Dear Editor,
The study by Rahmani et al. [1] evaluated the effects of cognitive behavioral therapy, with or without the use of Citrus aurantium essential oil, on sleep quality in pregnant women, as well as on anxiety and quality of life. Previous studies have shown that the quality of sleep of pregnant women tends to get worse over the course of the pregnancy, considering PSQI scores [2]. The publication of this interesting study in this reputable journal helps to fill a gap in the knowledge and provide valuable insights for healthcare professionals and researchers working in the field of maternal health. The study showed a reduction in anxiety and an improvement in quality of life in both intervention groups, when compared to a control group. However, in respect of sleep quality, the main outcome of the study, no differences were found between the experimental groups and the control group. It would be reasonable to expect that the reduced anxiety and increased quality of life would have had a positive impact on sleep.
Thus, this interesting finding requires further consideration given the fact that a recent systematic review and meta-analysis reported that cognitive behavioral therapy during pregnancy reduced the severity of insomnia, as well as the symptoms of depression and anxiety [3]. Moreover, our group undertook a study in another population of women who are subject to sleep disturbance, namely postmenopausal women. In this study, both groups received guidance on sleep hygiene, one of the pillars of CBT when delivered to improve sleep, while one group received aromatherapy and the other a placebo. We found that both groups had increased total sleep time and sleep efficiency, regardless of the use of aromatherapy [4].
One explanation for the findings in the study by Rahmani et al. is that the authors used only a subjective method, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, to assess sleep quality. Thus, we recommend that in future studies additional instruments, such as a sleep diary and actigraphy, should be used to improve the assessment of sleep. Actigraphy is an objective, non-invasive method that records patterns of activity and rest, offering data that are consistent with polysomnography (considered the gold standard in the diagnosis of sleep disorders). In addition to being affordable, actigraphy allows you to estimate sleep parameters, such as total sleep time, sleep latency and sleep efficiency, which contribute to a better assessment of objective sleep quality [5]. These assessment methods offer more precision in respect of the measurement of sleep variations over time, complementing the subjective assessments obtained through the PSQI.
We would like to emphasize the importance of the study by Rahmani et al. [1], as it showed that cognitive therapy can reduce anxiety and improve quality of life during pregnancy. However, we encourage researchers to consider including objective measures for a more in-depth analysis of sleep variables during pregnancy, although we stress that both subjective and objective aspects are valuable in the assessment of sleep.
Funding
This letter was funded by AFIP and CNPq.
Declarations
Conflict of interest
No potential conflicts of interest were reported by the authors.
Footnotes
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References
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