Research on Improving Sleep During Pregnancy

Study Overview
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Brief Summary
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The overarching goal is to utilize a randomized control design to examine acceptability, feasibility, and adherence of mindfulness-based stress reduction plus prenatal sleep supplement (MBSR+PS) compared to treatment as usual among pregnant people with poor sleep quality (n=50).

Detailed Description
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Poor sleep quality is highly prevalent during pregnancy, with important implications for maternal and infant health and well-being. Despite this, there is limited research on interventions to improve prenatal sleep, and prior research did not target the specific factors contributing to poor sleep quality in this population. Specifically, pregnant people report that physical symptoms, including discomfort and pain, disturb their sleep. In non-pregnant populations, this pain-sleep relationship is bidirectional, and maladaptive psychological responses to pain further exacerbate poor sleep. Theory and empirical evidence indicate that mindfulness-based interventions may be effective for targeting these psychological responses. The overarching goal is to utilize a randomized control design to examine acceptability, feasibility, and adherence of mindfulness-based stress reduction plus prenatal sleep supplement (MBSR+PS) compared to treatment as usual among pregnant people with poor sleep quality (n=50). Participants will be recruited to complete study questionnaires at two timepoints during pregnancy. Participants randomized to MBSR+PS will receive usual care, will be asked to attend 8 weekly group MBSR sessions (in addition to the MBSR orientation session, 1:1 interview with the instructor, and daylong retreat) and 6-8 PS sessions individually or in small groups, and will complete daily sleep and home practice diaries. Participants randomized to treatment as usual will receive usual care. The specific aims are: To determine acceptability of MBSR+PS. To determine feasibility of MBSR+PS. To determine adherence to MBSR+PS. To explore evidence of change in psychological mediators. To explore between-group differences in sleep. To explore group differences in other critical clinical outcomes (e.g. depressive symptoms, anxiety symptoms, stress). There is strong conceptual basis to predict the potential benefit of this approach for pregnant people. Targeting psychological responses to poor sleep during pregnancy may have significant public health benefits.

Official Title
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Randomized Controlled Trial of Mindfulness-based Stress Reduction Plus Prenatal Sleep Supplement Versus Usual Care: Acceptability, Feasibility, and Adherence

Conditions
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Sleep, Pregnancy Related

Intervention / Treatment
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* Behavioral: Mindfulness-Based Stress Reduction plus Prenatal Sleep supplement
* Other: Treatment as Usual


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pregnancy 12-28 weeks gestation at time of intervention start 18 years of age or older Regular access to a web-enabled computer, phone or tablet Ability to read and speak English, and to provide informed consent Poor sleep quality (PSQI > 5) Exclusion Criteria: Self-reported sleep disorder (e.g. sleep apnea, narcolepsy, parasomnia, circadian rhythm disorder) Shift-work or nighttime caregiving responsibilities Psychological, medical, or other issues that necessitate priority treatment (e.g. active suicidality, probable depression (PHQ-9 ≥ 10), psychosis, on bed rest, multiple gestation) Current regular mindfulness practice (>20 minutes/week)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mindfulness-Based Stress Reduction plus Prenatal Sleep supplement (MBSR+PS)<br>The study intervention is standard mindfulness-based stress reduction (MBSR), which will be delivered through 8 weekly 2.5-hour sessions via video conferencing to groups of 20-30 pregnant and non-pregnant people. MBSR also consists of a 2.5-hour orientation session, a 30-minute private interview with the instructor, and an all-day retreat, all conducted via video conferencing. The supplemental prenatal sleep content will be delivered through 6-8 30-minute sessions via video conferencing either individually or to small groups, and draws material from mindfulness-based therapy for insomnia, mindfulness-based childbirth and parenting program, and cognitive behavior therapy for prenatal insomnia. | Behavioral: Mindfulness-Based Stress Reduction plus Prenatal Sleep supplement<br>* MBSR+PS<br>Other: Treatment as Usual<br>* TAU<br>|
| Other: Treatment as Usual<br>The control condition was designed to reflect standard care for insomnia patients. No limits are placed on receiving non-study treatment, including medication or psychotherapy, with the exception of asking participants to refrain from participating in non-study mindfulness practice. Use of non-study treatment will be tracked. | Other: Treatment as Usual<br>* TAU<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With a Total Score Greater Than or Equal to 24 on the 8-item Client Satisfaction Questionnaire (CSQ-8) at 12 Weeks | The Client Satisfaction Questionnaire (CSQ-8) score ranges from 8 to 32, with high scores indicating greater satisfaction. The CSQ-8 score of participants randomized to MBSR+PS will be reported; participants randomized to TAU will not complete the CSQ-8 as the questions pertain to the MBSR+PS program. | Post-intervention, an average of 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Who Attend at Least One Session of MBSR and the PS Supplement From Baseline to 12 Weeks | Participants can attend 0-8 sessions of MBSR and of PS. | Baseline to post-intervention, an average of 12 weeks | 
| Number of Participants Completing Endpoint Measures at 12 Weeks | For a measure to be considered complete, at least 95% of items must be completed. | Post-intervention, an average of 12 weeks | 
| Completeness of Study Measures at Baseline and at 12 Weeks | For a measure to be considered complete, at least 95% of items must be completed. Completeness of study measures at baseline and 12 weeks are combined (averaged); the percentage of measures completed across timepoints is reported. | Baseline and post-intervention, an average of 12 weeks | 
| Percentage of MBSR and PS Sessions Attended | This measure will not be collected for participants randomized to TAU. | Baseline to post-intervention, an average of 12 weeks | 
| Frequency of Home Practices From Baseline to 12 Weeks | Participants randomized to MBSR+PS will complete daily diaries reporting their formal and informal practices. Participants randomized to TAU will not complete this measure. | Baseline to post-intervention, an average of 12 weeks | 
| Duration of Home Practices From Baseline to 12 Weeks | Participants randomized to MBSR+PS will complete daily diaries reporting their formal and informal practices. Participants assigned to TAU will not complete this measure. | Baseline to post-intervention, an average of 12 weeks | 
| Change in Self Compassion Scale - Short Form (SCS-SF) From Baseline to 12 Weeks | The Self Compassion Scale - Short Form (SCS-SF) score ranges from 1 to 5, with higher scores indicating greater self-compassion. The change in SCS-SF score from baseline to post-intervention (at 12 weeks) will be reported. | Baseline and post-intervention, an average of 12 weeks | 
| Change in Five-Facet Mindfulness Questionnaire (FFMQ) Nonjudging and Nonreactivity Factors From Baseline to 12 Weeks | We included two factors of the Five-Facet Mindfulness Questionnaire (FFMQ): the nonjudging factor (score ranges from 8 to 40) and the non-reactivity factors (score ranges from 7 to 35). Higher scores indicate greater mindfulness. The change in factor scores from baseline to post-intervention (at 12 weeks) will be reported. | Baseline and post-intervention, an average of 12 weeks | 
| Change in Coping Strategies Questionnaire - Revised (CSQ-R) From Baseline to 12 Weeks | The Coping Strategies Questionnaire - Revised (CSQ-R) score ranges from 0 to 36 on each of the 7 subscales, with higher scores indicating greater use of a coping strategy. The change in CSQ score from baseline to post-intervention (at 12 weeks) will be reported. | Baseline and post-intervention, an average of 12 weeks | 
| Change in Rumination-Reflection Questionnaire (RRQ) From Baseline to 12 Weeks | The Rumination-Reflection Questionnaire (RRQ) score ranges from 12 to 60 for each of the two factors. Greater scores indicate greater tendency to ruminate and reflect. The change in RRQ score from baseline to post-intervention (at 12 weeks) will be reported. | Baseline and post-intervention, an average of 12 weeks | 
| Change in Pittsburgh Sleep Quality Index Score (PSQI) From Baseline to 12 Weeks | The Pittsburgh Sleep Quality Index (PSQI) score ranges from 0 to 21. A total score of 5 or more indicates poor sleep quality; the higher the score, the worse the sleep quality. The change in PSQI score from baseline to post-intervention (at 12 weeks) will be reported. | Baseline and post-intervention, an average of 12 weeks | 
| Change in Insomnia Severity Index Score (ISI) From Baseline to 12 Weeks | The Insomnia Severity Index (ISI) score ranges from 0 to 28, with higher scores indicating greater insomnia severity. The change in ISI score from baseline to post-intervention (at 12 weeks) will be reported. | Baseline and post-intervention, an average of 12 weeks | 
| Change in Dysfunctional Beliefs About Sleep Score (DBAS) From Baseline to 12 Weeks | The Dysfunctional Beliefs About Sleep (DBAS) score ranges from 0 to 10, with a score of 4 or greater indicating unrealistic expectations for sleep, and greater scores indicating more dysfunctional beliefs about sleep. The change in DBAS score from baseline to post-intervention (at 12 weeks) will be reported. | Baseline and post-intervention, an average of 12 weeks | 
| Change in Measures for Coping With Sleep Disturbances Score From Baseline to 12 Weeks | The Measures for coping with sleep disturbances score ranges from 0 to 11, with greater scores indicating greater use of active coping measures for sleep disturbance. The change in Measures for coping with sleep disturbances score from baseline to post-intervention (at 12 weeks) will be reported. | Baseline and post-intervention, an average of 12 weeks | 
| Worry About Sleep Duration | Single item measure that assesses whether participants worried about not getting enough sleep in the past 2 weeks. | Post-intervention, an average of 12 weeks | 
| Change in Patient Health Questionnaire-9 Score (PHQ-9) From Baseline to 12 Weeks | The Patient Health Questionnaire-9 (PHQ-9) score ranges from 0 to 27, with a score greater than or equal to 10 indicating moderate to severe depression, and the higher the score, the greater the depressive symptom severity. The change in PHQ-9 score from baseline to post-intervention (at 12 weeks) will be reported. | Baseline to post-intervention, an average of 12 weeks | 
| Change in PROMIS 6-item Anxiety Score From Baseline to 12 Weeks | The PROMIS 6-item anxiety score ranges from 6 to 30, with higher scores indicating more severe anxiety; from raw scores, standardized T-scores can be determined. The change in PROMIS 6-item anxiety T-score from baseline to post-intervention (at 12 weeks) will be reported. The T-score values have a mean = 50 and SD = 10, with higher scores indicating greater anxiety. The T-scores are interpreted as follows: Less than 55 = None to slight anxiety 55.0-59.9 = Mild anxiety 60.0-69.9 = Moderate anxiety 70 and over = Severe anxiety | Baseline and post-intervention, an average of 12 weeks | 
| Change in Perceived Stress Scale Score (PSS) From Baseline to 12 Weeks | The Perceived Stress Scale score ranges from 0 to 40, with higher scores indicating greater appraisal of stress. The change in PSS score from baseline to post-intervention (at 12 weeks) will be reported. | Baseline and post-intervention, an average of 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pregnancy, sleep, mindfulness