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Observational Study
. 2025 Jun 2;25(1):569.
doi: 10.1186/s12888-025-07017-6.

Sleep disturbance as a marker of postpartum psychosis risk: a prospective actigraphy study

Chiara Petrosellini  1   2   3 , Sofia H Eriksson  4   5 , Nicholas Meyer  6   7 , Edwin Antony  5 , Olivia Protti  8   9 , Lucinda Donaldson  10 , Vincent van Hees  11 , Aviva Petrie  12 , Andrew McQuillin  13 , Dimitrios Siassakos  8   14
Affiliations
Observational Study

Sleep disturbance as a marker of postpartum psychosis risk: a prospective actigraphy study

Chiara Petrosellini et al. BMC Psychiatry. .

Abstract

Background: Postpartum Psychosis (PP) is a severe perinatal psychiatric disorder affecting 1-2 in 1000 individuals following childbirth. Most episodes emerge within the first two weeks postpartum and commonly present with mania and decreased need for sleep. The postnatal period is a time of profound sleep disruption and sleep deprivation is a known trigger for mania and psychosis. Despite growing recognition of the role of sleep in the onset and progression of PP, this relationship remains poorly understood. Existing research is largely retrospective, relies on self-reported data and primarily focuses on women with pre-existing bipolar disorder. This prospective study will integrate subjective and objective sleep measures to investigate the relationship between sleep disturbance and postnatal mania. We aim to establish whether sleep patterns in late pregnancy or the early postpartum period can predict mania as a marker of PP.

Methods: This prospective observational cohort study is recruiting pregnant women and will follow participants from the late third trimester until two weeks postpartum. We aim to recruit 100 participants, including individuals with and without psychiatric illness, to ensure broader applicability of the findings and capture the full spectrum of postnatal mania risk. Participants will wear a wrist accelerometer continuously during this period to monitor rest-activity patterns and infer objective sleep parameters including sleep duration, efficiency and fragmentation. Self-reported sleep quality and mood symptoms will be measured using the Pittsburgh Sleep Quality Index (PSQI), Altman Self-Rating Mania Scale (ASRM) and Edinburgh Postnatal Depression Scale (PSQI) at baseline and at days 3-5 and 12-14 postpartum. Actigraphy data will be analysed using the GGIR package in R. Associations between sleep measures and ASRM scores will be assessed using Pearson and Spearman correlation coefficients.

Discussion: This study is the first to prospectively investigate sleep and postnatal mania risk in a cohort including both high- and low-risk individuals. By integrating actigraphy with validated self-report measures, it aims to identify rest-activity patterns that may serve as early indicators of PP. Early recognition of sleep disturbances associated with postnatal mania could inform targeted interventions, improving clinical outcomes for women and families affected by PP.

Keywords: Actigraphy; Bipolar disorder; Mania; Postpartum psychosis; Sleep disturbance; Sleep efficiency; Sleep fragmentation; Sleep quality.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Sleep, cLock gEnes and Education in Postpartum Psychosis (SLEEPP) Study was approved by the London - City & East Research Ethics Committee (REC) on 17/01/2024 (reference: 23/LO/0960). The study was registered with the UCL Data Protection Office (reference: Z6364106/2023/06/85) and all data were processed in accordance with the General Data protection Regulation requirements. Confirmation of capacity and capability to begin this study at UCLH was received on 16/02/2024 and recruitment is ongoing. We expect to complete recruitment by the end of October 2025. Written informed consent will be obtained from all participants. The study will be conducted in accordance with the Declaration of Helsinki. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
Study flow diagram. PSQI = Pittsburgh Sleep Quality Index; ASRM = Altman Self-Rating Mania scale; EPDS = Edinburgh Postnatal Depression Scale
Fig. 2
Fig. 2
Time intervals used for data analysis. PSQI = Pittsburgh Sleep Quality Index; ASRM = Altman Self-Rating Mania scale; EPDS = Edinburgh Postnatal Depression Scale
See this image and copyright information in PMC

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