Treatment of Sleep Disordered Breathing Reverses Low Fetal Activity Levels in Preeclampsia

Blyton, Diane M; Skilton, Michael R.; Edwards, Natalie; Hennessy, Annemarie; Celermajer, David S.; Sullivan, Colin E.

doi:10.5665/sleep.2292

Cited by 61 publications

(97 citation statements)

References 22 publications

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“…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%

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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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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“…45 In a different study, nasal CPAP was shown to increase fetal movements in patients studied with polysomnography and continuous ultrasound. 28 These studies have been the subject of an insightful analysis by O’Brien et al 121 …”

Section: Is There a Role For Cpap In Preeclampsia?mentioning

confidence: 99%

A role for sleep disorders in pregnancy complications: challenges and opportunities

Romero

Badr

2014

American Journal of Obstetrics and Gynecology

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“…Recent evidence supporting this concept indicated that even treating very mild SDB (e.g. snoring or flow limitation) with nasal continuous positive airway pressure (CPAP) improves haemodynamic parameters and fetal wellbeing [32][33][34][35][36]. Figure 1 provides guidance for our proposed model explaining potential pathways linking sleep disturbances and pregnancy complications.…”

Section: Potential Pathophysiologic Mechanisms For Adverse Pregnancy mentioning

confidence: 99%

Sleep-disordered Breathing in Pregnancy

Balserak

2014

Am J Respir Crit Care Med

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Sleep disordered breathing (SDB) is common and the severity increases as pregnancy progresses.• • Frequent snoring, older age and high pre-pregnancy body mass index (>25 kg⋅m −2 ) could be reliable indicators for SDB in early pregnancy.• • SDB screening tools, including questionnaires, used in the nonpregnant population have poor predictive ability in pregnancy.• • Accumulating evidence suggests that SDB during pregnancy may be associated with increased risk of adverse pregnancy outcomes, including gestational diabetes and pre-eclampsia. However, the results should be interpreted cautiously because several studies failed to adjust for potential maternal confounders and have other study limitations.• • There are no pregnancy-specific practice guidelines for SDB treatment. Many clinicians and practices follow recommendations for the treatment in the general population. Women with preexisting SDB might need to be reassessed, particularly after the sixth month of pregnancy, because symptoms can worsen with nasal congestion and weight gain. Educational aims • •To highlight the prevalence and severity of sleep disordered breathing (SDB) in the pregnant population. • •To inform readers about risk factors for SDB in pregnancy. • •To explore the impact of SDB on adverse maternal and fetal outcomes, and biological pathways for associated adverse maternal and fetal outcomes.• • To introduce current management options for SDB in pregnancy, including medical and behavioural approaches. Sleep disordered breathing (SDB) is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancyrelated changes affecting the severity of SDB, the epidemiology and the risk factors of SDB in pregnancy, the association of SDB with adverse pregnancy outcomes, and screening and management options specific for this population.

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Treatment of Sleep Disordered Breathing Reverses Low Fetal Activity Levels in Preeclampsia

Abstract: The effectiveness of continuous positive airway pressure in improving fetal movements suggests a pathogenetic role for sleep disordered breathing in the reduced fetal activity and possibly in the poorer fetal outcomes associated with preeclampsia.

Cited by 61 publications

References 22 publications

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

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

A role for sleep disorders in pregnancy complications: challenges and opportunities

Sleep-disordered Breathing in Pregnancy

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