Sleep Disordered Breathing In Pregnancy Research Articles

Association between Sleep Disordered Breathing and Neonatal Outcomes in Nulliparous Individuals.

Our objective was to determine whether objectively measured sleep-disordered breathing (SDB) during pregnancy is associated with an increased risk of adverse neonatal outcomes in a cohort of nulliparous individuals. Secondary analysis of the nuMom2b sleep disordered breathing substudy was performed. Individuals underwent in-home sleep studies for SDB assessment in early (6-15 weeks' gestation) and mid-pregnancy (22-31 weeks' gestation). SDB was defined as an apnea-hypopnea index ≥5 events/h at either time point. The primary outcome was a composite outcome of respiratory distress syndrome, transient tachypnea of the newborn, or receipt of respiratory support, treated hyperbilirubinemia or hypoglycemia, large-for-gestational age, seizures treated with medications or confirmed by electroencephalography, confirmed sepsis, or neonatal death. Individuals were categorized into (1) early pregnancy SDB (6-15 weeks' gestation), (2) new onset mid-pregnancy SDB (22-31 weeks' gestation), and (3) no SDB. Log-binomial regression was used to calculate adjusted risk ratios (RR) and 95% confidence intervals (CIs) representing the association. Among 2,106 participants, 3% (n = 75) had early pregnancy SDB and 5.7% (n = 119) developed new-onset mid-pregnancy SDB. The incidence of the primary outcome was higher in the offspring of individuals with early (29.3%) and new onset mid-pregnancy SDB (30.3%) compared with individuals with no SDB (17.8%). After adjustment for maternal age, chronic hypertension, pregestational diabetes, and body mass index, new onset mid-pregnancy SDB conferred increased risk (RR = 1.43, 95% CI: 1.05, 1.94), where there was no longer statistically significant association between early pregnancy SDB and the primary outcome. New onset, mid-pregnancy SDB is independently associated with neonatal morbidity. · SDB is a common condition impacting pregnancy with known maternal risks.. · Objectively defined SDB in pregnancy was associated with a composite of adverse neonatal outcomes.. · New onset SDB in mid pregnancy conferred statistically significant increased risk..

Obstructive sleep apnoea and sleep disorders in pregnancy.

This review provides a summary for obstetricians, midwives, other health professionals and women contemplating pregnancy about the interactions between pregnancy and breathing during sleep. This review will first examine the normal physiological changes of pregnancy and their relationship to sleep-disordered breathing (SDB), and it will then summarise the current knowledge of SDB in pregnancy. Many changes in the respiratory system during pregnancy, particularly during the third trimester, can alter respiratory function during sleep, increasing the incidence and severity of SDB. These changes include increased ventilatory drive and metabolic rate, reduced functional residual capacity and residual volume, increased alveolar-arterial oxygen gradients and changes in the upper airway. The clinical importance of these changes during pregnancy is demonstrated by the increased incidence of snoring and obstructive sleep apnoea hypopnoea syndrome. As SDB is associated with obesity, the increasing incidence of obesity pre-pregnancy will likely increase SDB during pregnancy over the next decade. If a physician is asked to review a pregnant patient, they should always consider the possibility of SDB.

Maternal sleep disordered breathing during gestation produces sexually dimorphic autism‐relevant synaptic and behavioral aberrations in the offspring associated with excessive mTOR cortical signaling

Sleep disordered breathing (SDB) is characterized by recurring breathing cessations during sleep, causing intermittent hypoxia (oxygen deprivation) often several hundred times per night. Obstructive sleep apnea is the most common form of SDB in pregnancy, and confers risk for detrimental maternal‐fetal outcomes. Although many of the maternal risk factors for the onset SDB during pregnancy and the development of autism spectrum disorders (ASD) in her offspring are highly overlapping (e.g., maternal obesity, advanced maternal age), no studies to date have empirically investigated the potential link between these conditions. We subjected pregnant rat dams to intermittent hypoxia or normoxia (GIH and GNX, respectively) from gestation day 10‐21 to investigate the consequences of maternal SDB on offspring neural function. We found that male GIH offspring exhibited deficits in several behaviors which were accompanied by increased pyramidal neuron dendritic spine density in the medial prefrontal cortex (PFC). These effects appear to arise from a disruption of normal developmental synaptic pruning late in childhood and persisting into early adolescence. The mTOR kinase signal transduction pathway has emerged as a critical regulator of dendritic spine formation, and dysregulation of key components of this pathway are implicated in the etiology of the increased cortical dendritic spine density of ASD. Additionally, we found that mTOR is aberrantly activated in the prefrontal cortex of male GIH offspring. Furthermore, inhibition of mTOR by rapamycin treatment significantly reduced behavioral abnormalities within GIH offspring. These findings suggest an opportunity for clinical intervention for offspring of the SDB maternal model by targeting the mTOR signaling pathway.

Sleep-disordered breathing in high-risk pregnancies is associated with elevated arterial stiffness and increased risk for preeclampsia

Impaired vascular function is a central feature of pathologic processes preceding the onset of preeclampsia. Arterial stiffness, a composite indicator of vascular health and an important vascular biomarker, has been found to be increased throughout pregnancy in those who develop preeclampsia and at the time of preeclampsia diagnosis. Although sleep-disordered breathing in pregnancy has been associated with increased risk for preeclampsia, it is unknown if sleep-disordered breathing is associated with elevated arterial stiffness in pregnancy. This prospective observational cohort study aimed to evaluate arterial stiffness in pregnant women, with and without sleep-disordered breathing and assess the interaction between arterial stiffness, sleep-disordered breathing, and preeclampsia risk. Women with high-risk singleton pregnancies were enrolled at 10 to 13 weeks' gestation and completed the Epworth Sleepiness Score, Pittsburgh Sleep Quality Index, and Restless Legs Syndrome questionnaires at each trimester. Sleep-disordered breathing was defined as loud snoring or witnessed apneas (≥3 times per week). Central arterial stiffness (carotid-femoral pulse wave velocity, the gold standard measure of arterial stiffness), peripheral arterial stiffness (carotid-radial pulse wave velocity), wave reflection (augmentation index, time to wave reflection), and hemodynamics (central blood pressures, pulse pressure amplification) were assessed noninvasively using applanation tonometry at recruitment and every 4 weeks from recruitment until delivery. High-risk pregnant women (n=181) were included in the study. Women with sleep-disordered breathing (n=41; 23%) had increased carotid-femoral pulse wave velocity throughout gestation independent of blood pressure and body mass index (P=.042). Differences observed in other vascular measures were not maintained after adjustment for confounders. Excessive daytime sleepiness, defined by Epworth Sleepiness Score >10, was associated with increased carotid-femoral pulse wave velocity only in women with sleep-disordered breathing (Pinteraction=.001). Midgestation (first or second trimester) sleep-disordered breathing was associated with an odds ratio of 3.4 (0.9-12.9) for preeclampsia, which increased to 5.7 (1.1-26.0) in women with sleep-disordered breathing and hypersomnolence, whereas late (third-trimester) sleep-disordered breathing was associated with an odds ratio of 8.2 (1.5-39.5) for preeclampsia. High-risk pregnant women with midgestational sleep-disordered breathing had greater arterial stiffness throughout gestation than those without. Sleep-disordered breathing at any time during pregnancy was also associated with increased preeclampsia risk, and this effect was amplified by hypersomnolence.

Impact of nasal dilator strips on measures of sleep-disordered breathing in pregnancy.

Women with sleep-disordered breathing (SDB) in pregnancy are at a greater risk of developing serious adverse perinatal outcomes. However, the pathogenesis of SDB in pregnancy is poorly understood. As nasal congestion is common in pregnancy, nasal obstruction may contribute to SDB in this population. This study aims to assess the impact of nasal dilator strips (NDS) on measures of SDB and their potential for use as a placebo condition. Pregnant women ≥ 18 years old, body mass index ≥ 27 kg/m2, and habitual snoring were enrolled. Participants completed 2 consecutive level III home sleep apnea tests and used NDS during the second test. Objective measures including respiratory event index and pulse transit time drop index, a measure of increased arterial stiffness, were compared across tests. Subjective assessments of participants' perceived impact of NDS use was also obtained. 54 women, 59% White, 60% in the third trimester were enrolled. Median time between the 2 studies was 1 day (interquartile range [IQR] 4). There was no significant change between the night without NDS use and the night with NDS use in respiratory event index (5.30 [IQR 6.20] vs 4.80 [IQR 6.78], P = .8) or pulse transit time drop index (6.8 [IQR 13.3] vs 6.6 [IQR 15.8], P = .360). Subjective measures of sleep did not differ between the 2 nights. Despite the high prevalence of pregnancy-associated rhinitis, NDS do not have a significant impact on measures of SDB. Results from this study support the use of NDS as an appropriate placebo in prenatal clinical trials. Maxwell M, Sanapo L, Monteiro K, etal. Impact of nasal dilator strips on measures of sleep-disordered breathing in pregnancy. J Clin Sleep Med. 2022;18(2):477-483.

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

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)

507 Sleep disordered breathing in pregnancy and 2-7 years Post-Delivery: associations with hypertension and metabolic syndrome

Determine if sleep disordered breathing (SDB) identified in pregnancy or post-delivery (PD) is associated with incident hypertension (HTN) or metabolic syndrome 2-7 years PD. The Nulliparous Pregnancy Outcomes Study Monitoring: Mothers-to-be Heart Health Study (nuMoM2b-HHS) is a prospective cohort that followed participants 2 to 7 years after their first pregnancy. During pregnancy a subgroup of participants underwent objective SDB assessments in early (6-15 wks) and mid-pregnancy (22-31 wks). Participants were offered repeat SDB assessments at the follow-up visit done 2-7 years PD. An apnea-hypopnea index (AHI) of ≥5 was used to define SDB. The oxygen desaturation index (ODI) was also evaluated. Associations of AHI and ODI with incident HTN and metabolic syndrome 2-7 years PD were evaluated and risk ratios (RR) and 95% confidence intervals (CIs) were estimated after adjustment for age, BMI, race/ethnicity, and time from delivery to the HHS outcome assessment. 1,365 participants in the NuMoM2b-HHS study had sleep data from both early and mid-pregnancy in the parent NuMoM2b study. A follow-up sleep study at 2-7 years PD was completed in 844 of these participants. 710/844 (84.1%) did not have SDB during pregnancy or PD, 49/844 (5.8%) had SDB in pregnancy that persisted PD, 22/844 (2.6%) had SDB in pregnancy that resolved PD, and 63/844 (7.5%) had new-onset SDB detected at the 2-7 year PD visit. Both new-onset and persistent SDB were associated with incident HTN and metabolic syndrome (Table 1). Participants with SDB in pregnancy that persisted 2-7 years later had the highest risk for incident HTN (aRR 3.88, 95% CI 1.80, 8.34) and metabolic syndrome (aRR 2.34, 95% 1.41, 3.88) compared to women who did not have SDB during pregnancy and PD (Table 1). Similarly, women with a persistent PD ODI ≥ 5 were at the highest risk (HTN aRR 3.21, 95% CI 1.60, 6.43; metabolic syndrome aRR 2.72, 95% CI 1.77, 4.20, Table 2). SDB 2-7 years PD is associated with an increased risk of incident HTN and metabolic syndrome, but that risk is greatest when that SDB persists since pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Sleep-Disordered Breathing in Pregnancy.

Sleep-disordered breathing (SDB) is a spectrum of abnormal respiratory events including habitual snoring and increased upper airway resistance and obstructive episodes. The uncertainties concerning the incidence and recognition of SDB during pregnancy and the importance of the issue for fetal and maternal health prompted us to screen pregnant women for SDB. The study included 312 women in the third trimester of pregnancy aged 17-46 of whom 51 were preselected, based on the results of SDB questionnaires, for a nighttime home screening using a portable ApneaLink Air device. We found that single or multiple episodes of apnea were present in 35 (69%) women. The mean apnea/hypopnea index (AHI) was 1.8±1.8 episodes/h of sleep, which did not exceed the prevalence in the general young-adult female population. However, we noticed a substantial number of inspiratory airflow limitation (IFL) episodes most often accompanied by snoring and more frequent in pregnant women with a greater weight gain. IFLs, although not fulfilling the quantifiable criteria of hypopnea, raise the possibility of hardly recognizable oxygenation and cardiovascular disturbances in pregnancy, reflected in an increased risk index for SDB. We conclude that pregnancy encompasses the risk of revealing or intensifying pre-existing SDB which can jeopardize maternal and fetal health. The risk particularly applies to overweight women. We submit that women in late pregnancy should be carefully screened for possible SDB.

Maternal Sleep-Disordered Breathing in Pregnancy and Increased Nocturnal Glucose Levels in Women with Gestational Diabetes Mellitus

Women with hyperglycemia during pregnancy are at high risk for adverse perinatal outcomes. Maternal sleep-disordered breathing (SDB) during pregnancy is common and is a risk factor for gestational diabetes mellitus (GDM). However, the relationship between SDB severity and glucose control is unknown. Is there an association between SDB severity and glucose levels as assessed by continuous glucose monitoring in GDM? Women with GDM underwent sleep recordings and 72-hour continuous glucose monitoring. Linear mixed models were used to estimate the association of the apnea-hypopnea index (AHI), rapid eye movement (REM)-AHI, and non-REM-AHI with mean glucose levels during nighttime (two periods: 11 pm to 3 am and 3 am to 6 am), daytime (8 am to 9 pm), and 24-hours. Models were adjusted for BMI and antihyperglycemic medications. In 65 participants who were 35 ± 5 (mean ± SD) years of age with BMI of 33 ± 7kg/m2, 31%were undergoing insulin and/or metformin therapy. A ten-unit increase in AHI was associated with elevated nocturnal glucose levels (11 pm to 3 am: 0.20mmol/L [95%CI, 0.04-0.40]) with persistent elevations into the morning (8 am: 0.26mmol/L [95%CI, 0.08-0.4]) when adjusted for BMI and medications. REM-AHI was also associated with higher nocturnal and morning glucose levels, whereas non-REM was not. AHI was not associated with either mean daytime or 24-hour glucose levels. Greater severity of SDB was associated with higher nocturnal and morning glucose levels in women with GDM.

Sleep-disordered breathing in pregnancy: a developmental origin of offspring obesity?

Sleep-disordered breathing (SDB) worsens over pregnancy, and obstructive sleep apnea is associated with serious maternal complications. Intrauterine exposures that provoke insulin resistance (IR), inflammation, or oxidative stress may have long-term offspring health consequences. In obesity, worsening maternal SDB appears to be an exposure that increases the risk for both small- or large-for-gestational-age (SGA, LGA, respectively), suggesting distinct outcomes linked to a common maternal phenotype. The aim of this paper is to systematically review and link data from both mechanistic rodent models and descriptive human studies to characterize the impact of maternal SDB on fetal development. A systematic review of the literature was conducted using PubMed, Embase, and CINAHL (01/2000-09/2019). Data from rodent (9 studies) and human models (48 studies, 5 meta-analyses) were included and reviewed using PRISMA guidelines. Evidence from rodent models suggests that intermittent maternal hypoxia results in mixed changes in birth weight (BW) followed by accelerated postnatal growth, while maternal sleep fragmentation results in normal BW followed by later metabolic derangement. Human studies support that maternal SDB is associated with both SGA and LGA, both of which may predispose offspring to later obesity. Evidence also suggests a link between SDB, inflammation, and oxidative stress that may impact maternal metabolism and/or placental function. SDB is common in pregnancy and affects fetal growth and development. Given that SDB has significant potential to adversely influence the intrauterine metabolic environment, larger, prospective studies in humans are urgently needed to fully elucidate the effects of this exposure on offspring metabolic risk.

Exploring Fetal Sex as a Risk Factor for Sleep Disordered Breathing and Its Complications in Pregnancy.

Sleep disordered breathing (SDB) is a common, yet under-recognized and undertreated condition in pregnancy. Sleep disordered breathing is associated with pregnancy complications including preeclampsia, gestational diabetes, preterm birth, as well as severe maternal morbidity and mortality. The identification of risk factors for SDB in pregnancy may improve screening, diagnosis, and treatment of SDB prior to the onset of pregnancy complications. The goal of this study was to determine whether fetal sex increases risk of SDB in pregnancy. A cohort of singleton (N = 991) pregnant women were recruited within 24 to 48 hours of delivery and answered questions regarding SDB symptoms by questionnaire. Women who reported frequent loud snoring at least 3 times a week were considered to have SDB. Hospital records were reviewed to extract information on fetal sex and pregnancy complications including preeclampsia, pregnancy-induced hypertension, gestational diabetes, preterm delivery, and low birth weight. Women carrying male fetuses were significantly more likely to have SDB (β = .37, P = .01, OR: 1.45 [95% CI: 1.09–1.94]). Fetal sex was associated with increased risk of hypertensive disorders of pregnancy (defined as preeclampsia and/or pregnancy-induced hypertension) among women with SDB in pregnancy (β = .41, P = .02, OR: 1.51[95%CI:1.08–2.11]).Fetal sex did not increase risk of preterm birth, low birth weight, or gestational diabetes among women with SDB in pregnancy. Women carrying male fetuses were approximately 1.5 times more likely to report SDB in pregnancy compared to women carrying female fetuses, and women with pregnancy-onset SDB carrying male fetuses were 1.5 times more likely to have hypertensive disorders of pregnancy compared to women with SDB carrying female fetuses. Confirmation of fetal sex as a risk factor may, with other risk factors, play a role in identifying women at highest risk of SDB complications in pregnancy.

Can pregnant women accurately report snoring? A pilot study

Sleep-Disordered Breathing (SDB) has been associated with possible negative outcomes, such as preeclampsia and foetal growth restriction. SDB screening tools have been developed for use within general populations. These included the use of self-reports and objective measurements. Seventeen pregnant women within their 34th to 37th week of pregnancy were recruited. Participants undertook an overnight study within their home and SDB symptoms were monitored using the Watch-PAT 200 and an infra-red video camera. The women were administered an online questionnaire comprised of the Multivariable Apnea Risk Index (MAP Index) and the Basic Nordic Sleep Questionnaire (BNSQ). More than half of our participants (n = 10) were identified as snorers while much fewer (n = 4) met the current cut off for diagnosis of mild SDB. Investigation of concordance and predictive value of self-report measures compared to standard video-scoring and Watch-PAT 200 determined SDB indicators suggests that self-reports may not provide an accurate assessment of SBD symptoms in late pregnancy. Self-report in this study, resulted in an underestimation of the number of participants who experienced SDB symptoms. This was a pilot study, with a small sample size. However, our study lends weight to others that found poor predictive value of common scales to detect SDB in pregnancy. Future study is therefore needed to validate screening tools, which may need to be a combination of measures.

The Intrapartum and Perinatal Risks of Sleep-disordered Breathing in Pregnancy: A Systematic Review and Meta-Analysis

(Am J Obstet Gynecol. 2018;219(2):147–161) Sleep-disordered breathing (SDB) consists of a spectrum of respiratory and ventilation abnormalities ranging from snoring to obstructive sleep apnea and is an increasingly common condition in the nonobstetric population. It can be associated with morbidity. The incidence of SDB in pregnant women is unknown and many cases likely go undiagnosed. This systematic review and metaanalysis aimed to determine whether pregnant women diagnosed with SDB were more likely to have adverse intrapartum and perinatal outcomes compared with control subjects.

Predictors of Sleep-disordered Breathing in Pregnancy

(Am J Obstet Gynecol. 2018;218:521.e1–e12) Sleep-disordered breathing (SDB) in pregnancy is associated with an increased risk of complications and adverse outcomes, including preeclampsia, venous thromboembolism, severe maternal morbidity, preterm delivery, and maternal death. Identifying women with SDB is difficult, however, as SDB symptoms are not very specific. The best method for diagnosis of SDB is overnight polysomnography, which is expensive and inconvenient. This study used a large cohort of pregnant women to establish clinically feasible prediction models for SDB.

Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management.

Among obese pregnant women, 15%-20% have obstructive sleep apnea (OSA) and this prevalence increases along with body mass index and in the presence of other comorbidities. Prepregnancy obesity and pregnancy-related weight gain are certainly risk factors for sleep-disordered breathing in pregnancy, but certain physiologic changes of pregnancy may also increase a woman's risk of developing or worsening OSA. While it has been shown that untreated OSA in postmenopausal women is associated with a range of cardiovascular, pulmonary, and metabolic comorbidities, a body of literature is emerging that suggests OSA may also have serious implications for the health of mothers and fetuses during and after pregnancy. In this review, we discuss the following: pregnancy as a vulnerable period for the development or worsening of OSA; the associations between OSA and maternal and fetal outcomes; the current screening modalities for OSA in pregnancy; and current recommendations regarding peripartum management of OSA.

Sleep-Disordered Breathing in Pregnancy.

Sleep-disordered breathing (SDB) in pregnancy can present as snoring and/or obstructive sleep apnea (OSA), and the prevalence is increasing due to the increase in maternal obesity. Pregnant women often present with fatigue and daytime sleepiness rather than the classic symptoms. Habitual snoring, older age, chronic hypertension, and high prepregnancy body mass index are reliable indicators of increased risk for SDB and should trigger further testing. The gold standard for diagnosis of OSA is an overnight laboratory polysomnography. Although there are no studies linking SDB to poor fetal outcomes, fetal well-being remains paramount throughout the course of pregnancy.

Adolescent Perinatal Outcomes in South West Sydney, Australia

ObjectiveTo compare perinatal outcomes, blood pressures throughout pregnancy, rates of hypertensive disorders of pregnancy, preeclampsia, gestational diabetes mellitus, and immediate obstetric outcomes in adolescents younger than 20 years at delivery and those in the 20- to 34-year age group.Patients and MethodsQuestionnaires were administered to pregnant women at Campbelltown and Liverpool hospitals within South West Sydney, Australia, as part of a broader study of sleep-disordered breathing in pregnancy between February 1, 2009, and February 28, 2013. Data collected included demographic data, blood pressure readings, pregnancy complications, delivery type, and neonatal outcomes. Adolescents were compared with older women using Student t tests and χ2 statistics.ResultsA total of 103 adolescents were compared with 2291 women aged 20 to 34 years. Adolescents were more likely to be primiparous, had longer average gestations, and had lower pre-pregnancy body mass index. Adolescents had lower rates of cesarean section delivery and gestational diabetes mellitus. There was no significant difference in smoking rates, perinatal mortality rate, small for gestational age, intrauterine growth restriction, Apgar score of less than 7 at 5 minutes, admission to special care nursery, or hypertensive disorder of pregnancy rates. Adolescents had lower booking systolic and diastolic blood pressures, and their highest antenatal systolic blood pressures were lower.ConclusionAdolescents have birth outcomes to similar to those of their older counterparts. Adolescents had lower booking blood pressures. This may have implications for the screening and diagnosis of hypertensive disorders of pregnancy in adolescents.

Predictors of sleep-disordered breathing in pregnancy

Sleep-disordered breathing (SDB) is common in pregnancy, but there are limited data on predictors. The objective of this study was to develop predictive models of sleep-disordered breathing during pregnancy. Nulliparous women completed validated questionnaires to assess for symptoms related to snoring, fatigue, excessive daytime sleepiness, insomnia, and restless leg syndrome. The questionnaires included questions regarding the timing of sleep and sleep duration, work schedules (eg, shift work, night work), sleep positions, and previously diagnosed sleep disorders. Frequent snoring was defined as self-reported snoring ≥3 days per week. Participants underwent in-home portable sleep studies for sleep-disordered breathing assessment in early (6-15 weeks gestation) and mid pregnancy (22-31 weeks gestation). Sleep-disordered breathing was characterized by an apnea hypopnea index that included all apneas, plus hypopneas with ≥3% oxygen desaturation. For primary analyses, an apnea hypopnea index ≥5 events per hour was used to define sleep-disordered breathing. Odds ratios and 95% confidence intervals were calculated for predictor variables. Predictive ability of the logistic models was estimated with area under the receiver-operating-characteristic curves, along with sensitivities, specificities, and positive and negative predictive values and likelihood ratios. Among 3705 women who were enrolled, data were available for 3264 and 2512 women in early and mid pregnancy, respectively. The corresponding prevalence of sleep-disordered breathing was 3.6% and 8.3%, respectively. At each time point in gestation, frequent snoring, chronic hypertension, greater maternal age, body mass index, neck circumference, and systolic blood pressure were associated most strongly with an increased risk of sleep-disordered breathing. Logistic regression models that included current age, body mass index, and frequent snoring predicted sleep-disordered breathing in early pregnancy, sleep-disordered breathing in mid pregnancy, and new onset sleep-disordered breathing in mid pregnancy with 10-fold cross-validated area under the receiver-operating-characteristic curves of 0.870, 0.838, and 0.809. We provide a supplement with expanded tables, integrated predictiveness, classification curves, and an predicted probability calculator. Among nulliparous pregnant women, logistic regression models with just 3 variables (ie, age, body mass index, and frequent snoring) achieved good prediction of prevalent and incident sleep-disordered breathing. These results can help with screening for sleep-disordered breathing in the clinical setting and for future clinical treatment trials.

Progress on sleep disordered breathing in pregnancy

Sleep disordered breathing (SDB) is common, especially the obstructive sleep apnea, and the severity increases as pregnancy progresses. The review identifies the risk factors, possible mechanisms and clinical manifestations for sleep disordered breathing in pregnancy through investigating pregnant women, approaches the relationship between sleep disordered breathing in pregnant women and the complications of the mother and fetus, especially between the obstructive sleep apnea and hypertensive disorder complicating pregnancy or gestational diabetes mellitus, and the treatment of sleep disordered breathing in pregnancy. Key words: Pregnancy complications; Sleep apnea syndromes/CO; Review

Sleep-Disordered Breathing in Pregnancy

Sleep-disordered breathing (SDB) during pregnancy has emerged as a predictor of both maternal and fetal adverse outcomes. Data suggest that SDB during pregnancy is associated with maternal gestational hypertension and preeclampsia as well as gestational diabetes. Furthermore, there are increasing reports that SDB may play a role in fetal growth restriction, preterm birth, increased cesarean sections, and increased neonatal intensive care unit (NICU) admissions. The public health impact of unrecognized maternal SDB is therefore immense. Treatment of SDB in the general population has been shown to improve cardiovascular outcomes and daytime functioning, and although no large intervention trial has been conducted in pregnant women, small pilot studies demonstrate promising results.