Postpartum Behavioral Sleep Intervention for Smoking Relapse Prevention: A Pilot Trial.

OBJECTIVES: Rates of postpartum smoking relapse are high (70-90%) but standard relapse prevention interventions are not effective postpartum. This pilot study evaluated effects of a combined relapse prevention and sleep intervention on sleep and relapse to smoking. METHODS: Twenty-eight postpartum mothers were assigned to the intervention group-combined relapse prevention and behavioral sleep intervention-or to the comparison group-relapse prevention alone. Questionnaires and actigraphy were completed at baseline (1-week postpartum), post-treatment (8-weeks postpartum), and follow-up (12-weeks postpartum). Sleep diaries were completed weekly for the first 8 weeks postpartum and once at 12 weeks postpartum. To corroborate abstinence, CO levels in expired air were measured weekly for the first 8 weeks postpartum and at follow-up. Timeline Followback (TLFB) and salivary cotinine analysis were conducted at baseline, post-treatment, and follow-up to assess for nicotine and other substance use (TLFB) and to further corroborate abstinence (salivary cotinine analysis). RESULTS: The sleep intervention lengthened maternal nighttime actigraphic sleep by an average of 48 minutes nightly; lengthened the longest bout of consolidated actigraphic sleep by an average of 42 minutes nightly; increased actigraphic sleep efficiency into the healthy range (> 85%); and lowered subjective ratings of sleep disturbance (ps < .05). Findings were inconclusive regarding whether better sleep was associated with abstinence. Post Hoc analyses identified the presence of an additional support person in the home as well as social and emotional support as being positively correlated with smoking abstinence (p < .05; p < .01). CONCLUSIONS FOR PRACTICE: (1) Postpartum sleep can be improved with behavioral interventions in women with a history of smoking. (2) Social-emotional postpartum support is an important factor in preventing smoking relapse for these women.

Sleep problems in children with prenatal substance exposure: the Maternal Lifestyle study.

OBJECTIVE: To examine the associations between sleep problems and prenatal exposure to cocaine, opiates, marijuana, alcohol, and nicotine in children aged 1 month to 12 years. DESIGN: Sleep data were collected by maternal report in a prospective longitudinal follow-up of children participating in the Maternal Lifestyle multisite study. SETTING: Hospital-based research centers in Providence, Rhode Island; Miami, Florida; Detroit, Michigan; and Memphis, Tennessee. PARTICIPANTS: There were 808 participants, 374 exposed to cocaine and/or opiates, and 434 comparison subjects. MAIN EXPOSURE: Prenatal cocaine, opiate, marijuana, alcohol, and/or nicotine exposure. OUTCOME MEASURE: Sleep problems in early, middle, and/or late childhood, assessed as composites of maternal report items. RESULTS: Of the 5 substances, prenatal nicotine exposure was the only unique predictor of sleep problems (B = 0.074, R(2) change = 0.008, P = .01), with adjustment for covariates, including socioeconomic status, marital status, physical abuse, prenatal medical care, and postnatal cigarette smoke exposure. CONCLUSIONS: Prenatal exposure to nicotine was positively associated with children's sleep problems persisting throughout the first 12 years of life. Targeting of this group of children for educational and behavioral efforts to prevent and treat sleep problems is merited given that good sleep may serve as a protective factor for other developmental outcomes.

Longitudinal study of maternal report of sleep problems in children with prenatal exposure to cocaine and other drugs.

Sleep data were collected by maternal report in a prospective longitudinal follow up of cocaine-exposed and unexposed children. There were 139 participants: 23 with no prenatal drug exposure, 55 exposed to cocaine alone or in combination with other drugs, and 61 exposed to drugs other than cocaine. Characteristics differed between exposure groups including birth size, caretaker changes, maternal socioeconomic status, and postnatal drug use. Compared to those with no drug exposure, children with prenatal drug exposure other than cocaine experienced greater sleep problems (p = .026). Prenatal nicotine exposure was a unique predictor of sleep problems (p = .048). Early sleep problems predicted later sleep problems (all ps < .01). Together, these preliminary findings suggest possible neurotoxic sleep effects that persist over time. Larger studies, however, need to be conducted that better control for potential postnatal confounding factors.