Prevalence and predictors for postpartum sleep disorders: a nationwide analysis

Objective To describe the prevalence and predictors of postpartum sleep disorders. Design A retrospective cohort study. Setting Postpartum. Population Commercially insured women delivering in California (USA) between 2011 and 2014. Methods Using the Optum Clinformatics Datamart Database. Main outcome measures Prevalence of a postpartum sleep disorder diagnosis with and without a depression diagnosis up to 12 months following hospital discharge for inpatient delivery. We also identified predictors of a postpartum sleep disorder diagnosis using multivariable logistic regression. Results We identified 3535 (1.9%) women with a postpartum sleep disorder diagnosis. The prevalence of sleep disorder diagnoses was insomnia (1.3%), sleep apnea (0.25%), and other sleep disorder (0.25%). The odds of a postpartum sleep disorder were highest among women with a history of drug abuse (adjusted odds ratio (aOR): 2.70, 95% confidence interval (CI): 1.79-4.09); a stillbirth delivery (aOR: 2.15, 95% CI: 1.53-3.01); and chronic hypertension (aOR: 1.82; 95% CI: 1.57-2.11). A comorbid diagnosis of a postpartum sleep disorder and depression occurred in 1182 women (0.6%). These women accounted for 33.4% of all women with a postpartum sleep disorder. The strongest predictors of a comorbid diagnosis were a history of drug abuse (aOR: 4.13; 95% CI: 2.37-7.21) and a stillbirth delivery (aOR: 2.93; 95% CI: 1.74-4.92). Conclusions Postpartum sleep disorders are underdiagnosed conditions, with only 2% of postpartum women in this cohort receiving a sleep diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Insomnia was the most common disorder and one-third of women diagnosed with a postpartum sleep disorder had a co-morbid diagnosis of depression. Future studies are needed to improve the screening and diagnostic accuracy of postpartum sleep disorders.

Automated summary

This retrospective cohort study investigated the prevalence and predictors of postpartum sleep disorders among commercially insured women delivering in California between 2011 and 2014. The results showed a prevalence rate of 1.9% for postpartum sleep disorders, with insomnia being the most common type. Women with a history of drug abuse, stillbirth delivery, and chronic hypertension had the highest odds of developing postpartum sleep disorders. Additionally, one-third of women diagnosed with postpartum sleep disorders also had co-morbid depression. The study highlights the underdiagnosis of postpartum sleep disorders and the need for improved screening and diagnostic accuracy.