Editors' ChoiceSleep

Resting and gestating

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Science Translational Medicine  24 Feb 2016:
Vol. 8, Issue 327, pp. 327ec29
DOI: 10.1126/scitranslmed.aaf3850

Preterm birth and its complications are the leading cause of infant death. Several risk factors, including poor nutrition, race, and comorbidities, have been identified, but how they cause preterm birth is unclear. Long-chain polyunsaturated fatty acids in our diets, particularly ω-3 docosahexanoic acid (DHA), are crucial for fetal development, and higher levels are associated with longer gestation. Thus, Christian and colleagues examined potential mechanistic pathways linking DHA to gestational length. The investigators enrolled a total of 135 pregnant women into the study; evaluated nutrition [DHA and arachidonic acid (AA)], sleep, and serum inflammatory markers during their second trimester; and looked for an association with gestational length. Low levels of DHA as well as a low DHA:AA ratio were associated with shorter gestation. High interleukin-8 and poor sleep quality were found, through serial mediation models, to be significant steps in the pathway between DHA and gestational length. This suggests that the influence of nutritional status of fatty acids on gestational length is mediated by inflammatory factors and sleep. One limitation of this study is that sleep disorders were not assessed; specifically, obstructive sleep apnea, which increases in prevalence during pregnancy, has numerous effects, including disrupted sleep, increased inflammatory markers, hypoxia, cardiovascular stress, and other physiological changes that may influence the proposed mechanism. Additionally, the authors used the Pittsburgh Sleep Quality Index, which is a subjective measure of sleep quality; an objective measure such as polysomnography or actigraphy would have enhanced the study. This study underscores the importance of a holistic approach of improving sleep and reducing inflammation, in addition to optimizing nutrition, to improve pregnancy outcomes. Furthermore, Christian et al. demonstrate that sleep and inflammation are involved in seemingly unrelated physiological processes, and that sleep should perhaps be incorporated more broadly into mechanistic models of nutrition, neuropsychiatric function, and cardiovascular disease, to name a few.

L. M. Christian et al., Polyunsaturated fatty acid (PUFA) status in pregnant women: Associations with sleep quality, inflammation, and length of gestation. PLOS ONE 10.1371/journal.pone.0148752 (2016). [Full Text]

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