Stress and health-related well-being among mothers with a low birth weight infant: The role of sleep

This U.S.A.-based study examined the quantitative and qualitative characteristics of sleep, as well as the role of sleep, in the association of stress with depression, fatigue, and health-related quality of life (H-QOL) among mothers with a low-birth-weight, preterm infant in the neonatal intensive care unit at early postpartum. Fifty-five first-time mothers kept a sleep diary and filled out a battery of questionnaires. The wrist actigraphy method was also applied to collect information on maternal sleep. We tested a path model, with sleep disturbance and depression mediating the effect of stress on health-related well-being. Results showed that the majority of the study participants were stressed, depressed, fatigued, and at risk for poor physical and mental health. Poor sleep quality as perceived by mothers was significantly associated with their stress, fatigue, and poor mental and physical H-QOL. A cascading effect was found in the path model where maternal stress contributed to poor sleep quality and depression, which in turn contributed to poor mental H-QOL. In addition, poor sleep quality was associated with fatigue, which in turn contributed to poor physical and mental H-QOL. The underlying neurobiological mechanisms through which sleep affects the stress–health relation are discussed. The implications of sleep for intervention and prevention are also addressed.

► Postpartum women with a low birth weight preterm infant hospitalized in the ICU were sleep deprived and sleep disrupted.
► Mothers’ perceived poor sleep quality, not sleep actigraphy measures, was related to poor health-related quality of life.
► Poor sleep quality served as mediator linking maternal stress to fatigue, and then to poor health-related quality of life.
► Separate from sleep quality, maternal depression also mediated the link between stress and mental health quality of life.