42 Sleep-disordered breathing in pregnancy and its effect on endothelial and metabolic dysfunction

Abstract

Prior studies have demonstrated that sleep-disordered breathing (SDB) is a risk factor for preeclampsia and gestational diabetes. The pathophysiology of SDB in pregnancy remains poorly understood. We sought to examine vascular, angiogenic and metabolic markers in obese pregnant participants with and without SDB. Participants with a BMI ≥ 30 underwent overnight polysomnography (PSG) at 14-20 weeks (visit 1) and 28-31 weeks gestation (visit 2). An apnea-hypopnea index (AHI) was calculated. Clinical measurements, a fasting blood draw and uterine artery (UA) dopplers were obtained. After visit 1, participants with SDB (AHI ≥ 5) were offered enrollment in an ongoing trial. Participants without SDB (AHI < 5), returned for re-evaluation at visit 2. Three areas of interest were evaluated: the vascular domain using mean arterial blood pressure (MAP) and UA dopplers mean pulsatility index; angiogenic domain using soluble endoglin, soluble FMS-like tyrosine kinase 1 and placental growth factor; and metabolic domain using fasting glucose, insulin values and the homeostatic model assessment for insulin resistance. We used an adjusted linear regression model, controlling for BMI, gestational age and maternal age to examine the relationship between outcomes and AHI (≥ 5 and continuous). Data was available for 242 and 130 participants at visit 1 and visit 2, respectively. SDB was present in 37% of participants at visit 1, and 31% at visit 2. After adjusting for cofounders at visit 1, MAP and glucose was higher among women with SDB (85.35 mmHg vs 88.71 mmHg, p=0.028 and 86.59 mg/dL vs 92.38 mg/dL, p=0.05, respectively). These measures were positively correlated with AHI as a continuous measure (Table 1). No correlations between outcomes and SDB or AHI were detected at visit 2 (Table 2). In early pregnancy, SDB is associated with elevated MAP and fasting glucose, but not with angiogenic markers or UA dopplers. New-onset SDB in late pregnancy does not appear to impact these domains. Further research into other mechanisms such as oxidative stress and inflammation is still needed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)