(706) Insomnia in pregnancy: are hospitalized inpatients sleeping less than outpatients?

Objective: Optimizing physical and mental health during antepartum hospitalization is critical, and understanding sleep quality is a key component of this. Since little is known about how antepartum hospitalization affects sleep, we compared sleep between pregnant inpatients and outpatients.

Study Design: This was a prospective cohort between 2021-2022 including pregnant people aged 18-55 years with singleton gestations
>16 weeks. Outpatients from obstetrics clinics were gestational age matched to antepartum inpatients. Participants responded to the Insomnia Severity Index (ISI) and wore Actigraph accelerometer watches up to 7 days to evaluate sleep. The primary outcome was mean total sleep duration per 24 hours. Secondary outcomes were sleep efficiency (time asleep/time in bed as a percentage), ISI score, clinical insomnia based on ISI score >15, short sleep duration (< 300 minutes per 24 hours), Wakefulness After Sleep Onset (WASO), number of awakenings, and sleep fragmentation index. Sleep parameters were compared using Wilcoxon rank sum tests and multivariable generalized estimating equations adjusting for body-mass index and use of sleep aid medication.

Results: Data from 59 participants were analyzed. Inpatients were more likely to use sleep aids (39.9% versus 12.5%, p=0.03). Inpatients had significantly lower total sleep duration than outpatients (264.1 ± 97.5 minutes versus 309.4 ± 87.3 minutes, beta -62.8 [95% Confidence Interval -109.2 to -16.4], p=0.008). There were no differences in sleep efficiency, ISI score, clinical insomnia, or short sleep duration (Table 1). Number of awakenings and WASO were reduced among inpatients (p=0.01 and p=0.03, Figure 1).

Conclusion: Hospitalized pregnant inpatients slept 1 hour less than outpatients per day despite increased use of sleep aids, which is enough to have a clinically significant effect on health. Notably, average sleep time for inpatients was < 5 hours per day - well below the recommended 7 hours in pregnancy. Initiatives to improve sleep during pregnancy are warranted, particularly for antepartum inpatients.