Fiona Barwick, PhD, DBSM

All Publications

• Insomnia disorder at 6 weeks postpartum: a prospective study. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Takenoshita, M., Jalali-Sohi, A., Hidajat, N. Z., Michel, G., Guo, N., Manber, R., Lyell, D. J., Barwick, F., Morris, A. M., Moody, H., Elkhateb, R., Mhyre, J., Cella, D., Shaunfield, S., Mackey, S., Tian, L., Carmichael, S. L., Panelli, D. M., Tang, X., Sultan, P. 2026; 22 (1)

  Abstract

  To estimate the prevalence of insomnia disorder and insomnia symptoms, explore risk factors for insomnia disorder, and characterize sleep at 6 weeks postpartum.Following IRB approval, adults who delivered a live infant at two academic US hospitals were prospectively recruited with a pre-specified cross-sectional analysis planned at 6 weeks postpartum, evaluating new sleep disturbance (SD) and sleep-related impairment (SRI) surveys. Participants were invited to complete surveys (Bergen Insomnia Scale (BIS), PROMIS SD, and SRI), and a structured clinical interview for sleep disorders (SCISD-R, the diagnostic standard), at 6 weeks postpartum, until 150 interviews were completed. Demographic and clinical variables were collected. Primary outcome was prevalence of insomnia disorder by SCISD-R; secondary outcomes were sleep characteristics and survey scores, clinical and sociodemographic factors associated with insomnia disorder, and exploratory evaluation of the diagnostic accuracy of BIS, PROMIS SD, and SRI for insomnia disorder identified by SCISD-R. Associations were assessed using univariate odds ratios and 95% confidence intervals, and receiver operating characteristic (ROC) curve was used to evaluate diagnostic accuracy of the surveys.Of the 188 patients who accepted interview invitations, 150 completed interviews (79.8%) at 44 ± 7 days postpartum, mean age 33 ± 5 years. Insomnia symptoms were reported in 38 (25.3%) patients and 20 (13%) met diagnostic criteria for insomnia disorder. Only 2 had received clinical evaluation. Among 144 respondents, median BIS, PROMIS SD, and SRI T scores were 20 [IQR 14-27], 51 [IQR 45-56], and 57 [IQR 50-62] respectively, indicating normal SD and mild SRI in most patients. Fifty-one percent reported low or very low sleep satisfaction. Seventy percent reported sleeping ≤ 6 h. No statistically significant factors associated with insomnia disorder were identified, likely reflecting insufficient power rather than a true null finding. ROC curve analysis of BIS, PROMIS SD, and SRI in identifying insomnia disorder yielded area under the curve values of 0.73, 0.85, and 0.70 respectively.The prevalence of insomnia disorder at 6 weeks postpartum was 13%, with most cases clinically undiagnosed. Improved screening strategies are needed.Insomnia disorder is the most common sleep disorder in the postpartum period and accounts for up to 68% of sleep disorders; however, prevalence estimates of insomnia disorder in the first year after delivery vary widely. We aimed to estimate the prevalence of insomnia disorder and insomnia symptoms, explore risk factors associated with insomnia disorder, and characterize sleep at 6 weeks postpartum.The prevalence of insomnia disorder at 6 weeks postpartum was 13%, with most cases clinically undiagnosed, demonstrating that improved screening strategies are needed. Beyond diagnosed insomnia disorder, a larger population of patients endorsed clinically meaningful sleep disturbance and sleep-related impairment without meeting diagnostic criteria for sleep disorder, revealing a gap in current sleep medicine frameworks that may leave affected patients overlooked in clinical care.

  View details for DOI 10.1007/s44470-026-00150-3

  View details for PubMedID 42675333

  View details for PubMedCentralID 2975741

• SYMPOSIUM: NOVEL BEHAVIORAL MEDICINE ASSESSMENTS / INTERVENTIONS FOR SUCCESSFUL TREATMENT OF OBSTRUCTIVE SLEEP APNEA (OSA) WITH COMORBID INSOMNIA (COMISA) Barwick, F., Tingey, J., Sepulveda, M., Capasso, R. OXFORD UNIV PRESS INC. 2025: S636-S637

  View details for Web of Science ID 001691132305059

• Development and Validation of the Stanford Obstetric Recovery Checklist (STORK): A Delphi Consensus and Multicenter Clinical Validation Study. JAMA network open Sultan, P., Pandal, P., Murthy, A., Guo, N., Farber, M. K., Toledo, P., Higgins, N., Fiore, J. F., Domingue, B. W., Khorasani, E., Jensen, S. E., Lyell, D. J., Carvalho, B. 2025; 8 (4): e255713

  Abstract

  Existing patient-reported outcome measures (PROMs) evaluating outpatient postpartum recovery lack content validity and were mostly not designed for this population. A Delphi process was performed, aiming to develop a patient-reported outcome measure for outpatient postpartum recovery and then evaluate it in a multicenter cohort study.Development of the Stanford Obstetric Recovery Checklist (STORK) involved 3 phases: (1) postpartum recovery questions were identified in published reviews; (2) after institutional review board approval, 16 multidisciplinary experts and patient stakeholders participated in 3 Delphi rounds (January 11 to April 12, 2021) to select items, resulting in the development of STORK (47 items; total score range, 0-188, with 0 indicating the worst recovery and 188 indicating the best recovery); and (3) cognitive debriefing interviews were conducted with 10 postpartum individuals to finalize STORK items. Individuals then completed STORK during their inpatient stay and at 2, 6, and 12 weeks post partum in a prospective, 3-center, US longitudinal cohort study conducted from June 13, 2022, to February 28, 2023. Recruitment occurred until 300 six-week STORK surveys were completed. STORK was evaluated at 6 weeks for validity (ability to measure recovery), reliability, and responsiveness. Validity included (1) structural validity (exploratory factor analysis using root mean square residual [RMSR]; <0.08 indicates a good fit); (2) convergent validity (correlation with global health visual analog scale score [GHVAS; scale, 0-100] and EuroQoL Five-Dimensions Three-Levels [EQ-5D-3L]); (3) discriminant validity (mean difference in STORK scores with GHVAS <70 vs ≥70); and (4) confirmatory telephone interviews with postpartum individuals scoring the highest and lowest 10th percentiles of STORK scores. Reliability (consistency of STORK scores) was evaluated using Cronbach α, interitem correlation, split-half reliability, and floor and ceiling effects. Responsiveness (ability of STORK to detect changes in recovery over time) was evaluated using percentage change in score from baseline to 12 weeks.A total of 525 individuals were recruited after all delivery modes (response rate, 62% [324 of 525] at 6 weeks); 498 (mean [SD] age, 33.3 [4.9] years) completed baseline inpatient postpartum surveys. STORK demonstrated validity: (1) a 4-factor model was the best fit (RMSR = 0.05); (2) correlation with GHVAS scores was ρ = 0.52 (95% CI, 0.43-0.61), and correlation with EQ-5D-3L scores was ρ = -0.67 (95% CI, -0.76 to -0.63); (3) STORK was able to discriminate between patients reporting good and poor recovery (good recovery: median STORK score, 151 [IQR, 136-163] vs poor recovery: median STORK score, 129 [IQR, 107-148]; P < .001); and (4) the highest and lowest scores corresponded to subjective assessments. STORK demonstrated reliability (Cronbach α = 0.92; interitem correlation r = 0.20; and split-half reliability ρ = 0.98). It also demonstrated responsiveness: percentage increases in overall STORK scores from baseline to week 12 were 19% after spontaneous vaginal delivery, 31% after operative vaginal delivery, 27% after scheduled cesarean delivery, and 20% after nonscheduled cesarean delivery (P < .001).In this cohort study of US individuals, STORK was found to be a valid, reliable, and responsive measure of outpatient postpartum recovery. Future clinical trials are needed to determine its clinical utility.

  View details for DOI 10.1001/jamanetworkopen.2025.5713

  View details for PubMedID 40244582

• 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

• Insomnia in pregnancy: are hospitalized inpatients sleeping less than outpatients? Panelli, D. M., Miller, H. E., Simpson, S. L., Hurtado, J., Shu, C., Boncompagni, A. C., Chueh, J., Barwick, F., Carvalho, B., Sultan, P., Aghaeepour, N., Druzin, M. L. MOSBY-ELSEVIER. 2024: S378

  View details for Web of Science ID 001282913903132

• Association of antenatal anxiety, short sleep duration, and blood pressure parameters: a pilot study Miller, H. E., Simpson, S. L., Hurtado, J., Shu, C., Chueh, J., Barwick, F., Leonard, S. A., Carvalho, B., Sultan, P., Aghaeepour, N., Druzin, M. L., Panelli, D. M. MOSBY-ELSEVIER. 2024: S287

  View details for Web of Science ID 001282913902153

• 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. edited by 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