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Panyarath P, Goldscher N, Pamidi S, Daskalopoulou SS, Gagnon R, Dayan N, Raiche K, Olha A, Geater SL, Benedetti A, Kimoff RJ. Positive Airway Pressure Treatment of Obstructive Sleep Apnea-Hypopnea in Hypertensive Disorders of Pregnancy: A Pilot Randomized Proof-of-Concept Clinical Trial. Ann Am Thorac Soc 2024; 21:803-813. [PMID: 38252423 DOI: 10.1513/annalsats.202310-863oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/19/2024] [Indexed: 01/23/2024] Open
Abstract
Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). OSAH treatment with positive airway pressure (PAP) in the general population lowers blood pressure (BP). However, there are limited data on the effects of PAP therapy in maternal OSAH. Objectives: Our primary objective was to assess the feasibility of recruitment to a pilot randomized trial and adherence to PAP therapy for OSAH in women with HDP. Secondary objectives included assessment of PAP effects on 24-h BP, arterial stiffness, and maternal and fetal outcomes. Methods: Women with singleton pregnancies at ⩾12 weeks' gestation and hypertension underwent home level 2 polysomnography; those with mild to moderate OSAH (apnea-hypopnea index ⩾ 5 events/h; women with severe OSAH with apnea-hypopnea index > 30 events/h and oxygen desaturation index > 30 were excluded) were randomized to either PAP or nasal dilator strip (NDS; control) therapy. After PAP education, adherence was monitored online with episodic phone or in-person support by research personnel. Twenty-four-hour BP and arterial stiffness were assessed at baseline and before delivery. Maternal and fetal outcomes were also recorded. Results: Of 105 potentially eligible participants, 67 agreed to undergo screening for OSAH over 38 months; 48 women meeting OSAH inclusion criteria were randomized to PAP (n = 27) or NDS (n = 21) therapy. Of these, 14 PAP (52%) and 13 NDS (62%) participants completed all predelivery measurements, with lack of completion due to urgent delivery (19% in the PAP group, 14% in the NDS group), PAP intolerance at initiation (19%), or other factors. Mean PAP use was 3.1 ± 2.5 h/night, with use ⩾4 h/night on 38.4 ± 33.7% of nights during 9.6 ± 4.0 weeks of treatment. BP was controlled within the target range in most participants. There were no differences in mean change in 24-hour BP or arterial stiffness measurements or in adverse maternal and fetal outcomes between the PAP and NDS groups in either intention-to-treat or per-protocol analyses. Conclusions: PAP adherence was suboptimal in this HDP cohort despite education and troubleshooting. Further work is required to identify optimal OSAH treatment strategies during pregnancy. Clinical trial registered with www.clinicaltrials.gov (NCT03309826).
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Affiliation(s)
- Pattaraporn Panyarath
- Respiratory Division and Sleep Laboratory
- Division of Respiratory and Respiratory Critical Care Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; and
| | | | - Sushmita Pamidi
- Respiratory Division and Sleep Laboratory
- Respiratory Epidemiology Research Unit, Center for Research Outcomes Evaluation
| | - Stella S Daskalopoulou
- Respiratory Epidemiology Research Unit, Center for Research Outcomes Evaluation
- Division of Internal Medicine, Department of Medicine, and
| | - Robert Gagnon
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Natalie Dayan
- Division of Internal Medicine, Department of Medicine, and
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | | | - Allen Olha
- Respiratory Division and Sleep Laboratory
| | - Sarayut L Geater
- Division of Respiratory and Respiratory Critical Care Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; and
| | - Andrea Benedetti
- Respiratory Epidemiology Research Unit, Center for Research Outcomes Evaluation
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - R John Kimoff
- Respiratory Division and Sleep Laboratory
- Respiratory Epidemiology Research Unit, Center for Research Outcomes Evaluation
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Sarbhai V, Paswan P, Sarbhai V. Obstructive Sleep Apnoea: A Shrouded High-Risk Association for Development of Hypertensive Disorders of Pregnancy. J Obstet Gynaecol India 2023; 73:391-396. [PMID: 37916058 PMCID: PMC10615999 DOI: 10.1007/s13224-023-01835-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/16/2023] [Indexed: 11/03/2023] Open
Abstract
Background This objective of this study was to diagnose Obstructive Sleep Apnoea (OSA) in pregnant women using Questionnaire-based methods and to determine any association of Sleep-Disordered Breathing (SDB) with Hypertensive Disorder of Pregnancy (HDP). Additionally, the study aimed to identify factors associated with OSA. Methods This case-control study was conducted in department of Obstetrics in tertiary care hospital in Delhi. We Identified SDB using Berlin Questionnaire and Modified Stop-Bang Questionnaire in 100 pregnant women with Hypertension and 100 normotensive controls. We compared the groups using appropriate statistical analysis. Results The mean age of women with HDP (25.46 ± 4.38) was found to be slightly higher than controls (24.13 ± 3.89) (p value-0.02). Sleep apnoea as depicted by the presence of either high-risk STOP Bang or Berlin score was seen more often in hypertensive women in 45% as compared to controls in 8% (p value < 0.001). Higher pre-pregnancy weight (58.58 ± 9.77 vs. 53.0 ± 6.59), higher BMI (24.03 ± 5.89 vs. 20.68 ± 1.49), higher mean neck circumference (14.97 vs. 14.27 inches) weight gain more than 11 kg during pregnancy (55.6% vs. 38.2%) were the high-risk factors more commonly associated with SDB as seen in women with OSA in hypertensive women. On logistic regression analysis, the presence of OSA was singularly responsible for development of Hypertension (Odds Ratio-13.014, 95% CI 5.237-32.337) (p value < 0.001). Conclusion Gestational hypertension appears to be strongly associated with the presence of obstructive sleep apnoea. The recognition and treatment of OSA during pregnancy may lead to improved outcomes.
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Affiliation(s)
- Vinita Sarbhai
- Department of Gynecology and Obstetrics, Kasturba Hospital, C-36, First Floor, Pamposh Enclave, New Delhi, Delhi 110048 India
| | - Pooja Paswan
- Department of Obstetrics and Gynecology, Kasturba Hospital, Daryaganj, Delhi India
| | - Vikram Sarbhai
- East of Kailash, National Heart Institute, New Delhi, India
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3
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Kember AJ, Elangainesan P, Ferraro ZM, Jones C, Hobson SR. Common sleep disorders in pregnancy: a review. Front Med (Lausanne) 2023; 10:1235252. [PMID: 37671402 PMCID: PMC10475609 DOI: 10.3389/fmed.2023.1235252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023] Open
Abstract
In this review, we provide a comprehensive overview of common sleep disorders during pregnancy, including their characterization, prevalence, risk factors, and possible contribution to maternal and fetal outcomes. We conducted a quasi-systematic literature search of the MEDLINE database and identified 744 studies from 1991 through 2021, inclusive, that met our inclusion criteria. We synthesized the existing literature on sleep disorders during pregnancy and highlighted controversies, research gaps, and needed clinical developments. Our review covers a range of sleep disorders, including insomnia, obstructive sleep apnea, restless legs syndrome, and circadian rhythm disorders. We discuss the prevalence of these disorders in pregnancy and their potential impact on maternal and fetal health outcomes. We also explore the relationship between sleep disorders, pre-pregnancy comorbidities such as obesity, and pregnancy-related conditions such as gestational diabetes mellitus and preeclampsia. In addition to summarizing the existing literature on sleep disorders during pregnancy, we also highlight opportunities for further research in this area. We suggest that future studies should strive to employ validated and objective measurement tools for sleep disorders and prioritize utilization of longitudinal methods with participant follow-up through postpartum, mid-life, menopause, and beyond. We also put forward investigation into the impact of circadian rhythm disruption on reproductive physiology and early pregnancy outcomes as an area of important work. Overall, our review provides valuable insights on sleep and reproduction and into common sleep disorders during pregnancy and their potential impact on maternal and fetal health outcomes.
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Affiliation(s)
- Allan J. Kember
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Shiphrah Biomedical Inc., Toronto, ON, Canada
| | - Praniya Elangainesan
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
| | - Zachary M. Ferraro
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Claire Jones
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Reproductive Endocrinology and Infertility, Mount Sinai Hospital, Toronto, ON, Canada
| | - Sebastian R. Hobson
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada
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Liu Y, Xu B, Fan C. Single-Cell RNA Sequencing and Microarray Analysis Reveal the Role of Lipid-Metabolism-Related Genes and Cellular Immune Infiltration in Pre-Eclampsia and Identify Novel Biomarkers for Pre-Eclampsia. Biomedicines 2023; 11:2328. [PMID: 37626824 PMCID: PMC10452287 DOI: 10.3390/biomedicines11082328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Pre-eclampsia (PE) is a gestational hypertensive disorder that is characterized by hypertension and proteinuria, typically occurring after 20 weeks of gestation. Despite its global impact on pregnant women, the precise pathogenic mechanisms of PE remain unclear. Dysregulated lipid metabolism and immune cell infiltration contribute to PE development. Our study aimed to identify lipid-metabolism-related genes (LMRG-PEs) and investigate their association with immune infiltration. We utilized the "Seurat" R package for data quality control, cell clustering, and marker gene identification. The "SingleR" package enabled the matching of marker genes to specific cell types. Pseudotemporal ordering analysis was conducted using the "Monocle" package. Weighted correlation network analysis (WGCNA), gene set variation analysis (GSVA), and gene set enrichment analysis (GSEA) approaches were employed to explore lipid-metabolism-related genes, while potential targeted drugs were predicted using the drug-gene interaction database (DGIdb). Hub gene expression was validated through RT-qPCR. By analyzing single-cell RNA sequencing data, we identified and classified 20 cell clusters into 5 distinct types. Differential gene expression analysis revealed 186 DEGs. WGCNA identified 9 critical modules and 265 genes significantly associated with PE diagnosis, emphasizing the importance of the core genes PLA2G7 and PTGS2. RT-qPCR confirmed the significantly decreased expression of PLA2G7 and PTGS2 in PE patient tissues. These findings offer valuable insights into the molecular mechanisms of PE, particularly those involving lipid metabolism and immune infiltration. The identified hub genes have potential as therapeutic targets and biomarkers for future research and clinical applications.
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Affiliation(s)
- Yujie Liu
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, China;
| | - Borui Xu
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China;
| | - Cuifang Fan
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, China;
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A Narrative Review of Sex and Gender Differences in Sleep Disordered Breathing: Gaps and Opportunities. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122003. [PMID: 36556368 PMCID: PMC9786006 DOI: 10.3390/life12122003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Sleep disordered breathing (SDB) is a common condition, associated with multiple comorbidities including cardiovascular and metabolic disease. It has been previously established that SDB is more prevalent in men than women, shifting the literature's focus away from the latter population. As such, underdiagnosis, and thus undertreatment, of SDB in women exists. METHODS To establish the differences in prevalence, clinical presentation, and pathophysiology of SDB between the two sexes, a narrative review of the current literature was performed. RESULTS Rates of SDB are higher among men, likely driven by differences in symptom presentation between men and women, with women presenting with more "atypical" symptoms, and lack of sensitivity in SDB screening tools to detect SDB in women. In addition to the cardiovascular risks of SDB, women with SDB may have worse quality of life, higher prevalence of insomnia, and respiratory issues. DISCUSSION More research is needed to better define the unique pathophysiology and clinical presentation of SDB in women. In addition, an increased awareness among health care providers and the lay public of the SDB-specific sex and gender differences will serve to minimize disparities in identification and treatment of SDB in women.
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Lucchini M, O’Brien LM, Kahn LG, Brennan PA, Glazer Baron K, Knapp EA, Lugo-Candelas C, Shuffrey L, Dunietz GL, Zhu Y, Wright RJ, Wright RO, Duarte C, Karagas MR, Ngai P, O’Connor TG, Herbstman JB, Dioni S, Singh AM, Alcantara C, Fifer WP, Elliott AJ. Racial/ethnic disparities in subjective sleep duration, sleep quality, and sleep disturbances during pregnancy: an ECHO study. Sleep 2022; 45:zsac075. [PMID: 35724979 PMCID: PMC9453625 DOI: 10.1093/sleep/zsac075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/23/2022] [Indexed: 01/10/2023] Open
Abstract
In the United States, racial/ethnic minoritized groups experience worse sleep than non-Hispanic Whites (nHW), but less is known about pregnant people. This is a key consideration since poor sleep during pregnancy is common and associated with increased risk of adverse perinatal outcomes. This study reports the prevalence of subjective sleep measures in a multi-racial/ethnic pregnant population from the Environmental influences on Child Health Outcomes (ECHO) program. Participants' self-reported race and ethnicity were grouped into: nHW, non-Hispanic Black/African American (nHB/AA), Hispanic, non-Hispanic Asian (nHA). Analyses examined trimester-specific (first (T1), second (T2), third (T3)) nocturnal sleep duration, quality, and disturbances (Pittsburgh Sleep Quality Index and ECHO maternal sleep health questionnaire). Linear or multinomial regressions estimated the associations between race/ethnicity and each sleep domain by trimester, controlling for body mass index and age, with nHW as reference group. We repeated analyses within maternal education strata. nHB/AA participants reported shorter sleep duration (T2: β = -0.55 [-0.80,-0.31]; T3: β = -0.65 [-0.99,-0.31]) and more sleep disturbances (T2: β = 1.92 [1.09,2.75]; T3: β = 1.41 [0.09,2.74]). Hispanic participants reported longer sleep duration (T1: β = 0.22 [0.00004,0.44]; T2: β = 0.61 [0.47,0.76]; T3: β = 0.46 [0.22,0.70]), better sleep quality (Reference group: Very good. Fairly good T1: OR = 0.48 [0.32,0.73], T2: OR = 0.36 [0.26,0.48], T3: OR = 0.31 [0.18,0.52]. Fairly bad T1: OR = 0.27 [0.16,0.44], T2: OR = 0.46 [0.31, 0.67], T3: OR = 0.31 [0.17,0.55]), and fewer sleep disturbances (T2: β = -0.5 [-1.0,-0.12]; T3: β = -1.21 [-2.07,-0.35]). Differences persisted within the high-SES subsample. Given the stark racial/ethnic disparities in perinatal outcomes and their associations with sleep health, further research is warranted to investigate the determinants of these disparities.
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Affiliation(s)
- Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Louise M O’Brien
- Division of Sleep Medicine, Department of Neurology, and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Linda G Kahn
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Kelly Glazer Baron
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Emily A Knapp
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claudia Lugo-Candelas
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Lauren Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cristiane Duarte
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Pakkay Ngai
- Division of Pediatric Pulmonology, Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Thomas G O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, New York NY, USA
| | - Sean Dioni
- Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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Sleep Disturbance in Pregnancy. Sleep Med Clin 2022; 17:11-23. [PMID: 35216757 DOI: 10.1016/j.jsmc.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sleep is vital to life, even when women enter into pregnancy state. Good sleep is important for a healthy pregnancy. Sleep disturbances are common during pregnancy and can be due to the change of pregnancy itself or the results of sleep disorders. There is growing evidence linking sleep disturbances with adverse maternal and fetal outcomes. Differentiation of sleep disorders in order to provide appropriate treatment as well as promoting good sleep for pregnant women is important. A multidisciplinary team to provide sleep care during antenatal period may be needed.
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8
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Bublitz M, Bourjeily G. Timing is everything: snoring onset and blood pressure trajectories in pregnancy. J Clin Sleep Med 2022; 18:3-4. [PMID: 34705631 PMCID: PMC8807911 DOI: 10.5664/jcsm.9756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Margaret Bublitz
- Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island
| | - Ghada Bourjeily
- Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island
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9
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Madaeva IM, Protopopova NV, Sakhyanova NL, Berdina ON, Semenova NV, Ukhinov EB, Rychkova LV, Kolesnikova LI. [Sleep apnea syndrome, pregnancy and fetal condition]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:103-109. [PMID: 34078868 DOI: 10.17116/jnevro2021121402103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess fetal cardiac activity with simultaneous polysomnographic (PSG) study of pregnancy with obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS Forty-nine women, aged 18-30 years, 30-34 weeks pregnant, complaining of snoring, with a positive rating in 2 and/or 3 sections of the Berlin Sleep Questionnaire were included in the study. Sixteen pregnant women with the corresponding gestational age, without complaints of snoring, made up the control group. All participants underwent PSG monitoring and fetal cardiotocography (CTG) according to standard techniques. RESULTS PSG results demonstrate significant changes in sleep patterns in pregnant women with OSAS. There is a significant reduction in SWS 3, REM. High AHI, accompanied by desaturation and the appearance of activation EEG- patterns of cyclic alternations are characterized the sleep of pregnant women with OSAS. Analysis of CTG results shows that the average values of the basal rhythm are statistically higher in women with OSAS than in the control group. Also, the indicators of the amplitude of the oscillations, the frequency of oscillations and the number of movements in 30 minutes are statistically significantly different. Reaction of the fetus to episodes of apnea in the form of active perturbation, changes in heart rate as bradycardia (to 105-110 beats per minute) or tachycardia (to 155-160 beats per minute) compared to basal level (140 beats per minute) are noted. CONCLUSION OSAS during nocturnal sleep in pregnant women causes the changes in motor activity and cardiac activity of the fetus that indicates fetal hypoxemia.
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Affiliation(s)
- I M Madaeva
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - N V Protopopova
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - N L Sakhyanova
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - O N Berdina
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - N V Semenova
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - E B Ukhinov
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - L V Rychkova
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - L I Kolesnikova
- Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russia
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10
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Sanapo L, Bourjeily G. Maternal Sleep-Disordered Breathing and Gestational Diabetes. Chest 2021; 159:17-18. [PMID: 33422196 DOI: 10.1016/j.chest.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 01/16/2023] Open
Affiliation(s)
- Laura Sanapo
- The Miriam Hospital, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Ghada Bourjeily
- The Miriam Hospital, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI.
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Ives CW, Sinkey R, Rajapreyar I, Tita ATN, Oparil S. Preeclampsia-Pathophysiology and Clinical Presentations: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 76:1690-1702. [PMID: 33004135 DOI: 10.1016/j.jacc.2020.08.014] [Citation(s) in RCA: 265] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 01/01/2023]
Abstract
Preeclampsia is a hypertensive disorder of pregnancy. It affects 2% to 8% of pregnancies worldwide and causes significant maternal and perinatal morbidity and mortality. Hypertension and proteinuria are the cornerstone of the disease, though systemic organ dysfunction may ensue. The clinical syndrome begins with abnormal placentation with subsequent release of antiangiogenic markers, mediated primarily by soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng). High levels of sFlt-1 and sEng result in endothelial dysfunction, vasoconstriction, and immune dysregulation, which can negatively impact every maternal organ system and the fetus. This review comprehensively examines the pathogenesis of preeclampsia with a specific focus on the mechanisms underlying the clinical features. Delivery is the only definitive treatment. Low-dose aspirin is recommended for prophylaxis in high-risk populations. Other treatment options are limited. Additional research is needed to clarify the pathophysiology, and thus, identify potential therapeutic targets for improved treatment and, ultimately, outcomes of this prevalent disease.
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Affiliation(s)
- Christopher W Ives
- Tinsley Harrison Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Rachel Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Indranee Rajapreyar
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T N Tita
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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12
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Laposky AD, Pemberton VL. Sleep-Disordered Breathing and Pregnancy-Related Cardiovascular Disease. J Womens Health (Larchmt) 2020; 30:194-198. [PMID: 33181042 PMCID: PMC8020531 DOI: 10.1089/jwh.2020.8869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Sleep-disordered breathing (SDB) is a serious medical condition characterized by intermittent episodes of airflow limitation, intermittent hypoxia, and sleep disturbance triggering a pattern of autonomic dysfunction associated with hypertension, diabetes, and other adverse health conditions. SDB incidence is two to three times higher during pregnancy and is associated with an increased risk of cardiometabolic complications, including pre-eclampsia and gestational diabetes. Treatments to protect breathing during sleep are available, pointing to SDB as a potential therapeutic target to reduce maternal cardiometabolic morbidity. However, in clinical practice, the majority of SDB cases in pregnancy are undiagnosed, indicating a need to improve screening for SDB risk factors and referral for diagnostic testing. Furthermore, definitive clinical trials are needed to determine the extent to which SDB intervention reduces the risk of adverse cardiovascular and neonatal outcomes in pregnancy. This review article discusses an accumulation of research pointing to SDB as a prevalent risk factor for gestational cardiometabolic disease, as well as a potential therapeutic target to reduce cardiometabolic morbidity.
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Affiliation(s)
- Aaron D Laposky
- Division of Lung Diseases, National Center on Sleep Disorders Research
| | - Victoria L Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Gyselaers W. Preeclampsia Is a Syndrome with a Cascade of Pathophysiologic Events. J Clin Med 2020; 9:jcm9072245. [PMID: 32679789 PMCID: PMC7409017 DOI: 10.3390/jcm9072245] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/05/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022] Open
Abstract
This review integrates the currently available information on the molecular, cellular, and systemic mechanisms involved in the pathophysiology of preeclampsia. It highlights that the growth, protection, and promotion of the conceptus requires the modulation of an intact maternal immune system, communication between the mother and fetus, and adaptation of the maternal organic functions. A malfunction in any of these factors, on either side, will result in a failure of the cascade of events required for the normal course of pregnancy. Maladaptive processes, initially aiming to protect the conceptus, fail to anticipate the gradually increasing cardiovascular volume load during the course of pregnancy. As a result, multiple organ dysfunctions install progressively and eventually reach a state where mother and/or fetus are at risk of severe morbidity or even mortality, and where the termination of pregnancy becomes the least harmful solution. The helicopter view on pathophysiologic processes associated with preeclampsia, as presented in this paper, illustrates that the etiology of preeclampsia cannot be reduced to one single mechanism, but is to be considered a cascade of consecutive events, fundamentally not unique to pregnancy.
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Affiliation(s)
- Wilfried Gyselaers
- Department Obstetrics, Ziekenhuis Oost Limburg, B3600 Genk, Belgium; ; Tel.: +32-89-306420
- Department Physiology, Hasselt University, B3590 Diepenbeek, Belgium
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