Document Type : Original Articles

Authors

1 Department of midwifery, M.Sc, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Obstetrics and Gynecology, Gynecologist , Medical school, Shiraz University of Medical Sciences, Shiraz, Iran

3 Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

AbstractBackground: Sleep disorders like snoring, mouth breathing, andinsomnia are frequent in pregnancy and studies have shown thatpoor sleep is linked to obstetric complications. Muscle relaxationtechnique is an effective method used for improving sleepquality. The purpose of this study was to determine the effectof muscle relaxation technique on fetal outcomes in complicatedpregnancies with sleep disorders.Methods: This study was performed as a clinical trial on 160pregnant women who suffered from preeclampsia and gestationaldiabetes. The participants filled the Pittsburgh Sleep QualityIndex (PSQI) in order to measure the quality and patterns oftheir sleep. The participants with the total score of 5 or morewere included in the present study. Intervention group were askedto use muscle relaxation technique twice a week at home for 8weeks alongside the routine care. Study variables included sleepquality, Apgar scores, birth weight, levels of Interleukin- 6 (IL-6), as well as umbilical cord PH and PO2.Results: The mean score of PSQI before the intervention was9.28±4.16 and 9.18±3.06 in the intervention and control groupswithout a significant difference (P=0.6), respectively. However,PSQI global score of the experimental group was smaller than thecontrol group at the end of the study (P<0.001). Also, birth weight(P=0.04), Apgar score (P=0.01), and umbilical cord blood po2(P=0.03) and PH (P=0.01) were higher, and IL-6 (P=0.04) wassmaller in the experimental group compared to the control group.Conclusion: The results of this study showed that musclerelaxation, as a simple, inexpensive and safe method, canimprove the fetal outcomes such as birth weight, Apgar score,cord blood po2, and cord blood PH, and also it leads to lowerIL-6 in complicated pregnancies.

Keywords

  1. Facco FL, Kramer J, Ho KH, Zee PC, Grobman WA. Sleep disturbances in pregnancy. Obstetrics and gynecology. 2010;115(1):77-83. Epub 2009/12/23.
  2. Venkata C, Venkateshiah SB. Sleep-disordered breathing during pregnancy. The Journal of the American Board of Family Medicine. 2009;22(2):158-68.
  3. Sarberg M, Svanborg E, Wirehn AB, Josefsson A. Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study. BMC pregnancy and childbirth. 2014;14:15. Epub 2014/01/15.
  4. Cai X-H, Xie Y-P, Li X-C, Qu W-L, Li T, Wang H-X, et al. The prevalence and associated risk factors of sleep disorder-related symptoms in pregnant women in China. Sleep Breath. 2013;17(3):951-6.
  5. Leung PL, Hui DSC, Leung TN, Yuen PM, Lau TK. Sleep disturbances in Chinese pregnant women. BJOG: An International Journal of Obstetrics & Gynaecology. 2005;112(11):1568-71.
  6. Facco FL, Liu CS, Cabello AA, Kick A, Grobman WA, Zee PC. Sleep-disordered breathing: a risk factor for adverse pregnancy outcomes? American journal of perinatology. 2012;29(4):277-82. Epub 2011/11/23.
  7. Okun ML, Schetter CD, Glynn LM. Poor sleep quality is associated with preterm birth. Sleep. 2011;34(11):1493.
  8. Izci B, Martin SE, Dundas KC, Liston WA, Calder AA, Douglas NJ. Sleep complaints: snoring and daytime sleepiness in pregnant and pre-eclamptic women. Sleep Medicine. 2005;6(2):163-9.
  9. Herring SJ, Nelson DB, Pien GW, Homko C, Goetzl LM, Davey A, et al. Objectively measured sleep duration and hyperglycemia in pregnancy. Sleep Medicine.15(1):51-5.
  10. Tauman R. Maternal Sleep and Fetal Outcome. Open Sleep Journal. 2013;6(1):63-7.
  11. Mullington JM, Simpson NS, Meier-Ewert HK, Haack M. Sleep loss and inflammation. Best practice & research Clinical endocrinology & metabolism. 2010;24(5):775-84. Epub 2010/11/30.
  12. Okun ML, Coussons-Read ME. Sleep disruption during pregnancy: how does it influence serum cytokines? Journal of reproductive immunology. 2007;73(2):158-65.
  13. Rakhshani A, Nagarathna R, Mhaskar R, Mhaskar A, Thomas A, Gunasheela S. The effects of yoga in prevention of pregnancy complications in high-risk pregnancies: a randomized controlled trial. Preventive medicine. 2012;55(4):333-40.
  14. Chuang L-L, Lin L-C, Cheng P-J, Chen C-H, Wu S-C, Chang C-L. The effectiveness of a relaxation training program for women with preterm labour on pregnancy outcomes: A controlled clinical trial. International Journal of Nursing Studies. 2012;49(3):257-64.
  15. Rakhshani A, Nagarathna R, Mhaskar R, Mhaskar A, Thomas A, Gunasheela S. The effects of yoga in prevention of pregnancy complications in high-risk pregnancies: A randomized controlled trial. Preventive Medicine. 2012;55(4):333-40.
  16. Webb RC. Smooth muscle contraction and relaxation. Advances in physiology education. 2003;27(4):201-6.
  17. Van Montfrans G, Karemaker J, Wieling W, Dunning A. Relaxation therapy and continuous ambulatory blood pressure in mild hypertension: a controlled study. BMJ. 1990;300(6736):1368-72.
  18. Scheufele PM. Effects of progressive relaxation and classical music on measurements of attention, relaxation, and stress responses. Journal of behavioral medicine. 2000;23(2):207-28.
  19. Smith JC, Joyce CA. Mozart versus new age music: Relaxation states, stress, and ABC relaxation theory. Journal of Music Therapy. 2004;41(3):215-24.
  20. Nedstrand E, Wijma K, Wyon Y, Hammar M. Applied relaxation and oral estradiol treatment of vasomotor symptoms in postmenopausal women. Maturitas. 2005;51(2):154-62.
  21. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL et al. Williams obstetrics.2010; 23th. New York; the MaGraw- Hill companies.
  22. Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. Journal of Psychosomatic Research. 2002;53(3):737-40.
  23. Nazifi M, Mokarami H, Akbaritabar A, Kalte HO, Rahi A. Psychometric Properties of the Persian Translation of Pittsburgh Sleep Quality Index. Health Scope. 2014;3(2):e15547. Epub 2014-05-06.
  24. Farrahi Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath. 2012;16(1):79-82.
  25. Mol BW, Roberts CT, Thangaratinam S, Magee LA, de Groot CJ, Hofmeyr GJ. Pre-eclampsia. Lancet. 2015;2(15):00070-7.
  26. Erem C, Kuzu UB, Deger O, Can G. Prevalence of gestational diabetes mellitus and associated risk factors in Turkish women: the Trabzon GDM Study. Arch Med Sci. 2015;11(4):724-35.
  27. Ahmadpour-Kacho M, Asnafi N, Javadian M, Hajiahmadi M, Taleghani N. Correlation between Umbilical Cord pH and Apgar Score in High-Risk Pregnancy. Iran J Pediatr. 2010;20(4):401-6.
  28. Fink NS, Urech C, Cavelti M, Alder J. Relaxation during pregnancy: what are the benefits for mother, fetus, and the newborn? A systematic review of the literature. J Perinat Neonatal Nurs. 2012;26(4):296-306.
  29. Gedde-Dahl M, Fors EA. Impact of self-administered relaxation and guided imagery techniques during final trimester and birth. Complementary therapies in clinical practice. 2012;18(1):60-5.
  30. Van Den Berg PP, Nelen WL, Jongsma HW, Nijland R, Kollee LA, Nijhuis JG, et al. Neonatal complications in newborns with an umbilical artery pH< 7.00. American Journal of obstetrics and gynecology. 1996;175(5):1152-7.
  31. Phelan JP, Martin GI, Korst LM. Birth asphyxia and cerebral palsy. Clinics in perinatology. 2005;32(1):61-76.
  32. Amarilyo G, Oren A, Mimouni F, Ochshorn Y, Deutsch V, Mandel D. Increased cord serum inflammatory markers in small-for-gestational-age neonates. Journal of Perinatology. 2011;31(1):30-2.
  33. Smith SE, Li J, Garbett K, Mirnics K, Patterson PH. Maternal immune activation alters fetal brain development through interleukin-6. The Journal of Neuroscience. 2007;27(40):10695-702.
  34. Liu C, Xie H, Zhang X, Yu Y, Zhang X, Sun Y, et al. Health related management plans improve sleep disorders of patients with chronic liver disease. International journal of clinical and experimental medicine. 2015;8(6):9883.
  35. Dayapoğlu N, Tan M. Evaluation of the effect of progressive relaxation exercises on fatigue and sleep quality in patients with multiple sclerosis. The Journal of Alternative and Complementary Medicine. 2012;18(10):983-7.
  36. Tamrat R, Huynh-Le M-P, Goyal M. Non-pharmacologic interventions to improve the sleep of hospitalized patients: A systematic review. Journal of general internal medicine. 2014;29(5):788-95.