Fiona Barwick, PhD, DBSM

All Publications

• Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study. BMC pregnancy and childbirth Miller, H. E., Simpson, S. L., Hurtado, J., Boncompagni, A., Chueh, J., Shu, C. H., Barwick, F., Leonard, S. A., Carvalho, B., Sultan, P., Aghaeepour, N., Druzin, M., Panelli, D. M. 2024; 24 (1): 366

  Abstract

  The potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy.This was a prospective pilot cohort of pregnant people between 23 to 36 weeks' gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters.Among the 60 participants who completed the study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: β 6.1, p = 0.01, MAP: β 6.2 p < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: β 9.6, p = 0.01, DBP: β 8.1, p < 0.001, and MAP: β 8.8, p < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP.When including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1-9.6 mmHg higher SBP, 6.1-8.1 mmHg higher DBP, and 6.2-8.8 mmHg higher MAP than people without anxiety.

  View details for DOI 10.1186/s12884-024-06540-w

  View details for PubMedID 38750438

  View details for PubMedCentralID 2941423

• Evaluation of Sleep in Pregnant Inpatients Compared With Outpatients. Obstetrics and gynecology Panelli, D. M., Miller, H. E., Simpson, S. L., Hurtado, J., Shu, C. H., Boncompagni, A. C., Chueh, J., Barwick, F., Carvalho, B., Sultan, P., Aghaeepour, N., Druzin, M. L. 2024

  Abstract

  To evaluate whether antepartum hospitalization was associated with differences in sleep duration or disrupted sleep patterns.This was a prospective cohort study with enrollment of pregnant people aged 18-55 years with singleton gestations at 16 weeks of gestation or more between 2021 and 2022. Each enrolled antepartum patient was matched by gestational age to outpatients recruited from obstetric clinics at the same institution. Participants responded to the ISI (Insomnia Severity Index) and wore actigraph accelerometer watches for up to 7 days. The primary outcome was total sleep duration per 24 hours. Secondary outcomes included sleep efficiency (time asleep/time in bed), ISI score, clinical insomnia (ISI score higher than 15), short sleep duration (less than 300 minutes/24 hours), wakefulness after sleep onset, number of awakenings, and sleep fragmentation index. Outcomes were evaluated with multivariable generalized estimating equations adjusted for body mass index (BMI), sleep aid use, and insurance type, accounting for gestational age correlations. An interaction term assessed the joint effects of time and inpatient status.Overall 58 participants were included: 18 inpatients and 40 outpatients. Inpatients had significantly lower total sleep duration than outpatients (mean 4.4 hours [SD 1.6 hours] inpatient vs 5.2 hours [SD 1.5 hours] outpatient, adjusted β=-1.1, 95% CI, -1.8 to -0.3, P=.01). Awakenings (10.1 inpatient vs 13.8, P=.01) and wakefulness after sleep onset (28.3 inpatient vs 35.5 outpatient, P=.03) were lower among inpatients. There were no differences in the other sleep outcomes, and no interaction was detected for time in the study and inpatient status. Inpatients were more likely to use sleep aids (39.9% vs 12.5%, P=.03).Hospitalized pregnant patients slept about 1 hour/day less than outpatients. Fewer awakenings and reduced wakefulness after sleep onset among inpatients may reflect increased use of sleep aids in hospitalized patients.

  View details for DOI 10.1097/AOG.0000000000005591

  View details for PubMedID 38663016

• Prevalence and predictors for postpartum sleep disorders: a nationwide analysis. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Sultan, P., Guo, N., Kawai, M., Barwick, F. H., Carvalho, B., Mackey, S., Kallen, M. A., Gould, C. E., Butwick, A. J. 2023; 36 (1): 2170749

  Abstract

  To describe the prevalence and predictors of postpartum sleep disorders.A retrospective cohort study.Postpartum.Commercially insured women delivering in California (USA) between 2011 and 2014.Using the Optum Clinformatics Datamart Database.Prevalence of a postpartum sleep disorder diagnosis with and without a depression diagnosis up to 12 months following hospital discharge for inpatient delivery. We also identified predictors of a postpartum sleep disorder diagnosis using multivariable logistic regression.We identified 3535 (1.9%) women with a postpartum sleep disorder diagnosis. The prevalence of sleep disorder diagnoses was insomnia (1.3%), sleep apnea (0.25%), and other sleep disorder (0.25%). The odds of a postpartum sleep disorder were highest among women with a history of drug abuse (adjusted odds ratio (aOR): 2.70, 95% confidence interval (CI): 1.79-4.09); a stillbirth delivery (aOR: 2.15, 95% CI: 1.53-3.01); and chronic hypertension (aOR: 1.82; 95% CI: 1.57-2.11). A comorbid diagnosis of a postpartum sleep disorder and depression occurred in 1182 women (0.6%). These women accounted for 33.4% of all women with a postpartum sleep disorder. The strongest predictors of a comorbid diagnosis were a history of drug abuse (aOR: 4.13; 95% CI: 2.37-7.21) and a stillbirth delivery (aOR: 2.93; 95% CI: 1.74-4.92).Postpartum sleep disorders are underdiagnosed conditions, with only 2% of postpartum women in this cohort receiving a sleep diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Insomnia was the most common disorder and one-third of women diagnosed with a postpartum sleep disorder had a co-morbid diagnosis of depression. Future studies are needed to improve the screening and diagnostic accuracy of postpartum sleep disorders.

  View details for DOI 10.1080/14767058.2023.2170749

  View details for PubMedID 36710393

• DYNAMIC FEATURES OF THE TREATMENT PROCESS PREDICT DIFFERENT OUTCOMES FOR PATIENTS UNDERGOING COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA Hu, Y., Xu, Y., Barwick, F. OXFORD UNIV PRESS INC. 2022: A209

  View details for Web of Science ID 000838094800468

• RESTLESS LEG SYNDROME: DOES IT START WITH A GUT FEELING? Blum, D. J., During, E., Barwick, F., Davidenko, P., Zeitzer, J. M. OXFORD UNIV PRESS INC. 2019

  View details for Web of Science ID 000471071000011

• Factors associated with fatigue in patients with insomnia. Journal of psychiatric research Kim, S. J., Kim, S. n., Jeon, S. n., Leary, E. B., Barwick, F. n., Mignot, E. n. 2019; 117: 24–30

  Abstract

  Although fatigue is common in insomnia, the clinical associates of fatigue in patients with insomnia are largely unknown. We aimed to investigate the clinical associates of fatigue in patients with insomnia. Patients visiting the Stanford Sleep Medicine Center completed the Insomnia Severity Index (ISI), Insomnia Symptom Questionnaire (ISQ), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). Among 6367 patients, 2024 were diagnosed with insomnia (age 43.06 ± 15.19 years; 1110 women and 914 men) according to the ISI and the ISQ. Insomnia patients with severe fatigue (n = 1306) showed higher insomnia symptoms, daytime sleepiness, depression and longer habitual sleep duration than those without severe fatigue (n = 718). Higher insomnia symptoms, daytime sleepiness and depressive symptoms, and longer habitual sleep duration, independently predicted higher fatigue scores. Among insomnia patients with daytime sleepiness (ESS≥10), only habitual sleep duration and depression predicted fatigue scores. The interaction between insomnia severity and daytime sleepiness significantly predicted the severity of fatigue. Depression was a significant mediator between insomnia and fatigue. For 598 insomnia patients undergoing overnight polysomnography (PSG), no significant correlations were found between fatigue and any PSG parameters. The current study suggests that managing insomnia or depression may reduce the fatigue of insomnia patients, whereas arbitrary efforts to prolong sleep duration may worsen their fatigue.

  View details for DOI 10.1016/j.jpsychires.2019.06.021

  View details for PubMedID 31272015

• Sleep, sleeplessness and neuropsychiatric conditions. Practical Neurology Barwick, F. 2019
• Managing Sleep for Optimal Performance, Brain Function, and Mental Health LIFESTYLE PSYCHIATRY Kutscher, S., Barwick, F., Noordsy, D. L. 2019: 261–83

  View details for Web of Science ID 000552225000017

• Sleep disorders in patients with postural tachycardia syndrome: A review of the literature and guide for clinicians AUTONOMIC NEUROSCIENCE-BASIC & CLINICAL Miglis, M. G., Barwick, F. 2018; 215: 62–69

  View details for DOI 10.1016/j.autneu.2018.05.002

  View details for Web of Science ID 000455067500009

• Commentary: Parent-Reported Behavioral and Psychiatric Problems Mediate the Relationship between Sleep-Disordered Breathing and Cognitive Deficits in School-Aged Children FRONTIERS IN NEUROLOGY Barwick, F., Guilleminault, C. 2017; 8: 597

  View details for PubMedID 29180980