Association Between Sleep-Disordered Breathing and Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus

Abstract

Objective The objective of this prospective cohort study was to determine if sleep disordered breathing during pregnancy is a risk factor for the development of hypertensive disorders of pregnancy and gestational diabetes mellitus. Methods Nulliparous women underwent in-home sleep disordered breathing assessments in early (6–15 weeks) and mid-pregnancy (22–31 weeks). Participants and providers were blinded to the sleep test results. An apnea-hypopnea index (AHI) of ≥5 was used to define sleep disordered breathing. Exposure-response relationships were examined grouping participants into four AHI groups: AHI=0, 0<AHI<5, 5≤AHI<15 and AHI≥15. The study was powered to test the primary hypothesis that sleep disordered breathing occurring in pregnancy is associated with an increased incidence of preeclampsia.. Secondary outcomes were rates of hypertensive disorders of pregnancy, defined as preeclampsia and antepartum gestational hypertension, and GDM. Crude and adjusted odds ratios and 95% confidence intervals were calculated from univariate and multivariate logistic regression models. Results Three thousand seven hundred and five women were enrolled. AHI data were available for 3,132 (84.5%) and 2,474 (66.8%) women in early and mid-pregnancy, respectively. The corresponding prevalence of sleep disordered breathing was 3.6% and 8.3%. The prevalence of preeclampsia was 6.0%, hypertensive disorders of pregnancy 13.1% and GDM 4.1%. In early and mid-pregnancy the adjusted odds ratios for preeclampsia when sleep disordered breathing was present were 1.94 (95% CI 1.07–3.51) and 1.95 (95% CI 1.18–3.23), respectively; hypertensive disorders of pregnancy, 1.46 (95% CI 0.91–2.32) and 1.73 (95% CI 1.19–2.52); and GDM, 3.47 (95% CI 1.95–6.19) and 2.79 (95% CI 1.63–4.77). Increasing exposure-response relationships were observed between AHI and both hypertensive disorders and GDM. Conclusions There is an independent association between sleep disordered breathing and preeclampsia, hypertensive disorders of pregnancy, and GDM.

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