Intervenções não-farmacológicas para melhoria da qualidade do sono durante a gravidez: Uma revisão sistemática e metanálise

Paulino, Daiane Sofia Morais; Borrelli, Carolina Bicudo; Faria-Schützer, Débora Bicudo; Brito, Luiz Gustavo Oliveira; Surita, Fernanda Garanhani

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev Bras Ginecol Obstet. 44 (08) • 2022 • https://doi.org/10.1055/s-0042-1746200 copiar

Intervenções não-farmacológicas para melhoria da qualidade do sono durante a gravidez: Uma revisão sistemática e metanálise

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo

Investigar o efeito de intervenções não-farmacológicas para melhorar a qualidade do sono durante a gravidez.

Fontes dos dados

Uma busca foi feita nas bases de dados NBCI/PubMed, ClinicalTrials.gov, Embase, BVS, e Web of Science. Não houve limitações quanto ao idioma, tamanho da amostra e tipo de intervenção não-farmacológica. Incluímos estudos clínicos prospectivos entre julho de 2014 e julho de 2019.

Seleção dos estudos

Foi realizado um registro no banco de dados Prospective International Registration of Systematic Reviews (PROSPERO). O viés de publicação foi avaliado com gráficos de funil. O desfecho primário foi a pontuação total do Pittsburgh Sleep Quality Index (PSQI) antes e depois da intervenção. O risco de viés e os critérios Grading of Recommendations Assessment, Development, and Evaluation (GRADE) foram usados para avaliar a qualidade metodológica. Dos 28 estudos encontrados, selecionamos 8 para análise qualitativa e 6 para a metanálise.

Coleta de dados

Dois revisores independentes realizaram a seleção dos estudos. Em caso de discordância, um terceiro revisor foi consultado. Inicialmente o estudo foi avaliado com base no título e resumo. Para a inclusão, foi avaliado o texto completo.

Síntese dos dados

Uma melhora significativa na qualidade do sono (PSQI score) foi observada quando todas as intervenções foram agrupadas (MD = -3.03, 95% CI -4.15 a -1.92, n= 623, i²= 84%, p< 0.001). A análise por subgrupo (escutar música: MD = -1.96, 95% CI -3.27 a -0.65, n= 207, i²= 67%, p= 0.003 e outras intervenções: MD = -3.66, 95% CI -4.93 a -2.40, n= 416, i2 = 80%, p< 0.001) também mostrou uma melhora da qualidade do sono, porém com alta heterogeneidade. A análise do risco de viés mostrou que quase todos os estudos avaliados apresentaram viés de desempenho e detecção, e o nível de evidência GRADE foi muito baixo para todas as variáveis analisadas.

Conclusão

Intervenções não-farmacológicas - ouvir música, exercícios físicos, exercícios de relaxamento, sementes de alface, higiene do sono e acupressão - são eficazes para melhorar a qualidade do sono durante a gravidez.

Palavras-chave
qualidade do sono; intervenções não-farmacológicas; gestantes; revisão sistemática; metanálise

Study ID	Country	Year	Sample size, N		Participant criteria	Intervention		Instrument
			Intervention	Control		Strategies/Intervention	Duration
Özkan and Rathfisch²³23 Özkan SA, Rathfisch G. The effect of relaxation exercises on sleep quality in pregnant women in the third trimester: A randomized controlled trial. Complement Ther Clin Pract. 2018;32:79–84. Doi: 10.1016/j.ctcp.2018.05.008 https://doi.org/10.1016/j.ctcp.2018.05.0...	Turkey	2018	42	42	3rd trimester, ≥ 20 y, primiparous, singleton, HRP, GA 28–34 weeks, pre-pregnancy BMI ≤ 25 kg/m², neck circumference < 38 cm, and no RLS.	Listening to a relaxation exercises CD before sleeping. The CD comprised a 4-minute introduction, 10-minute of information on deep relaxation PE and points to consider during PE, 30-minute introduction to relaxation, and the last 30 minute includes relaxation music.	4 weeks	PSQI
Pour et al.²⁴24 Pour ZS, Hosseinkhani A, Asadi N, Shahraki HR, Vafaei H, Kasraeian M, et al. Double-blind randomized placebo-controlled trial on efficacy and safety of Lactuca sativa L. seeds on pregnancyrelated insomnia. J Ethnopharmacol. 2018;227:176–180. Doi: 10.1016/j.jep.2018.08.001 https://doi.org/10.1016/j.jep.2018.08.00...	Iran	2018	50	50	20–45 y, singleton pregnancy, GA 12–36 weeks, with insomnia and PSQI score > 5.	IG received capsules containing 1000 mg of lettuce seed daily. CG received placebo capsules containing starch.	2 weeks	PSQI
Rodriguez-Blanque et al.²²22 Rodriguez-Blanque R, Sánchez-García JC, Sánchez-López AM, Mur-Villar N, Aguilar-Cordero MJ. The influence of physical activity in water on sleep quality in pregnant women: A randomised trial. Women Birth. 2018;31(01):e51–e58. Doi: 10.1016/j. wombi.2017.06.018 https://doi.org/10.1016/j.wombi.2017.06....	Spain	2018	67	67	GA 12–20 weeks, without any absolute contraindications for PE^* ** Involved general perception of sleep quality and quantity, number of awakenings, difficulty falling asleep, insomnia, restless sleep, snoring, diurnal sleep, and consequences of inadequate sleep. .	IG took part in the SWEP program, performing three 1-hour sessions/week water exercises. CG followed the usual recommendations, including emphasis on the positive effects of PE.	17 weeks	PSQI
Sönmez and Derya²⁵25 Sönmez A, Aksoy Derya Y. Effects of sleep hygiene training given to pregnant women with restless leg syndrome on their sleep quality. Sleep Breath. 2018;22(02):527–535. Doi: 10.1007/ s11325-018-1619-5 https://doi.org/10.1007/s11325-018-1619-...	Turkey	2018	64	64	Diagnoses of RLS, literate, at 3rd trimester, HRP, using iron supplementation, without sleep disorder.	IG received sleep hygiene training. A sleep hygiene training booklet was issued after training, and 2 weeks later, during a home visit, participants received a counseling service on sleep hygiene.	4 weeks	PSQI
Kocsis et al.¹⁹19 Kocsis I, Szilágyi T, Turos J, Bakó A, Frigy A. Effect of a gymnastics program on sleep characteristics in pregnant women. Taiwan J Obstet Gynecol. 2017;56(02):204–209. Doi: 10.1016/j.tjog.2017. 02.001 https://doi.org/10.1016/j.tjog.2017.02.0...	Romania	2017	79	53	HRP, 18–40 y, GA 18–22 weeks, BMI < 35 kg/m², parity < 3.	IG followed a specific PE program under strict instruction by a PE training specialist. The PE program structure involved 2-hour training sessions twice a week. PE included posture correction, preserving muscle tone, and strengthening pelvic and posterior muscles, breathing exercises, and relaxation techniques.	10 weeks	CDQ^ Involved general perception of sleep quality and quantity, number of awakenings, difficulty falling asleep, insomnia, restless sleep, snoring, diurnal sleep, and consequences of inadequate sleep.
Neri et al.¹⁸18 Neri I, Bruno R, Dante G, Facchinetti F. Acupressure on selfreported sleep quality during pregnancy. J Acupunct Meridian Stud. 2016;9(01):11–15. Doi: 10.1016/j.jams.2015.11.036 https://doi.org/10.1016/j.jams.2015.11.0...	Italy	2016	134	101	HRP, singleton pregnancy, ability to understand Italian, with feelings of anxiety and poor sleep quality.	IG was advised by a midwife (trained by an expert acupuncturist) to wear a soft rubber pin kept in place by an adhesive plaque able to exert acupressure on Point 7 of the heart meridian.	2 weeks	PSQI
Shobeiri et al.²⁰20 Shobeiri F, Khaledi S, Masoumi SZ, Roshanaei G. The effect of music therapy counseling on sleep quality in pregnant women. Int J Med Res Health Sci.. 2016;5(9S):408–416	Iran	2016	42	44	PSQI score > 5, 18–35 y, GA 30–34 weeks, singleton pregnancy, no drug addiction, not taking drugs affecting sleep quality, avoiding antidepressants use, without mental/physical disorders, access to an audio player at home.	IG received music therapy counseling in two weekly sessions, with each session lasting 60 minutes, in groups of 5–7 people. The music therapy method was passive music-listening (instrumental music by Kitaro, a Japanese composer and performer).	4 weeks	PSQI
Liu et al.²¹21 Liu YH, Lee CS, Yu CH, Chen CH. Effects of music listening on stress, anxiety, and sleep quality for sleep-disturbed pregnant women. Women Health. 2016;56(03):296–311. Doi: 10.1080/03630242. 2015.1088116 https://doi.org/10.1080/03630242.2015.10...	Taiwan	2016	61	60	PSQI score > 5, > 18y, GA 18–34 weeks.	IG was instructed to listen to at least one disc (30-minute) of the five prerecorded CDs compiled by the researcher or a minimum 30 minute of their preferred music per day at bedtime for 2 weeks. CG received the usual prenatal care.	2 weeks	Chinese version of the PSQI

Certainty assessment						Participants, n (before and after)		Absolute effect (95% CI)	Certainty
Number of studies	Study design	Risk of bias	Inconsistence	Indirect evidence	Imprecision	IC	CG	Absolute effect (95% CI)	Certainty
Non-pharmacological interventions - Music listening
2	Randomized clinical trial	Severe^a	Severe^b	Not severe	Severe^c	103	104	MD −1.96 (−3.27 to −0.65)	⊕⚪⚪⚪ Very low
Non-pharmacological interventions - Other interventions
4	Randomized clinical trial	Severe^a	Severe^b	Too severe^d	Severe^c	208	208	MD −3.66 (−4.93 to −2.4)	⊕⚪⚪⚪ Very low

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[1] Address for correspondence Fernanda Garanhani Surita, Professor of Obstetrics (Full), R. Alexander Fleming, 101, 13083-881, Campinas, SP, Brazil (surita@unicamp.br).