Reviewer ’s report  
 
Title:  The Effect of Sleep Pattern Changes on Postpartum Depressive Symptoms  
 
Version: 1 Date: 25 Jan 2017 
 
Reviewer:  Jennifer  Doering  
 
Reviewer’s report:  
 
Overall the paper is well written and presents on an important topic. My main critique is that the 
methodology is not especially innovative and the argument made by the authors that most of the 
literature assesses sleep within the first 6 weeks is not espe cially convincing. Perhaps this 
argument was made without realizing that in 2015 and 2016 there were quite a few publications 
of new literature that assessed sleep and depressive symptoms between 12 weeks to 6 months 
postpartum. I would argue that the conc lusions made by the authors have already been made in 
the literature (and in the literature noted below that is already published. What is listed below is 
only a few of many more that may be cited for a stronger review of literature). The findings 
certainl y continue to verify that the relationships are stable - that sleep and depressive symptoms 
are related, but the more leading edge literature is pointing towards bidirectional relationships 
and looking at subgroup analyses such as through trajectory analys es.  
 
Methodologically, I have some question about the use of regression. The authors say they 
measured both measures (sleep and depressive symptoms) at both time points, yet I didn't see a 
report of multicollinearity or how that was handled. If both measures we re highly correlated at 
both time points, wouldn't this violate statistical assumptions and one's ability to draw valid 
conclusions?  
 
Under measures were the PSQI was described, I recommend the authors cite papers that have 
used the PSQI in postpartum wome n to support its validity and use in this population (there are 
several published papers).  
 
I also would appreciate the authors acknowledging the rather high socioeconomic status of their 
sample and recommend the need for more representative samples, part icularly because there are 
health disparities in both sleep and depression in underrepresented groups.  
 
On page 12 line 19, I recommend the authors not use a brand name "ActigGraph" but instead just 
simply say "actigraphy".  
 
Finally, I would recommend th e authors note the need to address environmental and other health -
related factors that disrupt sleep as there can be many reasons besides the infant why people may 
wake at night. These are factors that should be included within any sleep intervention.  
 
Sleep, Depression, and Fatigue in Late Postpartum.  
 
Thomas KA, Spieker S.  
MCN Am J Matern Child Nurs. 2016 Mar -Apr;41(2):104 -9. doi:  
10.1097/NMC.0000000000000213.  
 
PMID:26909724  
 
Trajectories of Sleep Quality and Associations with Mood during the Perinatal Pe riod. 
 
Tomfohr LM, Buliga E, Letourneau NL, Campbell TS, Giesbrecht GF.  
 
Sleep. 2015 Aug 1;38(8):1237 -45. doi: 10.5665/sleep.4900.  
 
The relationship between sleep and postpartum mental disorders: A systematic review.  
 
Lawson A, Murphy KE, Sloan E, Uleryk E, D alfen A.  
 
J Affect Disord. 2015 May 1;176:65 -77. doi: 10.1016/j.jad.2015.01.017. Review.  
 
PMID:25702602  
 
Diurnal fatigue patterns, sleep timing, and mental health outcomes among healthy 
postpartumwomen.  
 
McBean AL, Montgomery -Downs HE.  
 
Biol Res Nurs. 2015 Jan;17(1):29 -39. doi: 10.1177/1099800414528278.  
 
PMID:25504948  
 
Longitudinal change in sleep and daytime sleepiness in postpartum women.  
 
Filtness AJ, MacKenzie J, Armstrong K.  
 
PLoS One. 2014 Jul 31;9(7):e103513. doi: 10.1371/journal.pon e.0103513.  
 
A Postpartum Sleep and Fatigue Intervention Feasibility Pilot Study.  
 
Doering JJ, Dogan S.  
 
Behav Sleep Med. 2016 Jun 16:1 -17. [Epub ahead of print]  
 
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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