Association of Pregestational Maternal Sleeping Disorders and Preeclampsia: A Retrospective Cohort Study and Review of the Literature

Abstract

In this retrospective cohort study, primigravidas with normal pregnancies and women who developed preeclampsia (PE) were assigned to complete sleeping disorder questionnaires. The Crown-Rump length (CRL) of the first prenatal screening was used to determine the gestational age and the participants were assigned to complete the following questionnaires according to their everyday life before pregnancy: (1) Pittsburgh Sleep Quality Index (PSQI), (2) Epworth Sleepiness Scale (ESS), and (3) Athens Insomnia Scale (AIS). Women were also asked to evaluate their stress before pregnancy with the Beck Anxiety Inventory (BAI). The results of the women developing preeclampsia were analyzed to test the primary hypothesis that women with pre-existing to pregnancy sleep disorders are more likely to develop preeclampsia. Statistically significant differences were found between women who developed preeclampsia and women in the control group concerning sleeping disorder features before pregnancy of all three research tools, namely AIS (p<0.001), PSQI (p<0.001), and ESS (p=0.012<0.05). The results support that there is a possible statistical effect of pre-existing to pregnancy sleep disorders on the development of preeclampsia and women with pregestational sleep disorders request strict monitoring during pregnancy, however, further investigation with larger studies is needed to reach safe conclusions.

Maternal Sleep Problems in the Periconceptional Period and the Impact on Health of Mother and Offspring: A Systematic Review

“…Five studies investigated the effects of periconceptional sleep problems on hypertensive disorders [ 16 , 20 , 21 , 29 , 33 ]. One cross-sectional study did not find any statistically significant association [ 33 ], whereas longitudinal studies found that poor sleep was associated with more adverse outcomes, although not consistently [ 16 , 20 , 21 , 29 ].…”

“…Five studies investigated the effects of periconceptional sleep problems on hypertensive disorders [ 16 , 20 , 21 , 29 , 33 ]. One cross-sectional study did not find any statistically significant association [ 33 ], whereas longitudinal studies found that poor sleep was associated with more adverse outcomes, although not consistently [ 16 , 20 , 21 , 29 ]. Haney et al found that diary-assessed sleep latency at 10–12 weeks was associated with systolic blood pressure four weeks later, but this was not statistically significant after correcting for multiple comparisons [ 21 ].…”

“…However, the quality score was only 5, due to the small study sample (N = 89), not using a proper outcome assessment, and not adjusting for additional confounders. Georgiou et al found that poor sleep before pregnancy strongly predicted the risk of preeclampsia, with ORs ranging from 3.27 to 5.03 [ 20 ]. However, the confidence intervals were quite broad (e.g., 1.41–17.89 for insomnia), and the quality score was only 3, due to the small sample size (N = 71), the lack of proper adjustment for confounders, and the high risk for recall bias.…”

Association of sleep traits with risk of hypertensive disorders of pregnancy: a mendelian randomization study

“…Additionally, emerging evidence highlights EDS as an independent pathophysiological entity and a novel indicator of cardiovascular risk [ 41 ]. Several observational studies have suggested a potential association between EDS and HDPs [ 6 , 10 , 42 ]. Our Mendelian randomization analysis further strengthens this evidence by establishing a compelling causal association, highlighting the EDS as a possible preventable risk factor for HDPs.…”

“…Second, we cannot determine whether the null findings observed between several sleep traits and the risk of HDPs represent objective facts or are a consequence of potential limitations in the statistical power of our study to detect a significant relationship. Although previous observational studies have suggested an association between sleep disorders, such as insomnia [ 9 , 42 ] and short sleep duration [ 3 , 45 ], and increased rates of preeclampsia, it is important to note that the potential impact of residual confounding inherent in the observational setting may hinder the reliability of the drawn conclusions. This is particularly true in the case of preeclampsia, which is known to be influenced by various socioeconomic and behavioral factors [ 46 , 47 ].…”