Sleep disturbances are common in pregnancy, and sleep disorders may worsen or present de novo in the course of gestation. Managing a pregnant patient is complicated by the risk of teratogenicity, pharmacokinetic changes, and the dynamic nature of pregnancy. Although nonpharmacologic interventions are likely safest, they are often ineffective, and a patient is left dealing with frustrations of the sleep disturbance, as well as the negative outcomes of poor sleep in pregnancy. As with any other condition in pregnancy, management requires an understanding of pregnancy physiology, knowledge of the impact of a given condition on pregnancy or fetal and neonatal outcomes, and an ability to weigh the risk of the exposure to an untreated, or poorly treated condition, against the risk of a given drug. In partnership with the pregnant patient or couple, options for therapy should be reviewed in the context of the impact of the condition on pregnancy and offspring outcomes, while understanding that data (positive or negative) on the impact of therapy on perinatal outcomes are lacking. This article reviews the epidemiology of sleep disorders in pregnancy, general principles of prescribing in pregnancy and lactation, and safety surrounding therapeutic options in pregnancy.CHEST 2020; 157(1): [184][185][186][187][188][189][190][191][192][193][194][195][196][197]
Restless leg syndrome, more recently renamed Willis-Ekbom disease, is a condition that disrupts sleep and occurs more frequently in the pregnant population. We present a 39-year-old woman with restless legs syndrome in the third trimester and discuss the epidemiology, pathophysiology and therapeutic options in the pregnant population while highlighting the challenges posed by the lack of safety data of approved drugs.
concentration/meditation (dharana/dhyana), deep relaxation or yoga sleep (yoga nidra), lectures/ counseling sessions on lifestyle change, and information on anatomy. 3 In addition, yoga lowered pain intensity (measured on a scale of 0-10, with low scores indicating less pain) (median difference [MD], À6.12; 95% CI, À11.77 to À0.47, one trial, 66 women), provided greater satisfaction with pain relief (MD, 7.88; 95% CI, 1.51-14.25, one trial, 66 women), and provided greater satisfaction with childbirth experience (MD, 6.34; 95% CI, 0.26-12.42 one trial, 66 women) (assessed using the Maternal Comfort Scale, with higher scores indicating greater comfort). 4 Ray-Griffith et al 5 reports that chronic low back pain and pelvic pain occur in 71.7% of pregnancies. In the absence of contraindications, moderate-intensity physical exercise is encouraged for all pregnant and postpartum women. Exercise has been shown to increase deep sleep, improve restless legs syndrome (RLS) symptoms, and benefit mental health. Additional low-risk strategies that can help RLS symptoms based on small studies include yoga, 6 massage, and pneumatic compression devices. The authors have given the details of 13 drug's possible adverse events on pregnancy and lactation in Table 2. Unfortunately, such a table may not be of much help to the practicing physician who needs concise key points in the care of pregnant patients. Rational therapy of RLS in pregnant patients must consist of all possible nonpharmacologic therapies first before considering any of the drugs. Primum Non Nocere (First, do no harm).
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