Sleep and Cardiovascular Health Among Women With a History of Hypertensive Disorders of Pregnancy: Pilot Observational Study

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Abstract
Background: Both poor sleep health and hypertensive disorders of pregnancy (HDP) are independent risk factors for cardiovascular disease. Whether poor postpartum sleep contributes to the relationship between HDP and future cardiovascular disease is unknown. This pilot study evaluated the feasibility and acceptability of studying sleep health using a wearable device (Oura ring) among mothers of young children. Objective: We evaluated indices of sleep health both objectively with the Oura ring and subjectively via questionnaires and qualitative interviews among mothers with and without a history of HDP. We also aimed to compare cardiovascular health (CVH) among mothers with vs without a prior history of HDP. Methods: Women who were 3 to 7 years after childbirth completed baseline questionnaires (the Pittsburgh Sleep Quality Index [PSQI], Mediterranean Eating Pattern for Americans tool, and 7-item International Physical Activity Questionnaire) and wore the Oura ring continuously for 2 weeks to monitor sleep. Optimal sleep health was defined as a sleep duration of ≥7 hours, a PSQI score of ≤5, sleep timing with a sleep midpoint between 2 AM and 4 AM, a sleep efficiency of >85%, and a sleep onset variability of P= .22). Average sleep duration was suboptimal (6.7, SD 0.8 hours), with no difference between groups. Approximately half (n=23, 47%) had abnormal sleep timing, which was more common among those with a prior normotensive pregnancy. Sleep onset variability was high (mean 1.2, SD 0.5 hours), with no significant differences by HDP status. The mean CVH score fell within the moderate range (70.7, SD 12.8), with no differences between groups. The components of the CVH score that were lowest (ie, worst) among the entire cohort were diet (mean 37.3, SD 25.6) and BMI (mean 50.8, SD 35.4 kg/m 2 ). Common barriers to sleep included parenting, work, and household responsibilities. The study met our criteria for the feasibility and acceptability of using the Oura ring to study sleep in this population. Conclusions: Among postpartum women, sleep health was suboptimal regardless of HDP history. Interventions to improve sleep and CVH should target all mothers during the first decade after childbirth.

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