Pregnant Women with Gestational Hypertension May Have a High Frequency of Sleep Disordered Breathing

Reid, John; Skomro, Robert; Cotton, David; Ward, Heather; Olatunbosun, Femi; Gjevre, John; Guilleminault, Christian

doi:10.5665/sleep.1156

Cited by 81 publications

(95 citation statements)

References 49 publications

(58 reference statements)

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“…73 Although the mechanisms behind these differences are not clear, they may be similar to those that link short and long sleep durations with increased BP in the nonpregnant population.…”

mentioning

confidence: 90%

“…1 SDB, independent of maternal BMI, is associated with an increased risk of hypertension in pregnancy, as well as maternal morbidity. 73,78,[80][81][82][83][84][85][86] In one study, preeclampsia, a hypertensive syndrome in pregnancy, was significantly more common among snorers than non-snorers (10% versus 4%, p < 0.05), as was gestational hypertension (14% versus 6%, p < 0.01). 87 This was recently corroborated in a report by O'Brien and colleagues, who found that pregnancy-onset snoring was independently associated with gestational hypertension (OR 2.36 [1.48-3.77], p < 0.001) and preeclampsia (OR 1.59 [1.06-2.37], p = 0.024) in 1,719 third-trimester pregnant women.…”

Section: Sleep Related Breathing Disorders In Pregnancymentioning

confidence: 99%

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Sleep and Pregnancy-Induced Hypertension: A Possible Target for Intervention?

Haney

Buysse²,

Okun³

2013

Journal of Clinical Sleep Medicine

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Sleep disturbances in the general population are associated with elevated blood pressure. This may be due to several mechanisms, including sympathetic activation and hypothalamic-pituitary-adrenal (HPA) axis disturbance. Elevated blood pressure in pregnancy can have devastating effects on both maternal and fetal health and is associated with increased risk for preeclampsia and poor delivery outcomes. Preliminary evidence suggests that mechanisms linking sleep and blood pressure in the general population may also hold in the pregnant population. However, the effects of disturbed sleep on physiologic mechanisms that may directly infl uence blood pressure in pregnancy have not been well studied. The role that sleep disturbance plays in gestational blood pressure elevation and its subsequent consequences warrant further investigation. This review evaluates the current literature on sleep disturbance and elevated blood pressure in pregnancy and proposes possible treatment interventions. T he association between sleep disturbances and elevated blood pressure has been extensively studied in the general population. However, relatively few studies have investigated this relationship in the pregnant population. Pregnancy predisposes women to a variety of sleep disturbances.1,2 Similar to non-pregnant individuals, sleep disturbance in pregnancy may be a risk factor for elevated blood pressure, which can lead to maternal and fetal morbidity . 3,4Gestational hypertension, defi ned as a blood pressure higher than 140/90 diagnosed after 20 weeks of gestation, is associated with fetal growth restriction and abruptio placentae and can predispose to preeclampsia, as well as cardiovascular disease later in lif e. 1,[4][5][6] There are few studies evaluating the link between sleep and blood pressure during pregnancy. In this paper, we fi rst review the relationship between sleep and blood pressure in non-pregnant adults. We then outline factors that predispose pregnant women to poor sleep. We conclude with a review of the emerging literature on the associations between sleep and blood pressure in pregnancy. SLEEP AND BLOOD PRESSURE IN THE NON-PREGNANT POPULATIONIn the U.S. the average sleep duration has decreased by 1.5-2 h/night, with > 30% of Americans sleeping < 6 h/night. 7This phenomenon and the concurrent increase in hypertension intimated a possible link between sleep duration and blood pressure. Recently, a series of epidemiological papers have noted an association between sleep duration (both short and long) and elevated blood press ure [8][9][10][11] ; for example, the Sleep Heart Health Study reported that participants who slept < 5 or ≥ 9 h/night had a greater frequency of hypertension than individuals sleeping

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“…73 Although the mechanisms behind these differences are not clear, they may be similar to those that link short and long sleep durations with increased BP in the nonpregnant population.…”

mentioning

confidence: 90%

Section: Sleep Related Breathing Disorders In Pregnancymentioning

confidence: 99%

Sleep and Pregnancy-Induced Hypertension: A Possible Target for Intervention?

Haney

Buysse²,

Okun³

2013

Journal of Clinical Sleep Medicine

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“…Dodatkowo może ona wynikać z prewencji wzrostu ciśnienia www.pneumonologia.viamedica.pl parcjalnego PaCO 2 , który jest jednym z najlepiej znanych czynników wazokonstrukcyjnych [27,28].…”

Section: Program Working Group On High Blood Pressure Inunclassified

Czy istnieje związek między nadciśnieniem indukowanym ciążą a obturacyjnym bezdechem sennym? Opis przypadku

Gruca-Stryjak

Cofta

Wysocka

et al. 2014

Advances in Respiratory Medicine

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W pracy przeanalizowano przypadek kobiety w ciąży bliźniaczej powikłanej stanem przedrzucawkowym i zaburzeniami oddychania podczas snu. Pacjentka została przyjęta do szpitala z powodu nadciśnienia tętniczego, białkomoczu oraz narastających obrzęków. Wyniki badań laboratoryjnych ujawniły białkomocz oraz zmniejszenie stężenia białka całkowitego w surowicy krwi. Rozpoznano łagodną postać stanu przedrzucawkowego. Z uwagi na zaobserwowaną nasiloną senność dzienną, głośne chrapanie i przerwy w oddychaniu podczas snu wykonano u pacjentki badanie polisomnograficzne, podczas którego obserwowano liczne epizody bezdechów obturacyjnych i spłyconego oddychania podczas snu. Wartość wskaźnika AHI (apnea-hypopnea index) wynosiła 82.1 z licznymi epizodami desaturacji osiągającymi najniższą wartość 82%. Rozpoznano ciężką postać obturacyjnego bezdechu sennego i włączono leczenie za pomocą protezy powietrznej (CPAP). Zastosowanie CPAP pozwoliło na zmniejszenie wskaźnika AHI do 1.2 oraz lepszą kontrolę ciśnienia tętniczego. Między 33. a 35. tygodniem ciąży pacjentka stosowała CPAP. W 35. tygodniu ciąży z uwagi na wystąpienie objawów zagrożenia życia pierwszego bliźniaka w zapisie kardiotokograficznym ukończono ciążę cięciem cesarskim. Urodziły się dwa noworodki płci męskiej w stanie dobrym. W okresie połogu pacjentka zaprzestała stosowania CPAP. Obserwowano wzrost wskaźnika AHI do 45.3 oraz wzrost wartości ciśnienia tętniczego do najwyższej wartości 180/100 mm Hg. Pacjentka w stanie ogólnym dobrym w 7. dobie połogu została zwolniona do domu z zaleceniami dalszej diagnostyki i leczenia w poradni zaburzeń snu. Podsumowując, należy stwierdzić że, zaburzenia snu wywierają niekorzystny wpływ na zdrowie matki i płodu, na nastrój i jakość życia ciężarnej. Udowodniono, że istnieje wiele zależności między snem a zdrowiem. Zaburzenia snu wraz z zaburzeniami oddychania podczas snu przyczyniają się do rozwoju wielu różnych chorób ogólnych bądź też pogarszają ich przebieg. A choroby te z drugiej strony negatywnie wpływają na jakość snu. Podstawowe znaczenie ma leczenie schorzenia podstawowego, lecz towarzyszące mu zaburzenia snu także wymagają terapii.

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“…The majority of studies during pregnancy focus on snoring [4]. However, in recent years, there has been an increased interest regarding the presence of OSAS in pregnant women [5][6][7] as a result of its potential impact in areas such as gestational hypertension, gestational diabetes, and fetal damage [8,9].…”

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confidence: 99%

“…The usual clinical questionnaires are less useful in these patients, so overnight polysomnography remains the gold standard for OSAS diagnosis. Simplified sleep studies such as pulse oximetry are not useful because respiratory events will have a greater impact on fragmentation (arousals) than on oxyhemoglobin saturation [9]. Questionnaires and sleep apnea detection devices have not been validated for pregnant women.…”

mentioning

confidence: 99%