Reviewer ’s report  
 
Title:  The Effect of Sleep Pattern Changes on Postpartum Depressive Symptoms  
 
Version: 0 Date: 13 Feb 2017 
 
Reviewer:  Bronwyn  Sweeney  
 
Reviewer’s report:  
 
Thank you for the opportunity to review this paper which describes a prospective, longitudinal 
study of postpartum sleep changes and their relationship to depressive symptoms. This study  is  
welcome in an area of research with few studies extending so far into the postpartum period. The 
opportunity to study the association of postpartum sleep and mood arose from another 
intervention study of telephone -based exercise intervention and postpartu m depression. The 
paper is well -written and aims and results are, for the most part, very clear. Reflections and 
suggestions follow:  
 
1. Data collection occurred at 6 weeks and 7 months postpartum. Given the sizable 
developmental changes for infants, and maternal changes and transitions in an 
approximately 6 month period, could the authors give more information about why data 
was collect ed at those two particular time points?  
 
2. Page 5, line 7: perhaps say " identify a potential causal link between CHANGES IN sleep 
and the onset..." since the study examines changes in sleep.  
 
3. Page 5, line 19: Okun's study looked at sleep etc in the firs t 17 weeks postpartum - not 
weeks of pregnancy as stated.  
 
4. Page 7, line 36: could the authors note what population the sensitivity and specificity 
figures given relate to?  
 
5. In the exercise intervention trial from which these results were drawn, women a lso 
completed the EPDS. Can the authors comment on why this data was not reported in the 
current paper? The EPDS is more commonly used to describe postpartum depression.  
 
6. Data analysis: The inclusion of the statistical package(s) used and the significanc e level 
reported should be included.  
 
7. Page 10, line 7: I think it would be important for the authors to acknowledge that 
removing  an item from analysis of the PHQ9 negates the validity/reliability figures 
reported.  
 
8. Page 11, line 41: the potential pr evention strategies given for coping with sleep changes 
are all focused on infant feeding behaviours. A deeper delve into the literature should 
reveal a few more strategies, focused on the woman's actual sleep. Sleep changes and 
interruptions do not occur solely in relation to infant feeding at this time, for instance, 
women report being uncomfortable, thinking and worrying and pain as also interrupting 
sleep. Perhaps see Swanson, et al. (2012) An Open Pilot of Cognitive -Behavioral 
Therapy for Insomnia in W omen with Postpartum Depression, DOI: 
10.1080/15402002.2012.683902, for ideas and references.  
 
9. Page 13, line 7/8 - more discussion about why the authors see intervention studies 
targetting "sleep hygiene and habits" are important would be enjoyed. I agr ee with this 
notion but would like to see more discussion from the authors perspective.  
 
Overall, I think this paper adds to our growing understanding in this important area and the 
results support the findings of others in this field.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manus cript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no completing intere sts 
 
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