Jean E. Davis

Sleep disturbances, which can worsen during pregnancy, have been linked to inflammatory processes. This study tested the hypothesis that more pro-inflammatory diets during pregnancy are associated with a decrease in sleep quality and shorter sleep duration. The Health in Pregnancy and Postpartum study promoted a healthy lifestyle in pregnant women with pre-pregnancy overweight or obesity (n = 207). Data from ® armband. Diet was assessed using two 24-hr dietary recalls. Energy-density Dietary Inflammatory Index (E-DII^TM) scores were calculated from micro and macronutrients. Linear mixed-effects models estimated the impact of the E-DII score on sleep parameters. Women with more pro-inflammatory diets, compared to those with more anti-inflammatory diets, were more likely to be nulliparous (51% vs. 25%, p = 0.03), frequent consumers of fast food (29% vs. 10% consuming on 4–6 days during the previous week, p = 0.01), ever-smokers (21% vs. 6%, p = 0.02), and younger (mean age 29.2 vs. 31.3 years, p = 0.02). For every one-unit increase (i.e., more pro-inflammatory) in the E-DII score, sleep latency increased by 0.69 min (p < 0.01). Among European Americans only, every one-unit higher E-DII was associated with a 2.92-min longer wake-after-sleep-onset (p = 0.02). An E-DII score that is 5 points lower (i.e., more anti-inflammatory) would equate to about 105 min of additional sleep per week among European American women. Anti-inflammatory diets may help to counteract detriments in sleep during pregnancy, especially among European American women. Additional work is needed among African American women. Name: Promoting Health in Pregnancy and Postpartum (HIPP); URL: https://clinicaltrials.gov/ct2/show/NCT02260518; Registration Identifier: NCT02260518

Aim To clarify the meaning of the concept sleep quality. Background Sleep loss and sleep quality are global health concerns. Poor sleep quality has significant adverse health outcomes. A clarification of the term is necessary to inform patients and healthcare providers, promote consistent theoretical and operational definitions in research, and develop prevention and treatment strategies. Design Concept analysis. Data Sources Scientific literature from electronic databases (CINAHL, PsycINFO, PubMED, Web of Science, and JSTOR) and definitions from online dictionaries. Review Methods Rodgers' Evolutionary method was applied to guide the concept analysis to identify and determine the attributes, antecedents, and consequences. Results Sleep quality is defined as an individual's self-satisfaction with all aspects of the sleep experience. Sleep quality has four attributes: sleep efficiency, sleep latency, sleep duration, and wake after sleep onset. Antecedents include physiological (e.g., age, circadian rhythm, body mass index, NREM, REM), psychological (e.g., stress, anxiety, depression), and environmental factors (e.g., room temperature, television/device use), and family/social commitments. Good sleep quality has positive effects such as feeling rested, normal reflexes, and positive relationships. Poor sleep quality consequences include fatigue, irritability, daytime dysfunction, slowed responses, and increased caffeine/alcohol intake. Conclusions Sleep quality is essential, and poor sleep quality contributes to disease and poor health outcomes. Given the extensive consequences of poor sleep quality, nurses and clinicians are vital in instructing the importance of good sleep.