SAPS
SLEEP APNEA PREGNANCY SYNDROME
Medical Literature Review
By Charles
L. McPhee, R.PSG.T.
mcphee@dreamdoctor.com
|
Am Rev Respir Dis. 1991 Aug;144(2):461-3. |
Obstructive sleep apnea during pregnancy. Therapy and
implications for fetal health.
Charbonneau M,
Falcone
T, Cosio
MG, Levy RD.
Desmond N. Stoker Laboratory,
A 32 yr-old woman in her last trimester of pregnancy was found to have severe
obstructive sleep apnea (OSA). The overnight polysomnogram
demonstrated an apnea plus hypopnea index of 159
events per hour. Apneas were associated with severe oxygen desaturation
to 40% during rapid eye movement sleep, maternal bradycardia,
and second degree heart block. External cardiotocography
showed normal fetal heart rate reactivity to fetal movements, even during the
apneas and episodes of oxygen desaturation. Nasal
continuous positive airway pressure at a level of 15 cm H2O effectively treated
the apneas and desaturation and had no effect on the
fetal heart rate. The patient was
induced electively during the 39th wk of pregnancy and gave birth to a newborn
with growth retardation. Early recognition and treatment of OSA in pregnancy
might prevent problems with fetal development.
|
Obstet Gynecol Surv. 1996 Aug;51(8):503-6. |
Obstructive sleep apnea in pregnancy.
Lefcourt
LA, Rodis
JF.
Department of Obstetrics and Gynecology, University of
Obstructive sleep apnea is a common medical condition characterized by periodic
apneas during sleep that produce hypoxia and sleep disruption. Several cases of
obstructive sleep apnea in pregnancy have been reported. In the case reported
the woman admitted for evaluation and management of preeclampsia
was observed experiencing apneic episodes and oxygen desaturation during sleep. Subsequent evaluation confirmed
the diagnosis of obstructive sleep apnea. Pregnancy
may be complicated by obstructive sleep apnea with potential adverse effects on
the mother and fetus. Prompt diagnosis would allow early treatment and may
prevent low birth weight and the development of preeclampsia.
|
J Am Board Fam Pract. 2004 Jul-Aug;17(4):292-4. |
Obstructive sleep apnea in pregnancy.
Roush
SF, Bell L.
Cox Family Practice Residency,
A 25-year-old woman, gravida
4 para 2, at 37 weeks gestation was evaluated and
treated for preeclampsia. Overnight, the patient had
a witnessed apneic episode with maternal oxygen desaturation and concurrent fetal heart rate deceleration.
She subsequently delivered an infant that was small for gestational age. This is the first case described with
confirmed obstructive sleep apnea by formal polysomnography
and witnessed maternal desaturation with fetal heart
rate decelerations. Recognizing obstructive sleep apnea (OSA) early in
gestation will help dictate treatment options and may prevent adverse maternal
fetal outcomes. Continuous positive airway pressure (CPAP) seems to be a
safe treatment with minimal adverse effects. Questioning of patients at the first prenatal visit and monitoring for
increased snoring during gestation may help detect early signs and symptoms of
OSA. Treatment of OSA with CPAP
might improve perinatal outcomes.
|
Eur J Obstet Gynecol
Reprod Biol. 1978 Apr;8(2):77-81. |
Fetal response to periodic
sleep apnea: a new syndrome in obstetrics.
Joel-Cohen SJ,
Schoenfeld
A.
Periodic sleep apnea, a chronic sleep deprivation state, in which marked
changes in the arterial PO2 and PCO2 tensions have been recorded, is a
relatively new syndrome not previously reported in pregnancy. It is
characterized by episodes of apnea, prevalently obstructive, during sleep. The
majority of patients with this syndrome have snored heavily for years,
suggesting a causal relationship between snoring and periodic sleep apnea. The effects of prolonged snoring on
alveolar ventilation and systemic pressure(s) suggest that this snoring has physiopathological implications on maternal
cardio-respiratory reserve and indirectly upon the fetus, especially as there
are recordable changes in fetal heart rate and also a change in the acid-base
status of the fetus. The possibility that this syndrome may have an adverse
effect upon the fetus is stressed.
|
Lin Chuang Er
Bi Yan Hou Ke Za Zhi.
2002 Jun;16(6):295-6. |
[Obstructive sleep apnea of gestational period]
[Article in Chinese]
Zhu W, Shu
C.
OBJECTIVE: To explore the influence of obstructive sleep apnea syndrome (OSAS)
on the pregnant women. METHOD: 465 women in pregnancy were studied by random.
The snoring rate, the relation with hyper blood pressure and preeclamptism, and the influence on infant were observed.
RESULT: The magnificent statistics shows total snoring rate is 24.7%(115/465). 21.3%(92/442) is after pregnancy, of them,
28.7% meet the standard of OSAS, 12.17% with hyper blood pressure, 7.8% with preeclamptism, 5.2% infant with aplasia.
CONCLUSION: Diseases incidence with OSAS
is more obvious than that with normal pregnant women. OSAS has a marked
influence on pregnancy. Pregnant women with obvious OSAS can be regard as an
independent factor of high risk pregnancy. We should pay more attentions to
them in their early stage.
|
Clin Chest Med. 1992 Dec;13(4):637-44. |
Respiration
during sleep in pregnancy.
Feinsilver SH, Hertz G.
Several changes in maternal physiology may profoundly alter sleep, especially
during late pregnancy. Any condition that causes maternal hypoxemia will be
worsened during sleep, particularly in the supine position. Although high
circulating levels of progesterone increase respiratory drive during sleep, in
at least some women this protective mechanism is insufficient to prevent
sleep-disordered breathing and hypoxemia. The true incidence of
sleep-disordered breathing during pregnancy remains unknown. Although many women report sleep
disturbance during pregnancy, those with severe snoring, observed irregular
breathing with sleep, or excessive daytime somnolence should be referred for
clinical polysomnography. With few data thus far
available, nasal CPAP would appear to be the treatment of choice. Given the
possible consequences of sleep apnea for fetal outcome, any significant
sleep-disordered breathing is probably an indication for treatment.
|
Thorax. 2002 Jun;57(6):555-8. |
Sleep disordered breathing and pregnancy.
Edwards N, Middleton PG, Blyton
DM, Sullivan CE.
David Read Laboratory, Department of Medicine,
Many changes in the respiratory system occur during pregnancy, particularly
during the third trimester, which can alter respiratory function during sleep,
increasing the incidence and severity of sleep disordered breathing. These
changes include increased ventilatory drive and
metabolic rate, reduced functional residual capacity and residual volume,
increased alveolar-arterial oxygen gradients, and changes in upper airway patency. The
clinical importance of these changes is indicated by the increased incidence of
snoring during pregnancy, which is likely also to reflect an increased
incidence of obstructive sleep apnoea/hypopnoea
syndrome. For the respiratory physician asked to review a pregnant patient, the
possibility of sleep disordered breathing should always be considered. This
review first examines the normal physiological changes of pregnancy and their
relationship to sleep disordered breathing, and then summarises
the current knowledge of sleep disordered breathing in pregnancy.
|
Curr Opin Pulm Med. 2000 Nov;6(6):485-9. |
Complications
and consequences of obstructive sleep apnea.
Harding SM.
University of Alabama at Birmingham Sleep-Wake Disorders Center, Department of
Medicine, University of Alabama at Birmingham, 35294, USA. sharding@uab.edu
Obstructive sleep apnea (OSA) has many consequences. There is an independent
association between OSA and hypertension. The Sleep Heart Health Study reported
that hypertension prevalence increased as sleep disordered breathing severity
increased. The Nurses' Health Study noted an age-adjusted relative risk of
cardiovascular events of 1.46 for occasional snorers and 2.02 for regular
snorers, and a risk of stroke of 1.60 for occasional snorers and 1.88 for
regular snorers. Sleep apnea is also
associated with pulmonary hypertension, neurocognitive
effects, depressed quality of life, motor vehicle accidents, awakening
headache, childhood growth interruption, pregnancy-induced hypertension, fetal
growth retardation, and disruption of the patients' bed-partners' sleep
quality. Further research will examine the possibility of causality, pathophysiologic mechanisms, and outcomes of therapeutic
interventions for OSA on the many consequences of OSA.
|
Curr Opin Pulm Med. 2003 Nov;9(6):477-83. |
Sleep disorders in pregnancy.
Sahota
PK, Jain SS, Dhand R.
Department of Neurology and University of Missouri-Sleep Disorders Center,
University of Missouri Health Care, Columbia, Missouri 65212, USA.
sahotap@health.missouri.edu
PURPOSE OF REVIEW: Sleep disturbances
are frequent during pregnancy. The spectrum of association between
pregnancy and sleep disturbances ranges from an increased incidence of
insomnia, nocturnal awakenings, and parasomnias
(especially restless legs syndrome) to snoring and excessive sleepiness. These
disturbances occur as a result of physiologic, hormonal, and physical changes
associated with pregnancy. Although the timing and occurrence of different
sleep disorders varies, they are most prevalent during the third trimester.
Despite reports of the various sleep problems, the exact nature and incidence
of sleep disorders in pregnancy is not known. Given that limitation, we are
presenting an up-to-date review of the current understanding of the relation
between sleep and pregnancy. RECENT FINDINGS: Studies suggest that pregnancy
affects sleep in multiple ways. There are hormonal changes, physiologic
changes, physical factors, and behavioral changes in a pregnant woman-all of
which may affect her sleep. They may affect the duration and quality of sleep
and lead to a variety of sleep disorders. Pregnancy may also affect an existing
sleep disorder. Particular attention may
be given to obese pregnant women who would gain more weight during pregnancy or
those who develop hypertensive conditions (eg, preeclampsia). Snoring may be more common in women with
preeclampsia and the pressor
responses to obstructive respiratory events during sleep may be enhanced in preeclamptic women when compared with those with
obstructive sleep apnea alone. Several investigators have suggested that
obstructive sleep apnea (OSA) may be common in pregnant women despite the
presence of intrinsic mechanisms that seem to be geared towards preventing
sleep apnea. However, the exact incidence and prevalence of sleep apnea in
pregnant women is uncertain. In
addition, it is unclear if criteria that are used to define sleep apnea in the
general population should be applied to pregnant women. Further investigations
are needed to determine if lower thresholds for management of OSA should be
used in pregnant women to prevent harm to the fetus. SUMMARY: In
conclusion, sleep disturbances are common during pregnancy though the full
extent of this relation remains undefined. Large, multi-center, prospective
studies are needed for better understanding.
|
Obstet Gynecol. 1989
Sep;74(3 Pt 2):453-5. |
Precipitation of obstructive sleep apnea
during pregnancy.
Kowall
J, Clark G, Nino-Murcia G,
Powell N.
Sleep Disorders Clinic,
A case of severe obstructive sleep apnea developing during pregnancy is
reported. A 27-year-old primigravida was well until
the sixth month of pregnancy, when she developed loud snoring and excessive
daytime sleepiness. Polysomnography was performed at
36 weeks' gestation and revealed severe obstructive sleep apnea. The patient
was treated successfully during pregnancy with nasal continuous positive airway
pressure, but continued to suffer from moderate obstructive sleep apnea after
delivery. This case suggests that sleep
apnea may be either precipitated or exacerbated during pregnancy.
|
South Med J. 1998 Aug;91(8):761-2. |
Obstructive sleep apnea during pregnancy
resulting in pulmonary hypertension.
Lewis DF, Chesson
AL, Edwards MS, Weeks JW, Adair CD.
Department of Obstetrics and Gynecology,
Obesity is known to increase maternal morbidity and mortality. We describe a
case of obstructive sleep apnea due to obesity and discuss our treatment of the
resulting pulmonary hypertension. A patient was transferred to our hospital at
29 weeks' gestation with severe anasarca and more
than a 100-pound weight gain during pregnancy. Pulmonary hypertension due to
obstructive sleep apnea was diagnosed. The patient was treated with nasal
continuous positive airway pressure (CPAP) during sleep and remained in the
hospital the remainder of her pregnancy. She had a massive spontaneous diuresis during her hospital stay and lost more than 100
pounds. She was delivered at term via cesarean section because of transverse
lie. Preoperative hemodynamic monitoring confirmed
the diagnosis of pulmonary hypertension. This
represents the first case in the literature of obstructive sleep apnea leading
to pulmonary hypertension in pregnancy. This patient responded well to nasal
CPAP as evident by the massive diuresis and good
maternal outcome.
|
Rev Neurol ( |
[Respiratory disorders during sleep in the pregnant woman]
[Article in French]
Meurice JC, Paquereau J, Neau JP, Pourrat O, Pierre F.
Service de Pneumologie, CHU de Poitiers,
Sleep disordered breathing can occur during pregnancy due to the development of
hormonal changes and respiratory function abnormalities that perturb patency of the upper airways. Habitual snoring has been described in 25 p. 100 of the women during
the third trimester of pregnancy. The incidence of sleep apnea hypopnea syndrome is unknown due to the lack of
longitudinal epidemiological data, and results of the main studies are in favor
of upper airway resistance syndrome. However,
these sleep-related breathing disorders are more frequently associated with
maternal and fetal complications such as maternal hypertension, pre eclampsia and intrauterine growth restriction. This article
points out the importance of such associations because of the efficacy of
continuous positive airway pressure on the regression of these nocturnal
respiratory and vascular complications.
|
Harefuah. 2005 Feb;144(2):107-11,
150. |
[Maternal obesity as a
risk factor for complications in pregnancy, labor and pregnancy outcomes]
[Article in Hebrew]
Raichel
L, Sheiner
E.
Department of Obstetrics and Gynecology, Faculty of Health
Sciences,
Obesity is a worldwide growing epidemic.
The negative influence of obesity is huge and considered to be one of the major
contributors to health problems in the western world. There is a significant association between obesity and diabetes
mellitus, ischemic heart disease, some cancers and syndromes of sleep apnea.
Furthermore, obesity was described to have a negative influence on fertility,
pregnancy, labor and pregnancy outcomes. It was also discovered that obesity
was significantly associated with gestational hypertension, preeclampsia,
gestational diabetes mellitus and complications in cesarean delivery and
anesthesia. This review aims to present
updates on the relationship between obesity and pregnancy and labor outcomes,
emphasizing the significance of obesity as a risk factor for adverse pregnancy
outcome.
|
Sleep. 2004 Nov 1;27(7):1405-17. |
Sleep disorders during pregnancy.
Pien GW, Schwab RJ.
Divisions of Sleep Medicine and Pulmonary, Allergy & Critical Care,
Department of Medicine, University of Pennsylvania School of Medicine,
Philadelphia, PA 19104, USA. gpien@mail.med.upenn.edu
This paper reviews the topic of sleep disorders in pregnant women. We describe changes in sleep architecture
and sleep pattern during pregnancy, discuss the impact of the physical and
biochemical changes of pregnancy on sleep in pregnant women and examine whether
maternal-fetal outcomes may be adversely affected in women with disordered
sleep. The literature on common sleep disorders affecting pregnant women,
including insomnia, sleep-disordered breathing and restless legs syndrome, is
reviewed and recommendations are made for the management of these disorders
during pregnancy.
|
Acta Obstet Gynecol Scand. 2004 Feb;83(2):159-64. |
Arterial oxygen tension during sleep in
the third trimester of pregnancy.
Prodromakis
E, Trakada
G, Tsapanos
V, Spiropoulos
K.
Division of Pulmonology, Laboratory
of Sleep and the Department of Obstetrics and Gynecology, University of
BACKGROUND: Changes during pregnancy include reduced functional residual
capacity (FRC) and residual volume (RV), increased alveolar difference for
oxygen and, in the supine position, reduced cardiac output. In conjunction with
sleep-related disturbances, these changes could lead to maternal oxygen desaturation during sleep. OBJECTIVES: Because of
conflicting data from respiratory sleep studies in pregnancy, we performed
complete polysomnography on 21 pregnant women at the
36th week of gestation and again postpartum. We also measured the partial
pressure of oxygen in the arterial blood (PaO2) in the supine and sitting
positions. METHODS: We tested 21 healthy pregnant women at the 36th week of
gestation. Arterial samples were taken in the sitting position. Complete polysomnography was performed in all of the pregnant women.
Before the polysomnography arterial samples were
taken in the supine and sitting positions and then every 2 h until termination
of the study. RESULTS: We did not find any correlation between SaO2/PaO2 levels
and apnea, hypopnea or percent of rapid eye movement
(REM) sleep. The frequency of apnea and hypopnea was
significantly lower during pregnancy (5.81 +/- 2.1 apneas or hypopneas per hour of sleep) than postpartum (12.1 +/- 2.7
apneas or hypopneas per hour of sleep) (p <
0.001), which may be due to the raised level of progesterone. The PaO2 levels
in the supine position were significantly lower than in the sitting position at
36 weeks of gestation (p < 0.001). No differences were found between PaO2
levels in the sitting and supine positions postpartum (p < 0.5). CONCLUSIONS: According to our results we
conclude that 1) the frequency of apnea and hypopnea
in pregnancy was significantly lower than postpartum, and 2) a significant
difference in PaO2 levels in the sitting and supine positions was observed at
36 weeks of gestation.
|
Sleep Med. 2004 Jan;5(1):43-51. |
Pregnancy, sleep disordered breathing and treatment with nasal
continuous positive airway pressure.
Guilleminault C,
Kreutzer M, Chang JL.
OBJECTIVE: To investigate the tolerance,
compliance and problems associated with usage of nasal continuous positive
airway pressure (CPAP) by pregnant women with sleep disordered breathing (SDB).
PATIENTS AND METHOD: Twelve pregnant women diagnosed with SDB received polysomnography (PSG) at entry, CPAP titration, repeat PSG
at 6 months gestation (GA) and home monitoring of cardio-respiratory variables
at 8 months GA. Compliance was verified by the pressure at the mask. Results
from the Epworth sleepiness scale, fatigue scale and visual analogue scales
(VAS) for sleepiness, fatigue, and snoring were compared over time. RESULTS:
All of the subjects had full term pregnancies and healthy infants. Nightly
compliance was at least 4 h initially and 6.5 h at 6 months GA. Nasal CPAP
significantly improved all scales compared to entry. VAS scores remained lower
at 6 months GA compared to entry. Re-adjustment of CPAP pressure was needed in
six subjects at 6 months GA. CONCLUSION:
Nasal CPAP is a safe and effective treatment of SDB during pregnancy.
|
Curr Treat Options Neurol.
2004 Jul;6(4):319-330. |
Sleep Problems Across the Life Cycle in
Women.
Moline
M, Broch L, Zak R.
Eisai Incorporated, Glenpointe Centre West,
Across the life cycle of women, the quality and quantity of sleep can be markedly
impacted by internal (eg, hormonal changes and
vasomotor symptoms) and external (financial and child-care responsibilities;
marital issue) factors. This paper will outline some of the major phases of the
life cycle in women that have been associated with sleep problems. The main
messages from this paper include 1) that very little systematic, large-scale
research has been performed in virtually every area reviewed; and 2) once
identified, the sleep problem is generally best addressed by the standard
therapeutic approach, except in the case of pregnant and lactating women in
which concern for the fetus and child must be considered in the treatment
decision. This paper is organized into sections that address sleep problems
associated with the menstrual cycle, pregnancy, postpartum, and perimenopause. Anecdotal reports recommend treatment that
addresses the specific physical discomfort experienced by the woman (eg, analgesics for premenstrual pain, pregnancy pillows for
backache, and hormone replacement therapy for hot flashes). The importance of developing standard
treatment recommendations is stressed because the development of chronic
insomnia has been linked to precipitating events. In addition, primary sleep
disorders (eg, sleep apnea or restless legs syndrome)
have been shown to increase during pregnancy and menopause, but treatment
recommendations may be contraindicated or are not specific for women.
|
Clin Chest Med. 2004 Jun;25(2):257-68. |
Gender differences in sleep and
sleep-disordered breathing.
Collop
NA, Adkins D, Phillips BA.
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University,
1830 East Monument Street, Room 555,
Sleep and sleep disorders are different in several important ways between men
and women. Because of pregnancy and menopause, women experience changes in
sleep that may present as clinical problems. In clinical populations, women are
more likely to present with insomnia than are men, although their sleep may be
better preserved. The presentation of
sleep apnea in women is distinct from that of men and is less likely to include
a "classic" history of witnessed ap-nea or
heavy snoring. More likely it presents with nonspecific symptoms, such as
fatigue or mood disturbance. There are little data on the effects of
different treatments for OSA between men and women. OHS is a syndrome that may be as common in women as in men. The role of
hormones in its pathophysiology is not well-defined.
|
Eur Respir J. 2003 Jul;22(1):161-72. |
Sleep-disordered breathing and hormones.
Saaresranta T,
Polo O.
Dept of Pulmonary Diseases,
Sleep-disordered breathing (SDB) is not only a problem of the upper airway but
is a systemic condition with endocrine and metabolic interactions. The accumulating body of evidence shows
that SDB induces changes in the serum levels or secretory
patterns of several hormones. Conversely, various endocrine disorders and
hormone therapies may induce, exacerbate or alleviate SDB. Much of the
understanding of the interactions between hormones and sleep-disordered
breathing derive from intervention studies with nasal continuous positive
airway pressure therapy. Better
understanding of hormones and breathing may open new perspectives in developing
strategies to prevent, alleviate or cure sleep-disordered breathing and its
systemic consequences.
|
Sleep Med Rev. 2003 Apr;7(2):155-77. |
Sleep in women across the life cycle from adulthood through
menopause.
Moline ML, Broch
L, Zak
R, Gross V.
Department of Psychiatry, Weill Medical College of
Cornell University, New York Presbyterian Hospital, 21 Bloomingdale Road, White
Plains, New York, 10605, USA.
Studies of sleep across the life cycle in women have utilized both survey and polysomnographic techniques, but have tended to be of small
sample size with diverse methodology. As a result, definitive conclusions about
the impact of the menstrual cycle and use of oral contraceptives on sleep
parameters cannot yet be made. Sleep
disruption during pregnancy and postpartum is nearly universal, but effective and
practical countermeasures are still needed. Longitudinal studies of sleep
in the postpartum period are also lacking. Menopause is associated with
insomnia due to several factors including hot flashes, mood disorders and
increased sleep-disordered breathing. The use of hormone replacement therapy to
treat sleep and other variables is an active area of investigation. In summary,
much research is required to fully elucidate the impact of the life cycle on
sleep parameters in women.
|
Med Hypotheses. 1989 Sep;30(1):51-4. |
Obstructive sleep apnea (OSA)-implications
in maternal-fetal medicine. A hypothesis.
Schoenfeld
A, Ovadia
Y, Neri
A, Freedman S.
Department of Obstetrics and Gynecology,
During the past fifteen years the
obstructive sleep apnea syndrome (OSAS) has become widely recognized as a quite
common disorder with a wide range of serious clinical complications (1, 2, 3). This syndrome arises as a result of sleep related
changes in upper airway muscle function and progressive narrowing of the oropharyngeal lumen. The resulting hypoxia (or asphyxia)
leads to an arousal response that terminates the initial obstructive event. The
exact incidence and prevalence of OSAS is currently unknown. Lavie (4) concluded its prevalence to be 1.26 percent.
Others (5, 6) found that the prevalence of heavy regular snoring (taken as an
index of at least a partially obstructed airway) increased with age including
40 percent of women and 50 percent of men over 60 years of age. Polygraphically documented OSAS showed incidence of 0.99
percent in an unselected population. Postmenopausal women have frequent
episodes. of OSA in contrast with their premenopausal counterparts, who very rarely have any apnea.
Since we could not find in the literature any documented OSAS studies in
pregnancy, we would like to base our hypothesis on our previously published
clinical observations and our recent findings. In the present paper we would like to suggest that pathophysiologic
changes of OSAS prolonged throughout many weeks of pregnancy may have an
adverse effect upon the feto-placental unit.
|
Am J Hypertens. 2001 Nov;14(11 Pt 1):1090-5. |
Hemodynamic responses to obstructive respiratory
events during sleep are augmented in women with preeclampsia.
Edwards N, Blyton DM, Kirjavainen TT,
Sullivan CE.
Department of Medicine, The University of
Preeclampsia is the most common disease
of pregnancy, occurring in up to 10% of the pregnant population. The cause of
the disease is as yet undetermined; however, most of the clinical effects are
commonly attributed to damage to the endothelial layer, leading to increased pressor activity of all the maternal blood vessels.
Therefore, we suspected that if obstructive sleep apnea (OSA) coexisted with preeclampsia in pregnancy, the hemodynamic
effects of the OSA would be markedly potentiated.
To test this hypothesis, we performed full sleep studies and overnight
beat-to-beat blood pressure (BP) monitoring. The control patient group included
10 pregnant women with OSA and no evidence of hypertensive disease either
before or during their current pregnancy. The test group included 10 women with
preeclampsia and coexisting OSA. The pressor responses to obstructive respiratory events during
sleep were enhanced in preeclamptic patients compared
with control OSA patients (21+/-2/12+/-1 mm Hg and 38+/-5/25+/-4 mm Hg above
baseline in control OSA and preeclamptic OSA
patients, respectively, P = .005/.005). In contrast, there was no difference in
heart rate responses between the two groups of subjects (34+/-5 beats/min and
49+/-13 beats/min above baseline in control and preeclamptic
patient groups, respectively, P = .326). We
suggest that the augmented pressor responses in preeclamptic women occur as a result of maternal
endothelial damage induced by the preeclampsia
disease process. These findings may have important implications in the
management of preeclamptic patients.
|
Am J Respir Crit
Care Med. 2003 Jan 15;167(2):137-40. |
The upper airway in pregnancy and pre-eclampsia.
Izci
B, Riha
RL, Martin SE, Vennelle
M, Liston
WA, Dundas
KC, Calder AA, Douglas NJ.
Snoring is common in pregnancy, and
snoring pregnant women have increased rates of pre-eclampsia.
Patients with pre-eclampsia show upper airway
narrowing during sleep. The present study aimed to compare upper airway
dimensions in pregnant and nonpregnant women and in
patients with pre-eclampsia. A total of 50 women in
the third trimester of pregnancy and 37 women with pre-eclampsia
were recruited consecutively from the antenatal service and matched with 50 nonpregnant women. Upper airway dimensions were measured
using acoustic reflection. Comparisons were made by analysis of variance and
Student-Newman-Keuls tests. Snoring was reported by
14% of nonpregnant women, 28% of pregnant women, and
75% of pre-eclamptic women (p < 0.001). When seated, pregnant women had wider upper airways than nonpregnant women (p < 0.02), but there was no
difference when supine. Oropharyngeal junction
area in the seated position was less (p < 0.01) in the women with pre-eclampsia (mean +/- SD: 0.9 +/- 0.1 cm2) than either nonpregnant (1.1 +/- 0.1 cm2) or pregnant women (1.3 +/-
0.1 cm2). Supine oropharyngeal junction area was less
in the women with pre-eclampsia than in the nonpregnant women (0.8 +/- 0.1 versus 1.0 +/- 0.1 cm2; p =
0.01) but similar in women with pre-eclampsia and
pregnant women (0.9 +/- 0.1 cm2; p > 0.3). The study showed that women with pre-eclampsia
have upper airway narrowing in both upright and supine postures. These changes
could contribute to the upper airway resistance episodes during sleep in
patients with pre-eclampsia, which may further
increase their blood pressure.
|
J Hypertens. 2001 Aug;19(8):1437-44. |
The prevalence and clinical significance
of nocturnal hypertension in pregnancy.
Brown
MA, Davis GK, McHugh L.
Department of Medicine, St George Hospital, University of New South Wales, Kogarah, Sydney, Australia. mbrown@unsw.edu.au
OBJECTIVE: To determine (a) the
prevalence of hypertension during sleep in pre-eclampsia
and gestational hypertension, and (b) whether women with hypertension during
sleep have worse pregnancy outcomes than hypertensive pregnant women with
controlled (normal) blood pressure (BP) during sleep. DESIGN: Prospective
double-blind cohort study. SETTING: Inpatients and outpatients managed in a day
assessment unit (DAU) at St George Hospital,
|
Eur Respir J. 2001 Oct;18(4):672-6. |
Inspiratory flow limitation during sleep in pre-eclampsia: comparison with normal pregnant and nonpregnant women.
Connolly G, Razak
AR, Hayanga
A, Russell A, McKenna P, McNicholas
WT.
Depts of
Obstetrics and Gynaecology,
Self-reported snoring is common in pregnancy, particularly in females with pre-eclampsia. The prevalence of inspiratory
flow limitation during sleep in preeclamptic females
was objectively assessed and compared with normal pregnant and nonpregnant females. Fifteen females with pre-eclampsia were compared to 15 females from each of the
three trimesters of pregnancy, as well as to 15 matched nonpregnant
control females (total study population, 75 subjects). All subjects had
overnight monitoring of respiration, oxygen saturation, and blood pressure
(BP). No group had evidence of a clinically significant sleep apnoea syndrome, but patients with pre-eclampsia
spent substantially more time (31+/-8.4% of sleep period time, mean+/-SD) with
evidence of inspiratory flow limitation compared to
15.5+/-2.3% in third trimester subjects and <5% in the other three groups
(p=0.001). In the majority of preeclamptics, the
pattern of flow limitation was of prolonged episodes lasting several minutes
without associated oxygen desaturation. As expected,
systolic and diastolic BPs were significantly higher
in the pre-eclamptic group (p<0.001), but all
groups showed a significant fall (p< or =0.05) in BP during sleep. Inspiratory flow limitation is common during sleep in
patients with pre-eclampsia, which may have
implications for the pathophysiology and treatment of
this disorder.
|
Chest. 2001 Nov;120(5):1448-54. |
Sleep-related disordered breathing during pregnancy in obese
women.
Maasilta P, Bachour A, Teramo K, Polo O, Laitinen LA.
Department of Pulmonary Medicine,
STUDY OBJECTIVES: This study was designed to evaluate sleep-related disordered
breathing in obese women during pregnancy. Obesity
is known to predispose to sleep-related breathing disorders. During pregnancy,
obese mothers gain additional weight, but other mechanisms may counteract this
effect. DESIGN: A case-control study to compare sleep-related breathing in
obese pregnant women (mean prepregnancy body mass
index [BMI] > 30 kg/m(2)) with pregnant women of
normal weight (mean BMI, 20 to 25 kg/m(2)). SETTING: University teaching
hospital with a sleep laboratory. PARTICIPANTS: We recruited 11 obese women
(BMI, 34 kg/m(2); mean age 31 years) and 11 control
women (BMI, 23 kg/m(2); mean age 32 years). INTERVENTIONS: Overnight polysomnography was performed during early (after 12 weeks)
and late (after 30 weeks) pregnancy. MEASUREMENTS AND RESULTS: During
pregnancy, obese mothers gained 13 kg and control women gained 16 kg. Sleep
characteristics did not differ between the groups. During late pregnancy, the
women in both groups slept more poorly and slept in supine position less.
During early pregnancy, their apnea-hypopnea indexes
(1.7 events per hour vs 0.2 events per hour; p <
0.05), 4% oxygen desaturations (5.3 events per hour vs 0.3 events per hour; p < 0.005), and snoring times
(32% vs 1%, p < 0.001) differed significantly.
These differences between the groups persisted in the second polysomnography, with snoring time further increasing in
the obese. Preeclampsia and mild obstructive sleep
apnea were diagnosed in one obese mother. One obese mother delivered a baby
showing growth retardation (weight - 3 SD). CONCLUSIONS: We have shown significantly more sleep-related disordered
breathing occurring in obese mothers than in subjects of