Obstructive sleep apnoea and its association with gestational hypertension

Abstract

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.

Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing

“…Snoring could be indicative of flow limitation, for instance, which would not meet criteria for apnoea or hypopnoea. A recent study has found a significantly elevated apnoea/hypopnoea index, with hypopnoeas defined as a flow limitation without desaturation in females with gestational hypertension; however, the study did not evaluate the association of these findings with symptoms of SDB [29]. Evidence evaluating the association of symptoms of SDB with polysomnographic evidence of SDB in pregnancy is lacking.…”

“…A small number of studies have evaluated the association between SDB symptoms and fetal outcomes [14,17,29,47] and are somewhat conflicting [14,17] with some lacking a control arm [29]. A large study has shown an association between snoring and fetal growth restriction [14].…”

Increased upper airway cytokines and oxidative stress in severe obstructive sleep apnoea

“…Diagnostic polysomnography was performed as previously described either in the sleep laboratory (Sandman; Tyco Inc., Ottawa, Canada) [4] or at home (Suzanne portable complete polysomnography device; Tyco Inc.) [22]. The same signals were recorded during both types of studies and analysis was performed on the same computerised system (Sandman version 6.2) using identical scoring criteria.…”

“…The same signals were recorded during both types of studies and analysis was performed on the same computerised system (Sandman version 6.2) using identical scoring criteria. Polysomnographic recordings had to conform to ''very good'' or ''excellent'' recording quality criteria as previously described [22] and show a total sleep time of .4 h. Sleep-wake state and arousals were scored using conventional criteria [23,24] and respiratory events were scored according to the Chicago criteria [25]. Standard measures of sleep structure, respiratory disturbance and oxygenation were derived as previously described [4,22] for correlation with tissue findings.…”

Sleeping for Two: The Great Paradox of Sleep in Pregnancy

“…1 Meanwhile, there is growing evidence linking sleep disturbances with adverse pregnancy outcomes. [2][3][4] The message is clear: good sleep is important for a healthy pregnancy.…”