الفهرس 
AbstractOnly 14 pages are availabe for public view
 |  | from | 157 |  |  |
| | | from | 157 | | |
Abstract
Summary
Pregnancy and the postpartum period are recognized as times of vulnerability to psychiatric disorders, including mood, anxiety and psychotic disorders. The causes of these conditions are far from clear, although numerous hypotheses have been put forward. Many of these focus on the dramatic changes in peripheral concentrations of sex steroids that occur during pregnancy and in the immediate postpartum period.
Following delivery, the greatest degree of maternal sleep disturbance occurs during the first month, with a mean 24-hour total sleep time at 2 weeks postpartum of less than 6 hours, including more than an hour of nap time. Total maternal sleep time and sleep efficiency increase gradually as the infant’s circadian rhythm matures, with a transition from interrupted to uninterrupted sleep usually occurring at approximately the 12th postpartum week. Although the most common reason cited for maternal awakenings in postpartum studies is the infant’s sleep and feeding schedule.
The present study aimed to assess the sleeping quality index among postpartum mothers and to determine the impact of educational intervention on improvement of postpartum sleeping pattern alterations.
Randomized control trail study design used to achieve the aim of the study; the study was conducted at Al Azhar Assiut University Hospital, Assiut, in postpartum ward. The subjects of this study consist of 550 postpartum women immediately after birth who met the criteria of selection, the postpartum women was divided into main groups, 275 for each group. 275 postpartum women (study and control groups). The study group received an educational intervention about measures that improve the sleep quality and then received a booklet that containing sleeping educational intervention which focuses on the quality of sleeping pattern on their first day postpartum in their rooms in postpartum ward for 30 minutes, the control group received the routine care for postpartum period.
Tools of data collection:
The following tool was used to collect data the current study:
A structured interview questionnaire was developed by the researcher in English language based upon a review of current and previous national and international literature to assess the sleeping quality index of postpartum women and to determine the impact of educational intervention on improvement of postpartum sleeping pattern alterations. It included three parts to collect data related to socio demographic characteristics of the studied women, the current delivery outcomes and Pittsburg sleep quality index (PSQI,2016) to assessment of mother’s sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and day¬time dysfunction.
Scoring system:
Sleep quality index, providing an overall score of the seven components ranging from 0 to 21, where lower scores denote a healthier sleep quality and this score divided into:
• Good sleep quality (0-7).
• Moderate sleep quality (8-14)
• Poor sleep quality (15-21)
Procedure: at the first time it was concerned with construction and preparation of data collection tools. Managerial arrangement to carry out the study, where the investigator prepared formal requests to the directors of the study setting. The purpose and nature of the study were explained to gain their acceptance and support. All questionnaire items explained by the investigator sufficiently. Interview with women were conducted on their first day postpartum in their rooms in postpartum ward. Each interview took about 30 minutes with each postpartum woman. Every postpartum woman interviewed face to face to fill the questionnaire to assess sleep quality for the postpartum women in 30 minutes, immediately after delivery and followed up to assess the sleeping quality after 15 days and at the end of 6th week postpartum at the postpartum clinic or by telephone call.
Data of the current study were collected over a period from the first of November 2014; tell the end of April 2016. Tools were filled and completed through three times, immediately after delivery, after 15 days and at the end of 6th week postpartum (42 day’s postpartum mothers) from the beginning of the study.
After filling the questionnaire the researcher provide each mother in educational intervention group with knowledge about tips of healthy sleep hygiene, sleep habits, healthier sleep habits for their baby and develop a sleep routine for their baby through a booklet that developed by the researcher and revised by supervisors of the study.
A Pilot study was done on 10% (55 women) of the sample to assess the clarity, completeness and understanding of the tools. It also helped in the estimation of the time needed to hill questionnaire, according to the results of the pilot study, tools modified. The women who were participating in the pilot study were not included in the main study sample.
The main results obtained were:
About two thirds (65.5% Vs 69.8) of the study and control groups respectively had moderate sleep quality with no statistical significant difference between both groups immediately after delivery. While women of both groups after 15 days and after 42 days postpartum showed a highly statistical significant difference between both groups. (P=0.000).
There is no statistical significance between study and control as regards PSQI immediately after delivery.
Concerning Sleep quality index after 15 days postpartum, more than one third of the intervention group (34.2%) had good sleep quality and 65.8% had moderate sleep quality, compared to fewer of women’s in control group had good sleep quality and 80.7% had moderate sleep quality, with a highly statistical significant difference between groups.
Regarding Sleep quality index after 42 days postpartum, it was, the vast majority of intervention group had good sleep quality, compared to 13.5% had good sleep quality in control group with a highly statistical significant difference between groups.
Conclusion:
Based on the present study findings, it was concluded that most of the participants women experiencing disturbed sleeping quality during last the month of pregnancy and postpartum period. After implementing the educational intervention, maternal sleep quality, subjective sleep quality, sleep duration, sleep latency, habitual sleep efficiency, sleep disturbances, use of sleep medication and daytime dysfunction were improved after 15 and 42 day of postpartum period, with a highly statistical significant difference between groups.
Recommendations
Based on the results of this study it was recommended that:
IV. Further efforts are needed through educational intervention programs to improve maternal sleeping quality during pregnancy and the postpartum period.
V. Special attention is needed by health care providers for pregnant mothers in discussing sleep habits and healthy sleep hygiene.
VI. More researchers are needed to improve newborn sleep quality and pattern to improve maternal sleep quality and sleep pattern.