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

Abstract

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

Sleep Disturbances and Symptoms of Depression and Daytime Sleepiness in Pregnant Women

“…Given the high prevalence of sleep disturbances reported in women during the third trimester of pregnancy, appropriate clinical assessment and treatment that improve sleep during pregnancy should be the target of obstetric and sleep practice. Potential treatment strategies may include counseling on maternal sleep and health as well as prescribing behavioral sleep interventions .…”

Pathophysiological changes associated with sleep disordered breathing and supine sleep position in pregnancy

“…[84] Another possibility is that snoring is likely to increase in later gestations and therefore the timing of the insult may need to occur earlier in gestation to have an observable effect on placental biomarkers.Collectively, both in vivo and in vitro placental biomarker studies suggest that SDB, particularly OSA, has a detrimental effect on placental development. It is likely that the relative maternal "hypoxic" state associated with OSA results in placental malperfusion and hypo-oxygenation leading to aberrations in vasculogenesis and angiogenesis with many features similar to that in other placentally mediated disorders such as pre-eclampsia [5,6,[85][86][87][88][89]. Extraplacental consequences of altered levels of biomarkers include increased vascular permeability and extravasation of fluid into the airway interstitial space leading to constriction mediated by vascular endothelial growth factor (VEGF) in women with OSA [90].…”

Impact of Road Traffic Pollution on Pre-eclampsia and Pregnancy-induced Hypertensive Disorders

“…15 Maternal stress and/or disturbances of sleep during pregnancy is associated with increased risk of hypertensive disorders during pregnancy. 16,17 …”