Poor sleep quality and associated factors among pregnant women on antenatal care follow up at Nekemte Referral Hospital and Wollega University Hospital, Nekemte, Ethiopia, 2019: a cross-sectional study
Sleep Science and Practice volume 6, Article number: 7 (2022)
Sleep disturbances are common in women, especially during pregnancy. This can result in emotional and psychological consequences for pregnant women, and it could lead to some serious complications for both mothers and their babies. However, it is not well recognized and has not been studied in developing countries, including Ethiopia.
To assess the quality of sleep and associated factors among pregnant women on antenatal care follow-up at Nekemte Referral Hospital and Wollega University Hospital, Nekemte, Ethiopia 2019.
An institution-based cross-sectional study was conducted from May to June 2019 at Nekemte Referral Hospital and Wollega University Hospital. A systematic random sampling technique was used to get 408 samples. Sleep quality was assessed using structured questionnaires of the Pittsburgh Sleep Quality Index tool. Then, the collected data was coded and entered into Epi-Data 3.1 version and analyzed using SPSS version 20. A logistic regression analysis was computed to determine the association between independent variables and sleep quality. Statistically significant was considered at P-value < 0.05.
With 96.4% response rate, the magnitude of poor sleep quality was found to be 59.1% [95% CI: (54.2, 64)]. Poor sleep quality was high among participants with unplanned pregnancy [AOR = 4.25,95%CI:(1.47,12.23)],poor sleep hygiene[AOR = 2.93,95%CI:(1.41,6.09)],depressed women[AOR = 5.73,95%CI:(2.49,13.21)], anxiety disorder[AOR = 6.62,95%CI:(2.61,16.82)] and third trimester participants [AOR = 5.84,95% CI:(2.49,13.21)].
This study demonstrated that poor sleep quality among pregnant women is high. Factors like depression, anxiety, poor sleep hygiene, first time pregnancy, unplanned pregnancy, and late gestational age were found to be associated with poor sleep quality. This underlines health care planners’ needs to incorporate screening for poor sleep quality into routine ANC services.
Sleep is a systematic and organized behavior that is routinely repeated based on biological rhythms and significantly contributes to the reactivation of mental and physiological power and is required for accepting new tasks and roles (Abiola et al. 2013).The requirement for sleep varies between individuals depending on age, gender, diet, physical activity, health status, and other personal factors (Brown et al. 2002). Poor sleep quality is characterized by an inability to fall asleep within 30 min, wake up more than once during the night, or when it takes more than 20 min to drift back asleep after waking up from sleep (Buysse et al. 1989). Currently, about 17% of the populations in developing countries and 20% of the population in developed countries are suffering from sleep problems (Chang et al. 2010).
Pregnancy is a process that creates significant anatomical, physiological, and biochemical changes in a woman’s life (Chung et al. 2014). In this period, pregnant women need adequate sleep for the normal growth and development of the fetus. Adequate sleep during pregnancy gives them the energy that they need for their labor and delivery process (Da Costa et al. 2010). However, sleep disturbances and sleep disorders are common during this period (Ejeta et al. 2015; Huong 2019; Huong and Thuy 2018).
According to the National Sleep Foundation Women and Sleep poll, 79% of pregnant women suffer from sleep disorders (JAHDI et al. 2013). Sleep disturbances have been observed right from the first trimester of pregnancy until the end of the third trimester. However, the percentage of sleep disorders and sleep disturbances is higher in the third trimester of pregnancy (Kloss et al. 2015; Ko et al. 2010). Empirical research indicates that up to 25% of pregnant women report significant sleep disturbance in the first trimester, with rates climbing to nearly 75% by the third trimester (LeBourgeois et al. 2005).
Many studies state that pregnant women’s sleep quality may be faced with some challenges due to the systematic change caused by hormonal, psychological, and physical factors that happen during pregnancy (Lee et al. 2000).Physiological changes such as increased progesterone and prolactin levels, increase in body size, fetal movement, and bladder distention can potentially explain some of the disturbances to a pregnant woman’s sleep (Lee and Baratte-Beebe 2001).
Multiple psychological factors, including depression, anxiety, and stress, can pose troubles to sleep cycles, leading to sleep disorders, because the relationship between each of these factors and sleep quality has been confirmed in some studies (Medicine 2005). Depression during pregnancy affects the ability of self-care, the quality of diet and sleep, and ignorance of medical advice (Buysse et al. 1989). On the other hand, someone with anxiety and worries would be obsessed with recurring thoughts concerning negative events that there is the possibility of their happening, which is shared by pregnant women concerning their children’s future and it affects their sleep quality (O’Brien 2012). In particular, sleep hygiene practices have a great effect on sleep quality according to some research studies (Reshadat et al. 2018; Reutrakul et al. 2011).
Any changes in pregnant women’s quality of sleep may influence their attitudes towards experiencing labor pains and acceptance of the maternal role (O’Brien 2012). Poor sleep quality is associated with adverse pregnancy outcomes both in mother and fetus, such as low birth weight, preterm baby delivery, intra uterine growth retardation, low APGAR score, and still birth in the fetus and newborn (Rezaei et al. 2014).There are also increased maternal complications during pregnancy like preeclampsia, gestational diabetes, as well as increased complications during delivery like prolonged labor and caesarean section deliveries (Rezaei et al. 2014).
Prenatal care services are designed to enable pregnant women to undergo pregnancy with the minimum possible complications. Thus, regarding the necessity of examination of the quantity and quality of sleep, it is important to identify and follow-up the problems in this period (Buysse et al. 1989).
Although some studies have assessed sleep quality during pregnancy and its effects, most of these studies were carried out only in the western population, and no study has been done in Ethiopia. The aim of the current study was to assess the quality of sleep and associated factors among pregnant women in Nekemte Referral Hospital and Wollega University Hospital with a view to informing the development of appropriate intervention.
An institution-based cross-sectional study was conducted from May to June 2019. The study was conducted at Nekemte referral hospital and Wollega University hospital, which are located in Nekemte town, East Wollega zone. It isabout 331 km to the West of Addis Ababa, the capital city of Ethiopia. On average, about 1015 pregnant women visit ANC follow-up each month at Nekemte Referral Hospital and 525 pregnant women each month at Wollega University Hospital. Totally about 1,540 pregnant women visit ANC follow-up in both hospitals monthly (Sahota et al. 2003).
All pregnant women who were on ANC follow-up at Nekemte Referral Hospital &Wollega University Hospital were considered as source population. Pregnant women who were available during the data collection period were the study population. All pregnant women who were on ANC follow-up and older than 18 years were included. Participants who were critically ill and those who had verbal communication problems were excluded from this study.
The required number of samples for this study was determined by using a single population proportion formula considering the following assumptions: standard normal distribution with a confidence interval of 95% (Z = 1.96), absolute precision or tolerable margin of error (d = 0.05), and since the proportion of sleep disorders for pregnant women is unknown in Ethiopia (P = 50%). Thus, by adding 10% nonresponse rates, the final calculated sample size was 423.
A systematic random sampling technique was employed to select study participants. The sampling interval was determined by dividing the total number of pregnant women who were on follow-up during a month of data collection in both hospitals by the sample size from each hospital after proportional allocation. For analysis, data were entered into EPI-DATA version 3.1.5 and exported to SPSS version 20. Bivariate analysis was performed to determine the effect of each factor on the outcome variable. Only factors with a p-value < 0.25 on bivariate analyses were kept for multivariate logistic regression, and p-value < 0.05 on multivariate analyses was considered as statistically significant.
Sleep quality was assessed by using the Pittsburgh Sleep Quality Index (PSQI), which is a widely used instrument for assessing sleep quality. It is a self-reported instrument comprised of 19 items evaluating seven components of sleep over the past month, such as: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, daytime dysfunction, and use of sleep medications. Each component is scored ranging from 0 to 3, and a total global PSQI is derived by summing the seven component ranges: 0 to 21; with higher scores (PSQI score > 5) indicating poor sleep quality. It has a diagnostic sensitivity of 89% and a specificity of 86.5 in distinguishing "good" from "poor" sleepers (Brown et al. 2002).
Depression, anxiety, and stress were measured using Lovibond’s short version of the DASS-21. DASS-21 is a psychological screening instrument that is capable of differentiating symptoms of depression, anxiety, and stress. Each domain comprises seven items assessing symptoms of depression, anxiety, and stress. Each of the questions had four options: never (0), low (1), average (2), and high (3). Scores from each dimension were summed up, and the final score was multiplied by 2. Accordingly, for DASS-21 D; score > 9 categorized as depressed, for DASS-21A; score > 7 categorized as anxious, and for DASS-21S; score > 14 categorized as stressed. This questionnaire was studied in Iran, and the test–retest reliabilities for depression, anxiety, and stress were 0.80, 0.76, and 0.77, and the alphas were 0.81, 0.74, and 0.78, respectively (Buysse et al. 1989).
Sleep hygiene was assessed by using the sleep hygiene index (SHI), which is a 13-item self-reported measure designed to assess the practice of sleep hygiene behaviors. Each item is rated on a five-point scale ranging from 0 (never) to 4 (always). Total scores range from 0 to 52, with a higher score (> 16) representing poor sleep hygiene (Chang et al. 2010). Social support was measured using the Oslo 3 item social support scale (OSS-3), which is a poor social support-a score of "3–8", an intermediate social support-a score of "9–11", and strong social support-a score of "12–14" (Chung et al. 2014).
The questionnaire was initially prepared in English, translated to the local languages of Afaan Oromo, and Amharic, and retranslated to English by another person who was blind to the original questionnaire for consistency checks.
Poor sleep quality is explained by a cut-off point of greater than 5 by using the PSQI Screening tool (Sedov et al. 2018).
Good sleep quality is explained by a cut-off point of less than or equal to 5 by using the PSQI Screening tool (Sedov et al. 2018).
Ethical approval was obtained from the joint ethical review committee of the University of Gondar and Amanuel Mental Specialized Hospital. The data collectors were clearly explained the aims of the study to the study participants. Data was collected after obtaining verbal or written consent from each participant. The right was given to the study participants to refuse or discontinue participation at any time they wanted, and they had the chance to ask anything about the study. For anonymity, the participant’s name was not used at the time of data collection, and all other personnel information was kept entirely anonymously and confidentiality was assured throughout the study period.
A total of 408 participants were included in the study, with a response rate of 96.4%.
Sociodemographic Characteristics of Respondents
The majority of respondents were between (Shariat et al. 2017; Shariat et al. 2017; Stranges et al. 2012; Sun et al. 2017; Taskiran 2011; Venugopal et al. 2018) age groups and 390 (95.6%) were married. The educational status indicated that 139 (34.1%) and 129 (31.6%) of the participants attended primary and secondary school, respectively. According to the World Bank classification of poverty line scale, 154 (37.7%) of the participants earn an average monthly income < 1627 ETB (see Table 1).
Obstetric characteristics of respondents
Obstetric characteristics of the participants indicate that 196 (48%) were in their second trimesteand 162(39.7%) were on their first visit. Moreover, 237(58.1%) of participants were multigravida and 227(55.6%) were multiparous (see Table 2).
Psychosocial characteristics of participants
Among the study participants, 160(39.2%) had poor social support, 125(30.6%) were depressed, and 136(33.3%) had stress. Additionally, 129(29.7%) had anxiety, and 371 (90.9%) had planned pregnancies (see Table 3).
The correlation between variables was indicated as follows: depression and anxiety, depression and stress, anxiety and stress had (0.826, 0.590, and 0.634) correlations, respectively. Social support was negatively correlated with other variables, such that social support and depression had a -0.301 correlation, social support and anxiety had a -0.287 correlation, and social support and stress had a -0.357 correlation.
Pregnancy intention and social support had -0.009 correlation, pregnancy intention and depression had a 0.031 correlation, pregnancy intention and anxiety had a 0.190 correlation, Pregnancy intention and stress had a 0.066 correlation. And, sleep hygiene and depression, sleep hygiene and anxiety, and sleep hygiene and stress had (0.608, 0.675, and 0.521) correlations, respectively.
Participants' characteristics by clinical and behavioral factors
Among the total participants, 193 (47.3%) complained of back pain, 15 (3.7%) had chronic illness, 137 (33.6%) had poor sleep hygiene, and 17 (4.2%) consumed alcohol within three months of the data collection period.
The magnitudes of poor sleep quality
In the current study, the magnitude of poor sleep quality among pregnant women was 241 (59.1%) according to the global PSQI > 5. Seven components of sleep quality in the present study were assessed and identified as their sleep status. Only 16 (3.9%) of the participants reported that their subjective sleep quality was very bad, and 6 (1.5%) had a problem with a sleep latency of more than an hour. About 256 (61.8%) reported that they had less than 7 h of sleep per night, and 148 (36.3%) had low habitual sleep efficiency (65%). Moreover, 70 (19.1%) had sleep disturbance once or twice per week, 22 (5.4%) used sleep medication, and 106 (26%) of the participants reported daytime dysfunction once or twice per week within the past one month at the time of interview (see Table 4).
The percentage of poor and good sleep quality was done for the three trimesters among pregnant women and it was indicated in the following figure (see Fig. 1).
Factors associated with poor sleep quality among pregnant women
Bivariate logistic regression analysis was done for each of the independent variables and the outcome variable. Variables like socio-demographic variables (age and occupation), obstetric variables (gestational age and gravida), behavioral and psychosocial factors (sleep hygiene, pregnancy intention, depression, anxiety, stress, and social support) fulfilled the minimum requirement (p < 0.25) for multivariate logistic regration analysis.
In multivariate analysis, factors like depressive symptoms, poor sleep hygiene, first-time pregnancy, anxiety symptoms, unplanned pregnancy, and late gestational age were significantly associated with poor sleep quality (See Table 5).
The magnitude of poor sleep quality in this study was 59.1% (95%CI: 54.2, 64). This finding showed a similar prevalence to the results of other studies conducted among pregnant women in Turkey (61%) (Abiola et al. 2013) and in Chicago (64%) (Brown et al. 2002). However, the result of the present study was higher than studies conducted in China (15.2%) (Buysse et al. 1989), India (24.4%) (Chang et al. 2010), Vietnam (41.2%) (Chung et al. 2014) and Canada (45.7%) (Da Costa et al. 2010) and it is lower than studies conducted in Iran (88.5%, 87.2%, 75.26%) (Ejeta et al. 2015; Huong 2019; Huong and Thuy 2018)and Turkey 86% (JAHDI et al. 2013). The possible reason might be the difference in characteristics of the study population, such that only healthy individuals were involved from Vietnam and India, and only third-trimester pregnant women participated from Iran (Ejeta et al. 2015). Another possible reason for this difference might be variation in sample size, socio-cultural, and study settings.
This study shows a significant association of gestational age; first pregnancy, unplanned pregnancy, depression, anxiety, and poor sleep hygiene with poor sleep quality. In the present study, a significant association between gestational age and sleep quality was discovered. The odds of developing poor sleep quality were 5.84 times higher for the thirdtrimester and more than two times higher for the second trimester than for the first trimester [AOR = 5.84, 95%CI: (2.49, 13.21)] and [AOR = 2.07, 95%CI: (1.41,6.09)] respectively. This finding is supported by studies done in Turkey (Abiola et al. 2013) and China (Kloss et al. 2015). The possible reasons could be hormonal changes like increased secretion of estrogen and progesterone hormones and physiological changes such as increased tender breasts. The other reason could be a problem with respiration and the gastrointestinal system as a result of the pressure from the growing fetus on the thorax and abdomen as gestation advances (Kloss et al. 2015).
The likelihood of developing poor sleep quality among primigravida was two times higher than that of multigravida [AOR = 2.01, 95%CI:(1.07, 3.74)]. This result is supported by a study conducted in the USA (Ko et al. 2010). The possible justification for this association could be the fact that stress and work are involved with the challenges of maternal role acquisition that primigravida face with their first pregnancy and birth of the child.
In the current study, women with unplanned pregnancies were 4.25 times more likely to experience poor sleep quality compared with their counterparts [AOR = 4.25, 95%CI:(1.47, 12.23)]. Even though there is no relevant literature regarding this, it might be explained as inadequate preparation for pregnancy, childbirth, and nursing leading mothers to feel less or no ability to cope with all the changes and challenges that the birth of a baby brings to them.
In the present study, the prevalence of poor sleep quality among depressed pregnant women was 5.73 times higher compared to non-depressed pregnant women [AOR = 5.73, 95%CI:(2.49, 13.21)]. This result is supported by research conducted in China (Kloss et al. 2015)and Iran (LeBourgeois et al. 2005). The possible reason for this consistency could be the relationship between depression and sleep quality in pregnant women, showing that mood or emotional disturbances in depressed patients affect the quantity and quality of sleep, as depression is one of the main psychological factors leading to sleep disturbance (Kloss et al. 2015).
In the current study, the prevalence of poor sleep quality among participants with anxiety was 6.62 times higher compared to those who had no anxiety [AOR = 6.62, 95%CI: (2.61, 16.82)]. This result is supported by a study conducted in Iran (LeBourgeois et al. 2005). The possible reason might be due to emotional and physiological arousal caused by anxiety and worries, which would result in more attention to environmental and personal stimuli and lead to sleep disturbance.
The odds of having poor sleep quality among participants with poor sleep hygiene was nearly three times higher compared to those with good sleep hygiene [AOR = 2.93, 95%CI: (1.41, 6.09)]. This finding is in agreement with a study done in Vietnam (Chung et al. 2014). The possible justification for this might be drinking coffee in the evening, which affects melatonin hormone production that regulates sleep rhythms. Other reasons might be improper sleep hygiene behaviors like performing dynamic physical activity, flexible bedtime, going to bed without sleep sensation, and highly demanding activities before bedtime (like watching exciting movies) that disturb sleep patterns and lead to poor sleep quality (Lee et al. 2000).
In our study evaluating sleep quality and related factors in pregnant women, we found that sleep quality is poor for the majority of pregnant women and it is adversely affected by depression, anxiety, poor sleep hygiene, first-time pregnancy, unplanned pregnancy, and late gestational age.
The present study shows that the prevalence of poor sleep quality among pregnant women was high. Factors like depression, anxiety, poor sleep hygiene, first time pregnancy, unplanned pregnancy, and late gestational age were found to be associated with poor sleep quality.It is better to give attention to routine screening of sleep patterns in pregnant women and to give special concern for pregnant women with the above-stated factors.
The strength of the study
The strong points of this study were the sampling method and the use of valid and reliable instruments that have been applied in various studies. And the other strength of this study was using face-to-face interview techniques, which helped to address those mothers who were unable to read and write.
Because it is a cross-sectional study design, it did’t allow establishing a cause-effect relationship between sleep quality and potential risk factors, so it is recommended that future studies be performed in longitudinal format. It was a subjective assessment of sleep quality and not an objective assessment, so some information required participants to recall, which could lead to recall bias. Another limitation of the present study was that birth outcome was not assessed, which enables a better understanding of the effect of poor sleep quality on pregnancy.
Availability of data and materials
All data used to support the findings of this study are included within the manuscript and supporting information.
Amanuel Mental Specialized Hospital
Antenatal Care Follow Up
Depression, Anxiety and Stress Scale
Nekemte Referral Hospital
Oslo social support
Pittsburgh Sleep Quality Index
Sleep Hygiene Index
Statistical Package for Social Sciences
World Health Organization
Wollega University Hospital
Abiola T, Udofia O, Zakari M. Psychometric properties of the 3-item oslo social support scale among clinical students of Bayero University, Kano. Nigeria Malaysian Journal of Psychiatry. 2013;22(2):32–41.
Brown FC, Buboltz WC Jr, Soper B. Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students. Behav Med. 2002;28(1):33–8.
Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.
Chang JJ, Pien GW, Duntley SP, Macones GA. Sleep deprivation during pregnancy and maternal and fetal outcomes: is there a relationship? Sleep Med Rev. 2010;14(2):107–14.
Chung M-Y, Hwang K-H, Cho O-H. Relationship between fatigue, sleep disturbance, and gestational stress among pregnant women in the late stages. Korean J Women Health Nurs. 2014;20(3):195–203.
Da Costa D, Dritsa M, Verreault N, Balaa C, Kudzman J, Khalifé S. Sleep problems and depressed mood negatively impact health-related quality of life during pregnancy. Arch Womens Ment Health. 2010;13(3):249–57.
Ejeta E, Tadele G, Desalegn M, Abere S, Elias K. Health care providers satisfaction with the clinical laboratory service of Nekemte Referral Hospital, Western Ethiopia. International Journal of Medicine and Medical Sciences. 2015;7(5):91–7.
Huong NTT, Thuy NTH, Yen LTH. Quality of Sleep among Pregnant Women. International Journal of Clinical Medicine. 2019;Vol.10No.01:10.
Huong NTT, Thuy NTH. Quality of Sleep among Pregnant Women. International Journal of Clinical Medicine. 2018;10(1):16–25.
JAHDI F, REZAEI E, BEHBOODI MZ, HAGANI H. Prevalence of sleep disorders in pregnant women. 2013.
Kloss JD, Perlis ML, Zamzow JA, Culnan EJ, Gracia CR. Sleep, sleep disturbance, and fertility in women. Sleep Med Rev. 2015;22:78–87.
Ko SH, Chang SC, Chen CH. A comparative study of sleep quality between pregnant and nonpregnant Taiwanese women. J Nurs Scholarsh. 2010;42(1):23–30.
LeBourgeois MK, Giannotti F, Cortesi F, Wolfson AR, Harsh J. The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents. Pediatrics. 2005;115(Supplement 1):257–65.
Lee KA, Zaffke ME, McEnany G. Parity and sleep patterns during and after pregnancy. Obstet Gynecol. 2000;95(1):14–8.
Lee K, Baratte-Beebe K. Restless leg syndrome and sleep disturbance during pregnancy: The role of folate and iron. J Women’s Health Gender-based Medicine. 2001;10(4):335–41.
Medicine AAoS. International Classification of SleepDisorders. Diagnostic and coding manual. 2005:51–5.
O’Brien LM. Sleep disruption and adverse pregnancy outcomes. BMC Pregnancy Childbirth. 2012;12(1):A11.
Reshadat S, Zakiei A, Karami J, Ahmadi E. A study of psychological and family factors associated with sleep quality among pregnant women. Sleep and Hypnosis. 2018;20(1):17–24.
Reutrakul S, Zaidi N, Wroblewski K, Kay HH, Ismail M, Ehrmann DA, et al. Sleep disturbances and their relationship to glucose tolerance in pregnancy. Diabetes Care. 2011;34(11):2454–7.
Rezaei E, Moghadam ZB, Nejat S, Dehghannayeri N. The impact of sleep healthy behavior education on the quality of life in pregnant women with sleep disorders: A randomized control trial in the year 2012. Iranian Journal of Nursing and MidwiferyResearch. 2014;19(5):508.
Sahota PK, Jain SS, Dhand R. Sleep disorders in pregnancy. Current Opinions in Pulmonary Medicine. 2003;9(6):477–83.
Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM. Sleep quality during pregnancy: A meta-analysis. Sleep Med Rev. 2018;38:168–76.
Seyedahmadinejad F, Golmakani N, Asgharipour N, Shakeri M. Investigation of sleep quality during the third trimester of pregnancy and some related factors in primigravida women referred to health care centers in Mashhad-2014. 2015.
Shariat MAN, Noorbala AA, Raznahan M. The Relationship between Sleep Quality, Depression, and Anxiety in Pregnant Women: A Cohort Study. J Sleep Sci. 2017a;2(1–2):1–2.
Shariat M, Abedinia N, Noorbala AA, Raznahan M. The relationship between sleep quality, depression, and anxiety in pregnant women: a cohort study. Journal of Sleep Sciences. 2017b;2(1–2):20–7.
Stranges S, Tigbe W, Gómez-Olivé FX, Thorogood M, Kandala N-B. Sleep problems: an emerging global epidemic? Findings from the INDEPTH WHO-SAGE study among more than 40,000 older adults from 8 countries across Africa and Asia. Sleep. 2012;35(8):1173–81.
Sun L, Zhou C, Xu L, Li S, Kong F, Chu J. Suicidal ideation, plans and attempts among medical college students in china: the effect of their parental characteristics. Psychiatry Res. 2017;247:139–43.
Taskiran N. Pregnancy and sleep quality. Journal of Turkish Society of Obstetrics and Gynecology. 2011;8(3):181–7.
Venugopal L, Rajendran P, Parghavi V. A study on assessment of sleep quality in south Indian pregnant women. International Journal of Research in Medical Sciences. 2018b;6(10):3197.
Venugopal L, Rajendran P, V P. A study on assessment of sleep quality in south Indian pregnant women. International Journal of Research in Medical Sciences. 2018a.
Venugopal L, Rajendran P, V. P. A study on assessment of sleep quality in south Indian pregnant women. 2018c. 2018c;6(10):5.
Waters MA, Lee KA. Differences between primigravidae and multigravidae mothers in sleep disturbances, fatigue, and functional status. Journal of Nurses-Midwifery. 1996;41(5):364–7.
Xu X, Liu D, Zhang Z, Sharma M, Zhao Y. Sleep duration and quality in pregnant women: A cross-sectional survey in China. International Journal of EnvironmentalResearch and PublicHealth. 2017;14(7):817.
Yang Y, Mao J, Ye Z, Zeng X, Zhao H, Liu Y, et al. Determinants of sleep quality among pregnant women in China: a cross-sectional survey. J Matern Fetal Neonatal Med. 2018;31(22):2980–5.
Yucel SC, Yucel U, Gulhan I, Ozeren M. Sleep quality and related factors in pregnant women. Journal of Medicine and Medical Sciences. 2012;3(7):459–63.
We are grateful to the study participants for giving their time and energy to respond to the interview questions. The authors acknowledge Amanuel Mental Specialized Hospital and the University of Gondar, College of Medicine and Health Sciences, for their corporation in the overall accomplishment of the research. We also thank the data collectors, supervisors, and other members of the research team for their commitment to the study.
No funding was received for this research work.
Ethics approval and consent to participate
Ethical approval was obtained from the joint ethical review committee of University of Gondar and Amanuel Mental Specialized Hospital (Ref. No. Am/146/4/115) by Dr. Kibrom Haile, Tolesa Fanta, and Habtamu Derejew. The data collectors clearly explained the aims of the study to the study participants. Data was collected after obtaining verbal or written consent from each participant. The right was given to the study participants to refuse or discontinue participation at any time they wanted, and the chance to ask anything about the study. For the purpose of anonymity, the participant’s name was not used at the time of data collection, and all other personnel information was kept entirely anonymously and confidentiality was assured throughout the study period.
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The author declares no competing interests.
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Tasisa, J.T., Bisetegn, T., Hussen, H.U. et al. Poor sleep quality and associated factors among pregnant women on antenatal care follow up at Nekemte Referral Hospital and Wollega University Hospital, Nekemte, Ethiopia, 2019: a cross-sectional study. Sleep Science Practice 6, 7 (2022). https://doi.org/10.1186/s41606-022-00076-8
- Sleep quality
- Pregnant woman