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Panyarath P, Goldscher N, Pamidi S, Daskalopoulou SS, Gagnon R, Dayan N, Raiche K, Olha A, Benedetti A, Kimoff RJ. Effect of Maternal Obstructive Sleep Apnea-Hypopnea on 24-Hour Blood Pressure, Nocturnal Blood Pressure Dipping and Arterial Stiffness in Hypertensive Disorders of Pregnancy. Front Physiol 2021; 12:747106. [PMID: 34733178 PMCID: PMC8558510 DOI: 10.3389/fphys.2021.747106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022] Open
Abstract
Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). Attenuation of the normal nocturnal blood pressure (BP) decline (non-dipping) is associated with adverse pregnancy outcomes. OSAH is associated with nocturnal non-dipping in the general population, but this has not been studied in pregnancy. We therefore analyzed baseline data from an ongoing RCT (NCT03309826) assessing the impact of OSAH treatment on HDP outcomes, to evaluate the relationship of OSAH to 24-h BP profile, in particular nocturnal BP dipping, and measures of arterial stiffness. Methods: Women with a singleton pregnancy and HDP underwent level II polysomnography. Patients with OSAH (apnea-hypopnea index (AHI) ≥ 5 events/h) then underwent 24-h ambulatory BP monitoring and arterial stiffness measurements (applanation tonometry, SphygmoCor). Positive dipping was defined as nocturnal systolic blood pressure (SBP) dip ≥ 10%. The relationships between measures of OSAH severity, measures of BP and arterial stiffness were evaluated using linear regression analyses. Results: We studied 51 HDP participants (36.5 ± 4.9 years, BMI 36.9 ± 8.6 kg/m2) with OSAH with mean AHI 27.7 ± 26.4 events/h at 25.0 ± 4.9 weeks’ gestation. We found no significant relationships between AHI or other OSA severity measures and mean 24-h BP values, although BP was generally well-controlled. Most women were SBP non-dippers (78.4%). AHI showed a significant inverse correlation with % SBP dipping following adjustment for age, BMI, parity, gestational age, and BP medications (β = −0.11, p = 0.02). Significant inverse correlations were also observed between AHI and DBP (β = −0.16, p = 0.01) and MAP (β = −0.13, p = 0.02) % dipping. Oxygen desaturation index and sleep time below SaO2 90% were also inversely correlated with % dipping. Moreover, a significant positive correlation was observed between carotid-femoral pulse wave velocity (cfPWV) and REM AHI (β = 0.02, p = 0.04) in unadjusted but not adjusted analysis. Conclusion: Blood pressure non-dipping was observed in a majority of women with HDP and OSAH. There were significant inverse relationships between OSAH severity measures and nocturnal % dipping. Increased arterial stiffness was associated with increasing severity of OSAH during REM sleep in unadjusted although not adjusted analysis. These findings suggest that OSAH may represent a therapeutic target to improve BP profile and vascular risk in HDP.
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Affiliation(s)
- Pattaraporn Panyarath
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada.,Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Noa Goldscher
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Sushmita Pamidi
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada.,Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada
| | - Stella S Daskalopoulou
- Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada.,Division of Internal Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Robert Gagnon
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada
| | - Natalie Dayan
- Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada.,Division of Internal Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Kathleen Raiche
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Allen Olha
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Andrea Benedetti
- Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology and Biostatistics, McGill University Health Centre, Montreal, QC, Canada
| | - R John Kimoff
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada.,Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada
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Saremi AT, Shafiee MA, Montazeri M, Rashidi N, Montazeri M. Blunted Overnight Blood Pressure Dipping in Second Trimester; A Strong Predictor of Gestational Hypertension and Preeclampsia. Curr Hypertens Rev 2019; 15:70-75. [DOI: 10.2174/1573402114666180924143801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 11/22/2022]
Abstract
Background:
Preeclampsia is a global burden with 10 million incidences annually and
210 daily deaths worldwide. Diagnosis is mainly based on the features following full presentation.
Objective:
This study explored whether early pregnancy circadian changes of ambulatory blood
pressure monitoring (ABPM) could predict preeclampsia and hypertension.
Methods:
In a prospective study, 294 pregnant women who were referred to Sarem Women’s Hospital,
Iran were recruited. Systolic, diastolic and mean arterial pressures (MAP) were recorded
(diurnally and nocturnally) in each trimester. Dipping was defined as a minimum 10% decrease in
blood pressure.
Results:
Of the 251 women who completed the study, 25 percent (n=63) experienced blunted MAP
dipping during sleep phases in the second trimester. Eighty-nine percent (n=56) experienced hypertensive
disorder in the third trimester, one-third of which experienced preeclampsia. Of the women
with normal MAP dipping (n=188), 5 percent (n=10) had gestational hypertension and 1 percent
(n=2) became preeclamptic. (P<0.0001).
Conclusion:
This study clearly demonstrated blunted blood pressure dipping overnight during the
second trimester which is a strong predictor of forthcoming pregnancy-induced hypertension and
preeclampsia. A scoring system was developed to predict hypertensive disorder and it was significantly
correlated with preeclampsia occurrence.
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Affiliation(s)
- Abo Taleb Saremi
- Sarem Fertility and Infertility Research Center (SAFIR), Sarem Women's Hospital, Tehran, Iran
| | - Mohammad-Ali Shafiee
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Mahdi Montazeri
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Negin Rashidi
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Mohammad Montazeri
- Sarem Fertility and Infertility Research Center (SAFIR), Sarem Women's Hospital, Tehran, Iran
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