Polysomnographic analysis of maternal sleep position and its relationship to pregnancy complications and sleep-disordered breathing

Abstract

Links between supine “going to sleep” position and stillbirth risk have led to campaigns regarding safe maternal sleep position. This study profiles the distribution of sleep positions overnight and relationships to sleep onset position during pregnancy, and the relationships between supine sleep, sleep-disordered breathing (SDB) and pregnancy outcomes. Data from three prospective cohort studies evaluating SDB in healthy and complicated pregnancies was pooled. All participants underwent one night of polysomnography in late pregnancy and birth outcome data were collected. 187 women underwent polysomnography at a median gestation of 34 weeks’. The left lateral position was preferred for falling asleep (52%) compared to supine (14%), but sleep onset position was the dominant sleep position overnight in only half (54%) of women. The median percentage of sleep time in the supine position was 24.2%; women who fell asleep supine spent more time supine overnight compared to those who began non-supine (48.0% (30.0,65.9) vs. 22.6% (5.7,32.2), p<.001). Women with growth-restricted fetuses were more likely to fall asleep supine than those with well-grown fetuses (36.6% vs 7.5%, p <.001). Positional SDB was observed in 46% of those with an RDI ≥5. Sleep onset position was the dominant position overnight for half of the sample, suggesting that sleep onset position is not always a reliable indicator of body position overnight. Supine sleep was related to fetal growth restriction and birthweight at delivery, though causality cannot be inferred. It is critical that we pursue research into verifying the important relationship between supine sleep and increased stillbirth risk, and the mechanisms behind it.

A Relation between Obstructive Sleep Apnea in Pregnancy and Delivering Small for Gestational Age Infant—A Systematic Review

“…Louis et al [ 51 ] utilized type III HSAT to test pregnant participants with a high risk of OSA, but all subjects diagnosed with OSA underwent attended PSG ultimately. Wilson et al [ 39 ] and Antony et al [ 49 ] examined participants using type I or type III HSAT, but Antony et al assessed subjects regardless of the device used in the hospital. In contrast, Wilson et al assessed women depending on the methods in a hospital (type I) or home (type III).…”

Vision-based detection and quantification of maternal sleeping position in the third trimester of pregnancy in the home setting–Building the dataset and model

“…Despite training our models on less than 10% of our collected dataset, our models achieved an overall mAP@0.50 of 0.76 (0.81 without bed sheets, 0.71 with bed sheets; see Fig 4 ) in the testing phase on unseen images across 24 classes. The tools must account for factors unique to pregnancy anatomy and physiology including, but not limited to, the impact of the pelvis position on uteroplacental hemodynamics and fetal physiology, the location of the low-pressure, thin-walled, and collapsible IVC on the right side of the spine, and the challenge that pregnancy places on the respiratory system, especially during sleep [ 19 , 38 ], and especially when supine [ 19 , 38 , 88 , 89 ]. The models we developed may meet this requirement–we were able to train them to detect sleeping position at a high resolution in that it accounts for the position of the pelvis and the thorax and the direction (right vs. left) at varying degrees (recovery, lateral, tilt) for a total of eleven sleeping postures.…”

Contemporary Concise Review 2022: Sleep

“…Further research into SDB during pregnancy is needed and further highlighted by Wilson et al in pooled data from three prospective cohorts evaluating SDB during pregnancy, finding the overall respiratory disturbance index significantly increased with higher amounts of sleep in the supine position. 34 Furthermore, supine sleep was related to foetal growth restriction and lower birthweight, noting causality cannot be inferred.…”