Abstract
Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). Attenuation of the normal nocturnal blood pressure (BP) decline (non-dipping) is associated with adverse pregnancy outcomes. OSAH is associated with nocturnal non-dipping in the general population, but this has not been studied in pregnancy. We therefore analyzed baseline data from an ongoing RCT (NCT03309826) assessing the impact of OSAH treatment on HDP outcomes, to evaluate the relationship of OSAH to 24-h BP profile, in particular nocturnal BP dipping, and measures of arterial stiffness.Methods: Women with a singleton pregnancy and HDP underwent level II polysomnography. Patients with OSAH (apnea-hypopnea index (AHI) ≥ 5 events/h) then underwent 24-h ambulatory BP monitoring and arterial stiffness measurements (applanation tonometry, SphygmoCor). Positive dipping was defined as nocturnal systolic blood pressure (SBP) dip ≥ 10%. The relationships between measures of OSAH severity, measures of BP and arterial stiffness were evaluated using linear regression analyses.Results: We studied 51 HDP participants (36.5 ± 4.9 years, BMI 36.9 ± 8.6 kg/m2) with OSAH with mean AHI 27.7 ± 26.4 events/h at 25.0 ± 4.9 weeks’ gestation. We found no significant relationships between AHI or other OSA severity measures and mean 24-h BP values, although BP was generally well-controlled. Most women were SBP non-dippers (78.4%). AHI showed a significant inverse correlation with % SBP dipping following adjustment for age, BMI, parity, gestational age, and BP medications (β = −0.11, p = 0.02). Significant inverse correlations were also observed between AHI and DBP (β = −0.16, p = 0.01) and MAP (β = −0.13, p = 0.02) % dipping. Oxygen desaturation index and sleep time below SaO2 90% were also inversely correlated with % dipping. Moreover, a significant positive correlation was observed between carotid-femoral pulse wave velocity (cfPWV) and REM AHI (β = 0.02, p = 0.04) in unadjusted but not adjusted analysis.Conclusion: Blood pressure non-dipping was observed in a majority of women with HDP and OSAH. There were significant inverse relationships between OSAH severity measures and nocturnal % dipping. Increased arterial stiffness was associated with increasing severity of OSAH during REM sleep in unadjusted although not adjusted analysis. These findings suggest that OSAH may represent a therapeutic target to improve BP profile and vascular risk in HDP.
Highlights
Hypertensive disorders of pregnancy (HDP) complicate up to 10% of pregnancies and are a leading cause of maternal and infant morbidity and mortality worldwide (Lo et al, 2013; Seely and Ecker, 2014; Folk, 2018; Shah and Gupta, 2019)
Gestational hypertension is defined as blood pressure (BP) higher than 140/90 mmHg diagnosed after 20 weeks of gestation, and pre-eclampsia is characterized by new-onset hypertension with proteinuria or end organ damage symptoms (Roberts et al, 2013)
38 women declined to participate in the study, 184 women were ineligible on the basis of no hypertension at screening, preterm delivery expected within 2 weeks, twin pregnancy, current continuous positive airway pressure (CPAP) treatment, medical comorbidities, substance use, language barrier, or follow-up at another institution
Summary
Hypertensive disorders of pregnancy (HDP) complicate up to 10% of pregnancies and are a leading cause of maternal and infant morbidity and mortality worldwide (Lo et al, 2013; Seely and Ecker, 2014; Folk, 2018; Shah and Gupta, 2019). Chronic hypertension is defined as hypertension that develops either pre-pregnancy or at less than 20 weeks’ gestation. Gestational hypertension is defined as blood pressure (BP) higher than 140/90 mmHg diagnosed after 20 weeks of gestation, and pre-eclampsia is characterized by new-onset hypertension with proteinuria or end organ damage symptoms (Roberts et al, 2013). Many patients with HDP demonstrate an absence of nocturnal BP dipping (non-dippers) (Oney and Meyer-Sabellek, 1990; Ayala et al, 1997; Hermida et al, 2000; Gupta et al, 2011). The authors found that non-dipping in HDP patients was associated with impaired maternal cardiac function, including reduced left ventricle ejection fraction, velocity of longitudinal systolic function, and cardiac output (Ilic et al, 2017). Targeting factors associated with BP non-dipping could, potentially contribute to improved maternal and fetal outcomes in HDP
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