Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans
Open accessAbstract
STUDY OBJECTIVES: Poor sleep promotes inflammation. In turn, inflammation is a causal mechanism in term as well as preterm parturition. In the United States, a persistent racial disparity in preterm birth exists, with African Americans showing ∼1.5 times greater risk. This study examined associations among sleep quality, serum proinflammatory cytokines, and length of gestation in a racially diverse sample of 138 pregnant women. DESIGN: Observational. MEASUREMENTS: Women completed the Pittsburgh Sleep Quality Index (PSQI) and other psychosocial and behavioral measures during midpregnancy. Serum levels of interleukin (IL)-6, IL-8, IL-1β, and tumor necrosis factor (TNF)-α were determined by high-sensitivity assays. Birth outcomes were determined via medical record review. RESULTS: Among African American women (n = 79), shorter gestation was predicted by poorer overall sleep (rs = -0.35, P = 0.002) as well the following PSQI subscales: subjective sleep quality (rs = -0.34, P = 0.002), sleep latency (rs = -0.27, P = 0.02), and sleep efficiency (rs = -0.27, P = 0.02). African American women with poor sleep quality (PSQI > 5) had 10.2 times the odds of preterm birth compared to those with good sleep quality. In contrast, among European American women (n = 53), gestational length was not significantly predicted by sleep quality (Ps > 0.12). Bootstrapping analyses showed that, among African Americans, IL-8 significantly mediated the association between sleep quality and length of gestation (indirect effect estimate -0.029; 95% confidence interval -0.06, -0.002). CONCLUSIONS: The data provide novel evidence that African American women exhibit greater inflammation in response to sleep disturbance than European American women and these effects correspond with length of gestation. Racial differences in susceptibility to sleep induced immune dysregulation may contribute to marked racial disparities in preterm birth.
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Self-reported short or long sleep duration and poor sleep quality may be consistently associated with adverse health outcomes.
“self-reported short or long sleep duration (often defined as <6 or 7 and >8 or 9 h, respectively) and poor sleep quality [Pittsburgh Sleep Quality Index (PSQI) > 5] may be consistently associated with adverse health outcomes”
From Sleep Duration/Quality with Health Outcomes: An Umbrella Review of Meta-Analyses of Prospective Studies (2022) · cites this paper as [4]
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- Authors
- Blair, L. M., Porter, K., Leblebicioglu, B., & Christian, L. M.
- Affiliations
- The Ohio State University (US)
- Department of Dentistry, The Ohio State University, Columbus, OH
- The Ohio State University Wexner Medical Center (US)
- Corresponding author
- Christian, Lisa M.
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-08-01
- Volume
- 38
- Issue
- 8
- Pages
- 1259-1267
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC4507731
- OpenAlex
- W1940618374
- Cited by
- 179
- References
- 64
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 12 · 2023: 9 · 2022: 17 · 2021: 21 · 2020: 59 · 2019: 21 · 2018: 10 · 2017: 8 · 2016: 3
- FWCI
- 5.50
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- SLEEP (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ohio State University
- National Institutes of Health (UL1TR001070)
- College of Dentistry, Ohio State University
- National Institute of Nursing Research (T32NR014225)
- National Center for Research Resources
- NIH Clinical Center
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R21HD067670, R21HD061644, HD067670, HD061644)
- Topics
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- preterm birth, sleep quality, inflammation, inflammatory cytokines, interleukin-8, racial disparities, African American women, European American women, gestation length, sleep disorders, immune dysregulation, pregnancy
- MeSH terms
- Adolescent, Adult, Black or African American, Cross-Sectional Studies, Europe, Female, Gestational Age, Humans, Infant, Newborn, Inflammation, Interleukins, Pregnancy, Risk Factors, Sleep, Sleep Deprivation, Tumor Necrosis Factor-alpha, United States, Interleukin-8, White People, Premature Birth, Young Adult
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