Abstract
ObjectiveThe objective of this study is to determine whether obstructive sleep apnea (OSA) is associated with reduced fetal growth, and whether nocturnal oxygen desaturation precipitates acute fetal heart rate changes.Study DesignWe performed a prospective observational study, screening 371 women in the second trimester for OSA symptoms. 41 subsequently underwent overnight sleep studies to diagnose OSA. Third trimester fetal growth was assessed using ultrasound. Fetal heart rate monitoring accompanied the sleep study. Cord blood was taken at delivery, to measure key regulators of fetal growth.ResultsOf 371 women screened, 108 (29%) were high risk for OSA. 26 high risk and 15 low risk women completed the longitudinal study; 14 had confirmed OSA (cases), and 27 were controls. The median (interquartile range) respiratory disturbance index (number of apnoeas, hypopnoeas or respiratory related arousals/hour of sleep) was 7.9 (6.1–13.8) for cases and 2.2 (1.3–3.5) for controls (p<0.001). Impaired fetal growth was observed in 43% (6/14) of cases, vs 11% (3/27) of controls (RR 2.67; 1.25–5.7; p = 0.04). Using logistic regression, only OSA (OR 6; 1.2–29.7, p = 0.03) and body mass index (OR 2.52; 1.09–5.80, p = 0.03) were significantly associated with impaired fetal growth. After adjusting for body mass index on multivariate analysis, the association between OSA and impaired fetal growth was not appreciably altered (OR 5.3; 0.93–30.34, p = 0.06), although just failed to achieve statistical significance. Prolonged fetal heart rate decelerations accompanied nocturnal oxygen desaturation in one fetus, subsequently found to be severely growth restricted. Fetal growth regulators showed changes in the expected direction- with IGF-1 lower, and IGFBP-1 and IGFBP-2 higher- in the cord blood of infants of cases vs controls, although were not significantly different.ConclusionOSA may be associated with reduced fetal growth in late pregnancy. Further evaluation is warranted to establish whether OSA may be an important contributor to adverse perinatal outcome, including stillbirth.
Highlights
Detection of intrauterine growth restriction (IUGR) remains a leading priority in obstetric care, where the combined efforts of aggressive in utero surveillance and timely delivery are necessary to prevent stillbirth
obstructive sleep apnoea (OSA) may be associated with reduced fetal growth in late pregnancy
Further evaluation is warranted to establish whether OSA may be an important contributor to adverse perinatal outcome, including stillbirth
Summary
Detection of intrauterine growth restriction (IUGR) remains a leading priority in obstetric care, where the combined efforts of aggressive in utero surveillance and timely delivery are necessary to prevent stillbirth. Impairment of fetal growth may have maternal or placental contributors. Maternal contributors include hypertension [3] and conditions associated with hypoxia, such as cardio-respiratory disease, or living at high altitude [4]. A condition that shares the pathologies of hypoxia, sympathetic activation and systemic inflammation is obstructive sleep apnoea (OSA). It is plausible that, through these mechanisms, OSA may be an unsuspected contributor to fetal growth restriction and stillbirth. If this association was confirmed, it would be potentially important, given there is safe and effective treatment in the form of Continuous Positive Airway Pressure (CPAP). CPAP could be a novel treatment to decrease the burden of IUGR
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