Abstract P334: The Effects of Inadequate Sleep on Blood Pressure and Endothelial Inflammation in Women: Findings From the American Heart Association Go Red for Women Strategically Focused Research Network

Background: Insufficient sleep impairs blood pressure regulation. However, the effects of milder, highly prevalent but frequently neglected sleep disturbances, including poor sleep quality and insomnia, on vascular health in women are unclear. We investigated whether poor sleep patterns are associated with blood pressure and endothelial inflammation in a diverse sample of women. Methods: Women who participated in the ongoing AHA Go Red for Women Strategically Focused Research Network population project were studied (n=323, 57% minority, mean age=39 + 17 y, range=20-79 y). Sleep duration, sleep quality, and time to sleep onset were assessed using the Pittsburgh Sleep Quality Index (score > 5=poor sleep quality). Risk for obstructive sleep apnea (OSA) was evaluated using the Berlin questionnaire, and insomnia was assessed using the Insomnia Severity Index (ISI). In a subset of women who participated in the basic study (n=28), sleep duration was assessed objectively using actigraphy and endothelial inflammation was assessed directly in harvested endothelial cells by measuring nuclear translocation of nuclear factor kappa B (NFκB). Vascular reactivity was measured by brachial artery flow-mediated dilation (FMD). Systolic and diastolic blood pressure (SBP and DPB) were measured by trained personnel. Multivariate linear regressions were used to evaluate associations between sleep patterns and blood pressure, NFκB and FMD. Results: Mean sleep duration was 6.8 ± 1.3 h/night in the population study and 7.5 ± 1.1 h/night in the basic study. In the population study sample, 50% had poor sleep quality (25% in the basic study), and 37% had some level of insomnia (15% in the basic study). SBP was associated directly with poor sleep quality, and DBP with OSA risk after adjusting for confounders (p=0.04 and p=0.08, respectively). Poor sleep quality was associated with endothelial NFκB activation (β=30.6; p=0.03). Insomnia and longer time to sleep onset were also associated with endothelial NFκB activation (β=27.6; p=0.002 and β=8.26; p=0.02, respectively). Sleep patterns were not associated with FMD. Conclusions: These findings provide direct evidence that common but frequently neglected sleep disturbances such as poor sleep quality and insomnia are associated with increased blood pressure and vascular inflammation even in the absence of sleep deprivation in women.

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1142 Comprehensive Phenotyping Of Ambulatory Sleep Patterns In Multiple Sclerosis

SLEEP ◽

10.1093/sleep/zsaa056.1136 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A435-A435

Author(s):

T J Braley ◽

A L Kratz ◽

D Whibley ◽

C Goldstein

Keyword(s):

Multiple Sclerosis ◽

Sleep Quality ◽

Extreme Values ◽

Sleep Onset ◽

External Support ◽

Poor Sleep ◽

Sleep Patterns ◽

Poor Sleep Quality ◽

Historical Cohort ◽

The Impact

Abstract Introduction The majority of sleep research in persons with multiple sclerosis (PwMS) has been siloed, restricted to evaluation of one or a few sleep measures in isolation. To fully characterize the impact of sleep disturbances in MS, multifaceted phenotyping of sleep is required. The objective of this study was to more comprehensively quantify sleep in PwMS, using a recently developed multi-domain framework of duration, continuity, regularity, sleepiness/alertness, and quality. Methods Data were derived from a parent study that examined associations between actigraphy and polysomnography-based measures of sleep and cognitive function in MS. Actigraphy was recorded in n=55 PwMS for 7-12 days (Actiwatch2®, Philips Respironics). Sleep metrics included: duration=mean total sleep time (TST, minutes); continuity=mean wake time after sleep onset (minutes), and regularity=stddev wake-up time (hours). ‘Extreme’ values for continuity/regularity were defined as the most extreme third of the distributions. ‘Extreme’ TST values were defined as the lowest or highest sixth of the distributions. Sleepiness (Epworth Sleepiness Scale score) and sleep quality [Pittsburgh Sleep Quality Index (PSQI) sleep quality item] were dichotomized by accepted cutoffs (>10 and >1, respectively). Results Sleep was recorded for a mean of 8.2 days (stddev=0.95). Median (1st, 3rd quartile) values were as follows: duration 459.79 (430.75, 490.60), continuity 37.00 (23.44, 52.57), regularity 1.02 (0.75, 1.32), sleepiness/alertness 8 (4, 12), and sleep quality 1.00 (1.00, 2.00). Extreme values based on data distributions were: short sleep <=426.25 minutes (18%), long sleep >515.5 minutes (16%), poor sleep continuity ≥45 minutes (33%), and poor sleep regularity ≥1.17 hours (33%). Sleepiness and poor sleep quality were present in 36% and 40% respectively. For comparison, in a historical cohort of non-MS patients, the extreme third of sleep regularity was a stddev of 0.75 hours, 13% had ESS of >10, and 16% had poor sleep quality. Conclusion In this study of ambulatory sleep patterns in PwMS, we found greater irregularity of sleep-wake timing, and higher prevalence of sleepiness and poor sleep quality than published normative data. Efforts should be made to include these measures in the assessment of sleep-related contributions to MS outcomes. Support The authors received no external support for this work.

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Abstract P341: Poor Sleep Patterns Are Associated With Decreased Performance on the Montreal Cognitive Assessment in Both Younger and Older Women

Circulation ◽

10.1161/circ.137.suppl_1.p341 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Brooke Aggarwal ◽

Adam M Brickman ◽

Ming Liao ◽

Molly E Zimmerman

Keyword(s):

Risk Factors ◽

Cognitive Function ◽

Sleep Quality ◽

Sleep Duration ◽

Sleep Onset ◽

Poor Sleep ◽

Cvd Risk Factors ◽

Sleep Patterns ◽

Cvd Risk ◽

Quality Sleep

Introduction: Poor cardiovascular health has been linked to an increased likelihood of cognitive impairment in older adults. Cognitive impairment has also been identified as an emerging co-morbidity of obstructive sleep apnea, a highly prevalent sleep disorder, particularly in patients with neurological conditions. Whether other aspects of sleep, including sleep duration, sleep quality, sleep onset latency, and insomnia are associated with cognition is not established. Objective: The aim of this study was to evaluate whether specific sleep patterns were associated with cognitive function in a diverse population of both younger and older, neurologically healthy women, and to determine whether this association is mediated by cardiovascular disease (CVD) risk factors. Methods: This was a baseline analysis of 392 women (59% racial/ethnic minority, mean age=39±16.53y, range 20-76y) participating in the ongoing American Heart Association Go Red for Women Strategically Focused Research Network population-based study at Columbia University Medical Center (CUMC). Cognitive function was assessed by the validated Montreal Cognitive Assessment (MoCA) screening instrument. Sleep duration, sleep quality, and time to sleep onset were assessed using the Pittsburgh Sleep Quality Index; insomnia was assessed using the Insomnia Severity Index. Blood lipids and glucose were measured in the biomarker core laboratory at CUMC. Multivariable linear regression models were used to evaluate associations between sleep, CVD risk factors, and MoCA scores, adjusted for age, race/ethnicity, education, health insurance, and tested for interactions between age and sleep. Results: The prevalence of abnormal MoCA (score <26) was 38%; mean scores were lower in adults ≥55y vs. <55y (p<0.0001), and racial/ethnic minorities vs. whites (p<0.0001). Average nightly sleep duration was 6.75±1.29 h, and 50% of women had poor sleep quality. In multivariable models testing for interactions, lower MoCA scores were associated with shorter sleep duration (p=0.007), worse quality sleep (p=0.0005), and higher insomnia level (p=0.04). In stratified analyses, associations between MoCA scores and sleep duration, sleep quality, and insomnia persisted among both younger (<55y) and older (≥55y) groups. Lower MoCA scores were also associated with higher triglycerides (p=0.0001) and lower HDL-cholesterol (p=0.0006); formal tests of mediation suggested that the relation between cognition and insomnia was mediated by triglyceride level. Conclusions: Poor sleep patterns were highly prevalent and associated with lower cognitive function, even in younger women in this diverse population. Sleep patterns should be further investigated as a potential mechanism to identify individuals at risk of cognitive decline. Whether the relation is causal or mediated through traditional CVD risk factors deserves further study.

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The Impact of Sleep Timing, Sleep Duration, and Sleep Quality on Depressive Symptoms and Suicidal Ideation amongst Japanese Freshmen: The EQUSITE Study

Sleep Disorders ◽

10.1155/2016/8737654 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 17

Author(s):

Atin Supartini ◽

Takanori Honda ◽

Nadzirah A. Basri ◽

Yuka Haeuchi ◽

Sanmei Chen ◽

...

Keyword(s):

Depressive Symptoms ◽

Suicidal Ideation ◽

Sleep Quality ◽

Sleep Duration ◽

Sleep Onset ◽

Poor Sleep ◽

Sleep Onset Latency ◽

Onset Latency ◽

Poor Sleep Quality ◽

The Impact

Aim. The aim of this study was to identify the impact of bedtime, wake time, sleep duration, sleep-onset latency, and sleep quality on depressive symptoms and suicidal ideation amongst Japanese freshmen.Methods. This cross-sectional data was derived from the baseline survey of the Enhancement of Q-University Students Intelligence (EQUSITE) study conducted from May to June, 2010. A total of 2,631 participants were recruited and completed the following self-reported questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies Depression Scale (CES-D), and the original Health Support Questionnaires developed by the EQUSITE study research team.Results. Of 1,992 participants eligible for analysis, 25.5% (n=507) reported depressive symptoms (CES-D total score ≥ 16), and 5.8% (n=115) reported suicidal ideation. The present study showed that late bedtime (later than 01:30), sleep-onset latency (≥30 minutes), and poor sleep quality showed a marginally significant association with depressive symptoms. Poor sleep quality was seen to predict suicidal ideation even after adjusting for depressive symptoms.Conclusion. The current study has important implications for the role of bedtime in the prevention of depressive symptoms. Improving sleep quality may prevent the development of depressive symptoms and reduce the likelihood of suicidal ideation.

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Nightly sleep duration, fragmentation, and quality and daily risk of migraine

Neurology ◽

10.1212/wnl.0000000000008740 ◽

2019 ◽

Vol 94 (5) ◽

pp. e489-e496 ◽

Cited By ~ 5

Author(s):

Suzanne M. Bertisch ◽

Wenyuan Li ◽

Catherine Buettner ◽

Elizabeth Mostofsky ◽

Michael Rueschman ◽

...

Keyword(s):

Sleep Quality ◽

Sleep Duration ◽

Conditional Logistic Regression ◽

Sleep Onset ◽

Sleep Fragmentation ◽

Caffeine Intake ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Short Sleep Duration ◽

Short Sleep

ObjectiveTo test the hypotheses that insufficient duration, high fragmentation, and poor sleep quality are temporally associated with migraine onset on the day immediately following the sleep period (day 0) and the following day (day 1).MethodsIn this prospective cohort study of 98 adults with episodic migraine, participants completed twice-daily electronic diaries on sleep, headaches, and other health habits, and wore wrist actigraphs for 6 weeks. We estimated the incidence of migraine following nights with short sleep duration, high fragmentation, or low quality compared to nights with adequate sleep with conditional logistic regression models stratified by participant and adjusted for caffeine intake, alcohol intake, physical activity, stress, and day of week.ResultsParticipants were a mean age of 35.1 ± 12.1 years. We collected 4,406 days of data, with 870 headaches reported. Sleep duration ≤6.5 hours and poor sleep quality were not associated with migraine on day 0 or day 1. Diary-reported low efficiency was associated with 39% higher odds of headache on day 1 (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.06–1.81). Actigraphic-assessed high fragmentation was associated with lower odds of migraine on day 0 (wake after sleep onset >53 minutes, OR 0.64, 95% CI 0.48–0.86; efficiency ≤88%, OR 0.74, 95% CI 0.56–0.99).ConclusionShort sleep duration and low sleep quality were not temporally associated with migraine. Sleep fragmentation, defined by low sleep efficiency, was associated with higher odds of migraine on day 1. Further research is needed to understand the clinical and neurobiologic implications of sleep fragmentation and risk of migraine.

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Relationship between Sleep and Hypertension: Findings from the NHANES (2007–2014)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157867 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7867

Author(s):

Chunnan Li ◽

Shaomei Shang

Keyword(s):

Blood Pressure ◽

Sleep Disorder ◽

Sleep Duration ◽

Sleep Pattern ◽

Poor Sleep ◽

Sleep Patterns ◽

Short Sleep Duration ◽

Logistic Regression Models ◽

Increased Risk ◽

Definition Of

Background: To evaluate the association of sleep factors (sleep duration, self-reported trouble sleeping, diagnosed sleep disorder) and combined sleep behaviors with the risk of hypertension. Methods: We analyzed 12,166 adults aged 30–79 years who participated in the 2007–2014 National Health and Nutrition Examination Survey. Sleep duration, self-reported trouble sleeping and sleep disorders were collected using a standardized questionnaire. We included three sleep factors (sleep duration, self-reported trouble sleeping and sleep disorder) to generate an overall sleep score, ranging from 0 to 3. We then defined the sleep pattern as “healthy sleep pattern” (overall sleep score = 3), “intermediate sleep pattern” (overall sleep score = 2), and “poor sleep pattern” (0 ≤ overall sleep score ≤ 1) based on the overall sleep score. The definition of hypertension was based on self-reported antihypertensive medication use or biological measurement (systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg). We used weighted logistic regression models to investigate the associations between sleep and hypertension. Results: The overall prevalence of hypertension was 37.8%. A short sleep duration (OR = 1.20, 95% CI: 1.08 to 1.33, p = 0.001), self-reported trouble sleeping (OR = 1.45, 95% CI: 1.28 to 1.65, p < 0.001) and sleep disorder (OR = 1.33, 95% CI: 1.07 to 1.66, p = 0.012) were related to the risk of hypertension. Poor sleep patterns were closely correlated with the risk of hypertension (OR = 1.90, 95% CI: 1.62 to 2.24). Conclusions: Participants with poor sleep patterns were associated with an increased risk for hypertension.

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Association between pet ownership and sleep in the Swedish CArdioPulmonary bioImage Study (SCAPIS)

Scientific Reports ◽

10.1038/s41598-021-87080-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lieve T. van Egmond ◽

Olga E. Titova ◽

Eva Lindberg ◽

Tove Fall ◽

Christian Benedict

Keyword(s):

Sleep Quality ◽

Sleep Duration ◽

Odds Ratio ◽

Poor Sleep ◽

Pet Ownership ◽

Poor Sleep Quality ◽

Short Sleep Duration ◽

Dog Walking ◽

Dog Ownership ◽

Using Data

AbstractPreliminary findings suggest that pets may impact the owner’s sleep. By using data from the Swedish CArdioPulmonary bIoimage Study (SCAPIS) cohort, we aimed to investigate the association of pet ownership with the following self-reported sleep outcomes in 3788 to 4574 participants: (i) achieving the recommended daily sleep duration for adults (i.e., at least 7 h per day); (ii) sleep quality as measured by the Pittsburgh Sleep Quality Index (a score of > 5 indicating poor sleep quality); and (iii) difficulty falling or staying asleep. Sleep metrics were not associated with pet ownership, dog ownership, and dog walking when controlling the logistic regression for possible confounders (e.g., shift work, lack of social interaction, and chronic stress). In contrast, cat ownership was associated with a higher odds ratio of failing to achieve the recommended duration of 7 h of sleep per day (adjusted odds ratio [95% CI]:1.18 [1.02, 1.37] versus non-cat owners). Our findings suggest that certain pet groups might have a more significant impact on the owner’s sleep than others. As the observed association between cat ownership and short sleep duration might be a chance finding, this observation should be seen as hypothesis-generating only.

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778 Poor Sleep Quality is Associated with Reduced Myelination in Patients with Psychotic Disorders

SLEEP ◽

10.1093/sleep/zsab072.775 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A303-A303

Author(s):

Cagri Yuksel ◽

Xi Chen ◽

Lauren Watford ◽

Margaret Gardner ◽

Kathryn Lewandowski ◽

...

Keyword(s):

White Matter ◽

Sleep Quality ◽

Psychotic Disorders ◽

Sleep Onset ◽

Sleep Loss ◽

Magnetization Transfer Ratio ◽

Poor Sleep ◽

Sleep Onset Latency ◽

Healthy Controls ◽

Poor Sleep Quality

Abstract Introduction Recent studies show that sleep favors oligodendrocyte proliferation and myelination, and sleep loss is associated with alterations in white matter structure and decreased myelination. Psychotic disorders are characterized by disrupted white matter integrity, and abnormal axon and myelin structure. Despite common sleep disturbances in these disorders, little is known about the relationship between sleep quality and white matter findings. A novel in vivo neuroimaging technique that combines diffusion tensor spectroscopy (DTS) and magnetization transfer ratio (MTR) allows separately examining the axon structure and glial function, and myelin content, respectively. Using this method, we examined the association of sleep quality with white matter biology in a sample of patients with psychotic disorders and matched healthy controls. Methods Participants included patients diagnosed with bipolar disorder with psychotic features (euthymic or depressed, n=12) and schizophrenia spectrum disorders (n=9), and age and sex matched healthy controls (n=20). DTS and MTR data was collected from the right prefrontal white matter at 4T. DTS measures included apparent diffusion coefficients of water, NAA, creatine and choline. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI). Results PSQI total score was significantly higher in patients. and patient sample included a higher percentage of poor sleepers (PSQI total score>5). In patients, total PSQI score and sleep onset latency were significantly and negatively associated with MTR (F=6.9, p=0.02 and F=9.7, p=0.007, respectively). There was no difference in any DTS measures between groups. Conclusion Our preliminary results show that poor sleep quality is associated with decreased myelin content in the frontal lobe, in patients with psychotic disorders. This finding suggests that sleep loss may be a mediator of white matter alterations in psychosis. Support (if any) This work is supported by National Institute of Mental Health K23MH119322 to Cagri Yuksel

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142 Prenatal Sleep Quality and Infant Sleep: A Longitudinal Study

SLEEP ◽

10.1093/sleep/zsab072.141 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A58-A59

Author(s):

Rebecca Burdayron ◽

Marie-Helene Pennestri ◽

Elizabeth Keys ◽

Lianne Tomfohr-Madsen ◽

Gerald Giesbrecht

Keyword(s):

Sleep Quality ◽

Sleep Duration ◽

Gestational Age ◽

Sleep Onset ◽

Depression Scale ◽

Future Research ◽

Poor Sleep ◽

Infant Sleep ◽

Maternal Sleep ◽

Sleep Parameters

Abstract Introduction Poor sleep quality is common during pregnancy and can increase the risk of adverse obstetric and fetal outcomes. Existing research on the association between prenatal sleep and infant sleep is scarce and has focused on other aspects of prenatal sleep such as sleep duration, chronotype, and insomnia symptoms. To our knowledge, no studies have examined the association between prenatal sleep quality and infant sleep outcomes. Thus, this study aimed to investigate whether maternal sleep quality during pregnancy was prospectively associated with infant sleep dimensions, independent of relevant covariates. Methods Participants were a subset of 272 mother-infant dyads enrolled in an ongoing cohort study. Maternal prenatal sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) in early to mid- (M gestational age = 15.12 ± 3.56 weeks) and late- (M gestational age = 32.44 ± 0.99 weeks) pregnancy. Mothers completed the Brief Infant Sleep Questionnaire (BISQ) at 3, 6, and 12 months postpartum. The following infant sleep parameters were assessed: sleep duration (day, night, 24-hour), number of night awakenings, and wake after sleep onset. Prenatal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at both pregnancy time points. Other covariates included maternal age at enrollment, infant age, parity, and co-sleeping status. Results Generalized estimating equations (GEE) models revealed that poorer maternal sleep quality during early-to-mid pregnancy did not significantly predict infant sleep parameters after adjustment for covariates (p > .05). However, in late pregnancy, poorer maternal sleep quality significantly predicted shorter 24-hour sleep duration and longer wake after sleep onset, but not daytime sleep duration, nighttime sleep duration, and number of night awakenings (p < .05). Conclusion Study findings advance our understanding of the prospective link between maternal prenatal sleep quality and infant sleep. Results indicate that maternal sleep quality during late gestation may play a role in the development of infant sleep patterns. These findings have important implications for intervention efforts targeting maternal sleep quality during pregnancy. Future research should use objective measures of sleep, such as actigraphy, to better elucidate the effects of prenatal sleep quality on infant sleep outcomes. Support (if any) The Canadian Institutes of Health Research (CIHR)

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Sleep Duration and Sleep Quality as Predictors of Health in Elderly Individuals

Sustainability ◽

10.3390/su10113918 ◽

2018 ◽

Vol 10 (11) ◽

pp. 3918 ◽

Cited By ~ 1

Author(s):

Lovro Štefan ◽

Vlatko Vučetić ◽

Goran Vrgoč ◽

Goran Sporiš

Keyword(s):

Sleep Quality ◽

Sleep Duration ◽

The Elderly ◽

Cross Sectional Study ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Cross Sectional ◽

Elderly Individuals ◽

Self Rated Health ◽

Study Participants

The main purpose of the present study was to explore the associations of sleep duration and sleep quality with self-rated health. In this cross-sectional study, participants were 894 elderly individuals. Self-rated health, sleep duration, and sleep quality were self-reported. The associations were examined using multiple logistic regression analyses.After adjusting for sex, physical activity, smoking consumption, alcohol consumption, psychological distress, socioeconomic status, and chronic disease/s, sleeping <6 h (OR (Odds ratio) = 3.21; 95% CI (95 percent confident interval) 1.61 to 6.39), 6–7 h (OR = 2.47; 95% CI 1.40 to 4.36), 8–9 h (OR = 3.26; 95% CI 1.82 to 5.83), and >9 h (OR = 3.62; 95% CI 1.57 to 8.34) and having ‘poor’ sleep quality (≥5 points; OR = 2.33; 95% CI 1.46 to 3.73) were associated with ‘poor’ self-rated health. When sleep duration and sleep quality were entered simultaneously into the model, the same associations remained. Our findings provide evidence that both ‘short’ and ‘long’ sleep and ‘poor’ sleep quality are associated with ‘poor’ self-rated health. Thus, interventions that promote healthy sleep hygiene in the elderly are warranted.

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Association between maternal sleep duration and quality, and the risk of preterm birth: a systematic review and meta-analysis of observational studies

10.21203/rs.2.12630/v6 ◽

2020 ◽

Author(s):

ling wang ◽

Feng Jin

Keyword(s):

Systematic Review ◽

Preterm Birth ◽

Sleep Quality ◽

Sleep Duration ◽

Meta Analysis ◽

Controlled Study ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Increased Risk ◽

Study Heterogeneity

Abstract Background : To assess the association of sleep duration and quality with the risk of preterm birth. Methods : Relevant studies were retrieved from the PubMed and Web of Science databases up to September 30, 2018. The reference lists of the retrieved articles were reviewed. Random effects models were applied to estimate summarized relative risks (RRs) and 95% confidence intervals (CIs). Results : Ten identified studies (nine cohort studies and one case-controlled study) examined the associations of sleep duration and quality with the risk of preterm birth. As compared with women with the longest sleep duration, the summary RR was 1.23 (95% CI = 1.01–1.50) for women with the shortest sleep duration, with moderate between-study heterogeneity ( I 2 = 57.4%). Additionally, as compared with women with good sleep quality, the summary RR was 1.54 (95% CI = 1.18–2.01) for women with poor sleep quality (Pittsburgh Sleep Quality Index > 5), with high between-study heterogeneity ( I 2 = 76.7%). Funnel plots as well as the Egger’s and Begg’s tests revealed no evidence of publication bias. Conclusions : This systematic review and meta-analysis revealed that short sleep duration and poor sleep quality may be associated with an increased risk of preterm birth. Further subgroup analyses are warranted to test the robustness of these findings as well as to identify potential sources of heterogeneity.

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