EARLY PREGNANCY OUTCOMES AFTER IVF AND SLEEP DISORDERED BREATHING

Abstract

While sleep disordered breath (SDB) is associated with multiple medical comorbidities and adverse late stage pregnancy complications such as preeclampsia and gestational diabetes, there is little understanding of its impact on early pregnancy outcomes after IVF. Patients between 18 to 45 years old undergoing autologous IVF and anticipating an embryo transfer were eligible for participation in this single-arm prospective observational study. Women with current treatment of obstructive sleep apnea were excluded. Demographics, medical history, and sleep surveys including the STOP-BANG Questionnaire, Epworth Sleepiness Survey, Pittsburgh Sleep Quality Index, and the Insomnia Severity Index were collected. Participants completed a single night of home sleep monitoring prior to IVF with a novel sensor system composed of two wireless patches located at the suprasternal notch and the index finger (ANNE Sleep, Sibel Health), which collected continuous measurements of heart rate, respiratory rate, peripheral arterial tonometry, temperature, blood pressure, and pulse oxygenation. Sleep nights were reviewed for SDB determined by an apnea hypopnea index (AHI), defined as the average number of apneic events per hour based on American Academy of Sleep Medicine scoring guidelines. IVF cycle and early pregnancy outcomes were followed to at least 12 weeks. The primary exposure was SDB (AHI 5 events/hr) and the primary outcome was rate of clinical pregnancy (defined as intrauterine gestational sac with a yolk sac) after IVF. Continuous variables were compared using Student’s t-test or Mann–Whitney U test based on normality, while χ2 or Fisher’s exact tests were used to compare categorical variables by SDB exposure. Logistic regression assessed predictors of clinical pregnancy after adjusting for confounders. A total of 30 subjects were recruited from an academic fertility center. The overall rate of SDB was 58%. Participants with SDB had a mean AHI of 13.4 compared to 2.7 events/hr (p<0.01), were younger, and more likely to have ovulatory dysfunction. There were otherwise no significant differences in body mass index (BMI), parity, IVF cycle stimulation parameters, embryological yield, or sleep survey results. Clinical pregnancy occurred in only 38% of women with SDB vs 64% in those without (p=0.18). After adjusting for age, BMI, and ovulatory dysfunction, SDB was an independent risk factor for reduced clinical pregnancy rates (aOR 0.13, 95% CI: 0.02-0.83, p=0.03). Though SDB occurred more frequently among women with ovulatory dysfunction (88% vs 46%, p=0.04), SDB remained a risk factor for unsuccessful pregnancy after IVF, independent of underlying infertility diagnosis. Sleep disordered breathing of any severity is associated with an 87% (95% CI: 0.02-0.83) lower likelihood of clinical pregnancy after IVF.