | Evening | Mental | Physical | |||||||
Lee & Kimble (2009), USA | 20 | GSDS | .52* | .51* | – | – | ns | −.53* | ns | |
Sleep quality | ns | .54* | – | – | ns | −.55* | ns | |||
Daytime function | .55* | .52* | – | – | ns | −.48* | −.45* | |||
TST | ns | – | – | ns | ns | ns | ||||
WASO | – | – | ns | ns | ||||||
Sleep debt | .48* | ns | – | – | ns | ns | ns | |||
Lee et al. (2012b), USA | 51 | CAR | ns | – | – | ns | ns | ns | ||
TST | −.30* | – | – | – | ns | ns | ns | |||
WASO | ns | – | – | ns | ns | ns | ||||
Sleep quality | .38** | – | – | – | ns | −.49* | −.38* | |||
Lee & Hsu (2012a), USA | 55 | Sleep quality index | .54** | – | .36** | ns | −.49* | −.34* | ||
TST | ns | – | – | – | ns | ns | ||||
WASO | ns | – | – | – | ns | ns | ||||
SDI | ns | – | – | – | ns | ns | ||||
Schaffer (2012), USA | 20 | Sleep quality | – | .514*‡ | ns | .496*† | – | −.462* † | ||
Gennaro & Fehder (2000), USA | 23 | SWAI | ns | |||||||
SSS |