Inspiratory flow limitation during sleep in pre-eclampsia: comparison with normal pregnant and nonpregnant women

Connolly, Geraldine; Razak, Albiruni Ryan Abdul; Hayanga, Awori J.; Russell, Andrew E.; McKenna, Peter; McNicholas, WT

doi:10.1183/09031936.01.00053501

Cited by 106 publications

(64 citation statements)

References 24 publications

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“…Differences in risk factors between women with mild and severe pre-eclampsia include higher maternal weight and a higher predilection for metabolic syndrome in those with the milder pre-eclampsia phenotype. (32) As it relates to SDB, mild pre-eclampsia may be a marker for women at risk for snoring or SDB when confronted with pregnancy-related weight gain or fluid changes; (33)(34)(35)(36)(37) or the association we observed may relate to an underlying genetic predisposition of both mothers and their children to upper airway obstruction or to obesity-related diseases. (38) Differences in the association of SDB with mild as compared to severe pre-eclampsia may also be due to differences in smoking exposures in each group and potential confounding by this exposure.…”

Section: Discussionmentioning

confidence: 91%

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

Hibbs

Johnson

Rosen

et al. 2008

The Journal of Pediatrics

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Objectives-Previously published data from the Cleveland Children's Sleep and Health Study (CCSHS) demonstrated that preterm infants are especially vulnerable both to sleep disordered breathing (SDB) and its neurocognitive sequelae at age 8-11 years. In this analysis, we aimed to identify the components of the neonatal medical history associated with childhood SDB among children born prematurely.Study design-This analysis focuses on the 383 children in the population-based CCSHS cohort who were born <37 weeks gestational age and who had technically acceptable sleep studies performed at ages 8-11 years (92% of all preterm children). Logistic regression was used to evaluate the associations between candidate perinatal and neonatal risk factors and the presence of childhood SDB by sleep study.Results-Twenty-eight preterm children (7.3%) met the definition for SDB at age 8-11 years. Having a single mother and mild maternal pre-eclampsia were strongly associated with SDB in unadjusted and race-adjusted models. Unadjusted analyses also identified xanthine use and CPR and/ or intubation in the delivery room as potential risk-factors for SDB. We did not find a significant link between traditional markers of severity of neonatal illness --such as gestational age, birth weight, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), or duration of ventilation --and childhood SDB at school age.Conclusions-These results represent a first step in identifying prenatal and neonatal characteristics which place preterm infants at higher risk for childhood SDB. The strong association between mild pre-eclampsia and childhood SDB underscores the importance of research aimed at understanding in utero risk factors for neurorespiratory development. Corresponding Author: Anna Maria Hibbs, MD, MSCE, Division of Neonatology, Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Suite 3100, Cleveland, email: annamaria.hibbs@case.edu. Edited by AJ and WFB Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (1) Furthermore, the association between sleep disordered breathing (SDB) and childhood cognitive impairment is stronger in preterm than term infants. (8) The mechanisms by which prematurity predisposes children to SDB are unknown. The association may be mediated by altered development of the lungs, airway, or nervous system. In this analysis, we aimed to identify the components of the prenatal and neonatal medical history associated with SDB occurring in children in the CCSHS studied at ages 8-11 years who had been born prematurely. NIH Public Access METHODSThe CCSHS is a po...

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Section: Discussionmentioning

confidence: 91%

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

Hibbs

Johnson

Rosen

et al. 2008

The Journal of Pediatrics

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“…There are several studies on SDB in pregnancy, but most are based on questionnaires [1,2] or clinical examinations [12] or focused on pre-eclampsia [3,4,23]. Therefore, this study would seem to be one of the first that presents both objective and subjective measurements regarding SDB in healthy pregnant females.…”

Section: Discussionmentioning

confidence: 99%

Sleep-disordered breathing and upper airway size in pregnancy and post-partum

Izci

Vennelle

Liston

et al. 2006

European Respiratory Journal

187

118

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Sleep-disordered breathing and snoring are common in pregnancy. The aim of this study was to determine whether pregnancy was associated with upper airway narrowing.One-hundred females in the third trimester of pregnancy were recruited and 50 agreed to be restudied 3 months after delivery. One-hundred nonpregnant females were also recruited. Upper airway dimensions were measured using acoustic reflection.Snoring was less common in nonpregnant (17%) than pregnant females (41%; odds ratio (OR) 3.34; 95% confidence interval (CI) 1.65-6.74) and returned to nonpregnant levels after delivery (18%; OR 0.15; 95% CI 0.06-0.40). Pregnant females had significantly smaller upper airways than nonpregnant females at the oropharyngeal junction when seated (mean difference 0.12; 95% CI 0.008-0.25), and smaller mean pharyngeal areas in the seated (mean difference 0.14; 95% CI 0.001-0.28), supine (mean difference 0.11; 95% CI 0.01-0.22) and lateral postures (mean difference 0.13; 95% CI 0.02-0.24) compared with the nonpregnant females. Pregnant females had smaller mean pharyngeal areas compared with post-partum in the seated (mean difference 0.18; 95% CI 0.02-0.32), supine (mean difference 0.20; 95% CI 0.06-0.35) and lateral postures (mean difference 0.26; 95% CI 0.12-0.39).In conclusion, this study confirmed increased snoring and showed narrower upper airways during the third trimester of pregnancy.

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“…CONNOLLY et al [29] reported increased periods of inspiratory flow limitation among 15 pre-eclamptic females compared with normotensive pregnant females, although the AHI based on the o50% reduction in airflow did not differ between study groups. EDWARDS et al [30] reported similar findings, although the flow limitation episodes were not quantified.…”

Section: Controls N=33mentioning

confidence: 99%

Obstructive sleep apnoea and its association with gestational hypertension

Champagne¹,

Schwartzman²,

Opatrny³

et al. 2009

European Respiratory Journal

111

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Hypertension develops in 10% of pregnancies. Snoring, a marker of obstructive sleep apnoea, is a newly identified risk factor for gestational hypertension. Moreover, obstructive sleep apnoea is an independent risk factor for incident hypertension in the non-pregnant population. The aim of the present study was to test the hypothesis that obstructive sleep apnoea is associated with new onset of hypertension among pregnant females.A case-control study was performed involving 17 pregnant females with gestational hypertension and 33 pregnant females without hypertension. Subjects were frequency-matched for gestational age and recruited in a tertiary obstetrical centre. Obstructive sleep apnoea was ascertained by polysomnography and defined by an apnoea/hypopnoea index (AHI) of o15 events?h -1 , without requirement for desaturation. The mean¡SD AHI for normotensive pregnant females was 18.2¡12.2 events?h -1 compared with 38.6¡36.7 events?h -1 for females with hypertensive pregnancies. The crude odds ratio for the presence of obstructive sleep apnoea given the presence of gestational hypertension was 5.6. The odds ratio was 7.5 (95% confidence interval 3.5-16.2), based on a logistic regression model with adjustment for maternal age, gestational age, pre-pregnancy body mass index, prior pregnancies, and previous live births.In conclusion, gestational hypertension appears to be strongly associated with the presence of obstructive sleep apnoea.

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Inspiratory flow limitation during sleep in pre-eclampsia: comparison with normal pregnant and nonpregnant women

Cited by 106 publications

References 24 publications

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

Sleep-disordered breathing and upper airway size in pregnancy and post-partum

Obstructive sleep apnoea and its association with gestational hypertension

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