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Balkan N, Çavuşoğlu M, Hornung R. Application of portable sleep monitoring devices in pregnancy: a comprehensive review. Physiol Meas 2024; 45:05TR01. [PMID: 38663417 DOI: 10.1088/1361-6579/ad43ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
Objective.The physiological, hormonal and biomechanical changes during pregnancy may trigger sleep disordered breathing (SDB) in pregnant women. Pregnancy-related sleep disorders may associate with adverse fetal and maternal outcomes including gestational diabetes, preeclampsia, preterm birth and gestational hypertension. Most of the screening and diagnostic studies that explore SDB during pregnancy were based on questionnaires which are inherently limited in providing definitive conclusions. The current gold standard in diagnostics is overnight polysomnography (PSG) involving the comprehensive measurements of physiological changes during sleep. However, applying the overnight laboratory PSG on pregnant women is not practical due to a number of challenges such as patient inconvenience, unnatural sleep dynamics, and expenses due to highly trained personnel and technology. Parallel to the progress in wearable sensors and portable electronics, home sleep monitoring devices became indispensable tools to record the sleep signals of pregnant women at her own sleep environment. This article reviews the application of portable sleep monitoring devices in pregnancy with particular emphasis on estimating the perinatal outcomes.Approach.The advantages and disadvantages of home based sleep monitoring systems compared to subjective sleep questionnaires and overnight PSG for pregnant women were evaluated.Main Results.An overview on the efficiency of the application of home sleep monitoring in terms of accuracy and specificity were presented for particular fetal and maternal outcomes.Significance.Based on our review, more homogenous and comparable research is needed to produce conclusive results with home based sleep monitoring systems to study the epidemiology of SDB in pregnancy and its impact on maternal and neonatal health.
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Affiliation(s)
- Nürfet Balkan
- Department of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, 8006 Zurich, Switzerland
| | - Mustafa Çavuşoğlu
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - René Hornung
- Department of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, 8006 Zurich, Switzerland
- Gynecology and Obstetrics Department, Kantonspital St Gallen, Rorschacherstrasse 95, 9007 St Gallen, Switzerland
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2
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Johnson CE, Duncan MJ, Murphy MP. Sex and Sleep Disruption as Contributing Factors in Alzheimer's Disease. J Alzheimers Dis 2024; 97:31-74. [PMID: 38007653 PMCID: PMC10842753 DOI: 10.3233/jad-230527] [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] [Indexed: 11/27/2023]
Abstract
Alzheimer's disease (AD) affects more women than men, with women throughout the menopausal transition potentially being the most under researched and at-risk group. Sleep disruptions, which are an established risk factor for AD, increase in prevalence with normal aging and are exacerbated in women during menopause. Sex differences showing more disrupted sleep patterns and increased AD pathology in women and female animal models have been established in literature, with much emphasis placed on loss of circulating gonadal hormones with age. Interestingly, increases in gonadotropins such as follicle stimulating hormone are emerging to be a major contributor to AD pathogenesis and may also play a role in sleep disruption, perhaps in combination with other lesser studied hormones. Several sleep influencing regions of the brain appear to be affected early in AD progression and some may exhibit sexual dimorphisms that may contribute to increased sleep disruptions in women with age. Additionally, some of the most common sleep disorders, as well as multiple health conditions that impair sleep quality, are more prevalent and more severe in women. These conditions are often comorbid with AD and have bi-directional relationships that contribute synergistically to cognitive decline and neuropathology. The association during aging of increased sleep disruption and sleep disorders, dramatic hormonal changes during and after menopause, and increased AD pathology may be interacting and contributing factors that lead to the increased number of women living with AD.
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Affiliation(s)
- Carrie E. Johnson
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
| | - Marilyn J. Duncan
- University of Kentucky, College of Medicine, Department of Neuroscience, Lexington, KY, USA
| | - M. Paul Murphy
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
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3
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Sharma V, Sharkey KM, Palagini L, Mazmanian D, Thomson M. Preventing recurrence of postpartum depression by regulating sleep. Expert Rev Neurother 2023; 23:1-9. [PMID: 37462620 PMCID: PMC10527998 DOI: 10.1080/14737175.2023.2237194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Women are at a high risk of recurrence of depression in the postpartum period. Given the circumscribed duration of the risk period and knowledge of its triggers, postpartum depression should be easily preventable. However, prophylactic drug studies have reported contradictory findings partly due to the heterogeneity of the disorder. Currently, there are no studies on the efficacy of psychotherapy in the prevention of postpartum depression in women with major depressive or bipolar disorder. AREAS COVERED This review evaluates the results of controlled medication and psychotherapeutic studies in the prevention of depression in women with major depressive disorder or bipolar disorder; it further suggests that the management of sleep loss/insomnia may be an effective strategy in the prevention of postpartum depression. EXPERT OPINION A thorough understanding of the clinical course of the antecedent mood disorder and historical treatment response is necessary before the implementation of strategies for the prevention of postpartum depression. Targeting disturbed and/or insufficient sleep - a common and early transdiagnostic symptom of peripartum psychiatric disorders - may be a more effective intervention for the prevention of postpartum depression and psychiatric comorbidities in some individuals than the traditional approach of antidepressant use.
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Affiliation(s)
- Verinder Sharma
- Department of Psychiatry, Western University, London, Ontario, Canada
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada
- Parkwood Institute Mental Health, St. Joseph’s Health Care, London, Ontario, Canada
| | - Katherine M. Sharkey
- Department of Medicine, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University Providence, Rhode Island
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - Dwight Mazmanian
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Michael Thomson
- Department of Psychiatry, Western University, London, Ontario, Canada
- Parkwood Institute Mental Health, St. Joseph’s Health Care, London, Ontario, Canada
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Tayade S, Toshniwal S. Obstructive Sleep Apnea in Pregnancy: A Narrative Review. Cureus 2022; 14:e30387. [DOI: 10.7759/cureus.30387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
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Shahveisi K, Abdoli N, Khazaie H, Farnia V, Khodamoradi M. Maternal sleep deprivation affects extinction and reinstatement of methamphetamine reward memory in male offspring: role of the D1-like and D2-like dopamine receptors. Brain Res 2022; 1792:148033. [PMID: 35905786 DOI: 10.1016/j.brainres.2022.148033] [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: 04/24/2022] [Revised: 07/09/2022] [Accepted: 07/23/2022] [Indexed: 11/28/2022]
Abstract
Maternal sleep-deprivation (MSD) has been shown to induce stress, hyperactivity, and risk taking behavior in the offspring; howbeit, it is not yet clear whether it may also affect vulnerability to psychostimulant abuse in the offspring. We aimed to determine whether MSD affects extinction and reinstatement of methamphetamine (METH) reward memory in the offspring and also to evaluate the possible role of dopamine D1-like and D2-like receptors in these processes. Thirty-day-old male offspring born to control and sleep-deprived dams (during the third week of pregnancy) were trained to acquire METH-induced place preference (2 mg/kg., i.p.). METH reward memory was then reinstated following an 8-day period of extinction. The offspring received SCH 23390 (0.03 or 0.1 mg/kg, i.p.) or sulpiride (20 or 60 mg/kg, i.p.) as antagonists of dopamine D1-like and D2-like receptors, respectively, either immediately after each daily extinction session or prior to the reinstatement session. MSD postponed METH extinction and facilitated METH reinstatement in the offspring. SCH 23390 facilitated METH extinction and decreased reinstatement of the extinguished METH preference. Sulpiride in the offspring from sleep-deprived dams facilitated METH extinction, but it did not affect reinstatement of the extinguished METH place preference. It seems that MSD may enhance vulnerability to METH abuse in the offspring. Furthermore, both dopamine D1-like and D2-like receptors may mediate METH extinction in the offspring born to the sleep-deprived dams; however, only the dopamine D1 receptor may play an important role in reinstating the extinguished METH reward memory in the offspring.
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Affiliation(s)
- Kaveh Shahveisi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nasrin Abdoli
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahid Farnia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Khodamoradi
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Dominguez JE, Habib AS. Obstructive sleep apnea in pregnant women. Int Anesthesiol Clin 2022; 60:59-65. [PMID: 35261345 PMCID: PMC9045012 DOI: 10.1097/aia.0000000000000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The prevalence of OSA in the low-risk obstetric population is thought to be low; best estimates have been extrapolated from the one available large prospective study and likely range between 3–8%.1 OSA prevalence in high-risk pregnant women such as those with obesity and chronic hypertension is significantly higher as extrapolated from several smaller prospective studies which have reported a prevalence as high as 37% in obese women.2 –6 Despite the high prevalence of OSA in high-risk pregnant women, it remains underdiagnosed due to several factors. An emerging body of literature suggests that OSA may also have serious implications for the health of mothers and fetuses during and beyond pregnancy, but there is still no data to determine if OSA treatment mitigates these adverse outcomes. In this review, we will examine this body of literature from the perspective of the anesthesiologist: the association between pregnancy and the development or worsening of OSA; OSA as it relates to adverse maternal and fetal outcomes; antepartum and screening considerations for OSA in pregnant women; and recommendations regarding the peripartum management of OSA.
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Affiliation(s)
- Jennifer E Dominguez
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
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7
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Chan C, Poon SH, Chua TE, Razali NS, Tan KH, Chen H. A Prospective Study of the Relationship Between Sleep Quality and Depression in Pregnancy. PROCEEDINGS OF SINGAPORE HEALTHCARE 2022. [DOI: 10.1177/20101058211068591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Poor sleep and depression are common problems during pregnancy, but there has been little investigation into the association between them. This prospective study aims to examine the relationship between sleep quality and depression during pregnancy. Methods Pregnant women under 14 weeks’ gestation attending routine outpatient antenatal care in Singapore’s largest maternity hospital were recruited between 2012 and 2014. Women with multiple pregnancies and deemed at high risk of miscarriage were excluded. Six hundred and forty participants completed the Pittsburgh Sleep Quality Index (PSQI) and Edinburgh Postnatal Depression Scale (EPDS) at the three trimesters during pregnancy. Results Mean PSQI score was highest in the third visit, suggesting poorer quality sleep in the late third trimester compared to other trimesters. 15.6% of participants at each time point fulfilled the criteria for antenatal depression according to the EPDS cut-off score > 14. PSQI scores were significantly correlated with EPDS scores, and also prospectively predicted EPDS scores in all three trimesters. Conclusion Sleep quality in Singaporean pregnant women was poorest in the third trimester, and was associated with the development of depressive symptoms. With more than 1 in 10 women having antenatal depression, interventions targeting sleep quality might be particularly beneficial.
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Affiliation(s)
| | - Shi Hui Poon
- Duke-National University of Singapore, Singapore
| | - Tze-Ern Chua
- Duke-National University of Singapore, Singapore
- Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Nurul Syaza Razali
- Division of Obstetrics & Gynaecology, KK Women’s and Children’s Hospital, Singapore
| | - Kok Hian Tan
- Duke-National University of Singapore, Singapore
- Division of Obstetrics & Gynaecology, KK Women’s and Children’s Hospital, Singapore
| | - Helen Chen
- Duke-National University of Singapore, Singapore
- Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore
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Bublitz MH, Sharp M, Freeburg T, Sanapo L, Nugent NR, Sharkey K, Bourjeily G. Sleep Disordered Breathing Measures in Early Pregnancy Are Associated with Depressive Symptoms in Late Pregnancy. Diagnostics (Basel) 2021; 11:858. [PMID: 34064603 PMCID: PMC8151613 DOI: 10.3390/diagnostics11050858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
Sleep disordered breathing (SDB) and depression are both common complications of pregnancy and increase risk for adverse maternal and neonatal outcomes. SDB precedes onset of depression in non-pregnant adults; however, the longitudinal relationship has not been studied in pregnancy. The present research examined temporal associations between SDB and depressive symptoms in 175 pregnant women at risk for SDB (based on frequent snoring and obesity), but without an apnea hypopnea index of ≥5 events per hour at enrollment. Women completed a self-report assessments of depressive symptoms using PHQ-9 and in-home level III sleep apnea monitoring at approximately 12- and 32-weeks' gestation. We also assessed the risk for SDB using the Berlin Questionnaire in early pregnancy. Results revealed that measures of SDB in early pregnancy as assessed by in-home sleep study, but not by self-reported SDB, predicted elevated depressive symptoms in late pregnancy. SDB in late pregnancy was not associated with depressive symptoms. To conclude, these findings suggest that SDB may increase the risk for elevated depressive symptoms as pregnancy progresses.
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Affiliation(s)
- Margaret H. Bublitz
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (M.S.); (N.R.N.); (K.S.)
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (L.S.); (G.B.)
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, RI 02906, USA;
| | - Meghan Sharp
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (M.S.); (N.R.N.); (K.S.)
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, RI 02906, USA;
| | - Taylor Freeburg
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, RI 02906, USA;
- The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Laura Sanapo
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (L.S.); (G.B.)
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, RI 02906, USA;
| | - Nicole R. Nugent
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (M.S.); (N.R.N.); (K.S.)
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Katherine Sharkey
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (M.S.); (N.R.N.); (K.S.)
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (L.S.); (G.B.)
- Rhode Island Hospital, Providence, RI 02905, USA
| | - Ghada Bourjeily
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA; (L.S.); (G.B.)
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, RI 02906, USA;
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Dorsey A, de Lecea L, Jennings KJ. Neurobiological and Hormonal Mechanisms Regulating Women's Sleep. Front Neurosci 2021; 14:625397. [PMID: 33519372 PMCID: PMC7840832 DOI: 10.3389/fnins.2020.625397] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/22/2020] [Indexed: 01/22/2023] Open
Abstract
Sleep is crucial for optimal well-being, and sex differences in sleep quality have significant implications for women's health. We review the current literature on sex differences in sleep, such as differences in objective and subjective sleep measures and their relationship with aging. We then discuss the convincing evidence for the role of ovarian hormones in regulating female sleep, and survey how these hormones act on a multitude of brain regions and neurochemicals to impact sleep. Lastly, we identify several important areas in need of future research to narrow the knowledge gap and improve the health of women and other understudied populations.
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Affiliation(s)
| | | | - Kimberly J. Jennings
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
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Watanabe M, Shinohara H, Kodama H. Nocturnal oxygen desaturation in the late third trimester of uncomplicated pregnancy for prediction of late-onset gestational hypertension. J Obstet Gynaecol Res 2020; 46:1735-1743. [PMID: 32715551 DOI: 10.1111/jog.14362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/29/2020] [Accepted: 06/05/2020] [Indexed: 12/21/2022]
Abstract
AIM This study aimed to determine whether 1-night screening of oxygen desaturation in women with uncomplicated pregnancy about 1 month before the due date is useful to predict late-onset gestational hypertension (GH) after 37 weeks of gestation. METHODS We recruited 102 women with uncomplicated pregnancy between 34 and 36 weeks of gestation. These women then completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Berlin Questionnaire for obstructive sleep apnea, and recorded their oxygen saturation (SpO2 ) and physical acceleration profiles during nocturnal sleep for 1 night at home using a portable pulse oximeter and actigraph, respectively. Thereafter, their blood pressure was monitored weekly until delivery. RESULTS Pulse oximetry data between 34 and 36 weeks of gestation revealed that three women had an oxygen desaturation index (ODI) ≥5.0 and seven had a minimum SpO2 < 90%. During follow-up until delivery, two women with an ODI ≥5.0 and a minimum SaO2 <90% developed GH at 37 weeks of gestation. Among clinical measures at recruitment, body mass index (BMI) and pulse oximetry measures appeared available for the prediction of GH. The positive predictive values (95% confidence intervals) of the criteria using these measures were 0.67 (0.26-0.67) for ODI ≥5.0, 0.29 (0.10-0.35) for minimum SpO2 <90%, and 0.07 (0.02-0.07) for BMI ≥25.0. CONCLUSION For the prediction of late-onset GH after 37 weeks of gestation, pulse oximetry measures about 1 month before the due date are particularly useful because of their high positive predictive values.
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Affiliation(s)
- Minako Watanabe
- The Japanese Red Cross Akita College of Nursing, Akita, Japan
| | - Hitomi Shinohara
- Department of Maternity Child Nursing, Akita University Graduate School of Medicine and Faculty of Medicine, School of Health Science, Akita, Japan
| | - Hideya Kodama
- Department of Maternity Child Nursing, Akita University Graduate School of Medicine and Faculty of Medicine, School of Health Science, Akita, Japan
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11
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Cain MA, Brumley J, Louis-Jacques A, Drerup M, Stern M, Louis JM. A Pilot Study of a Sleep Intervention Delivered through Group Prenatal Care to Overweight and Obese Women. Behav Sleep Med 2020; 18:477-487. [PMID: 31130005 DOI: 10.1080/15402002.2019.1613995] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We sought to investigate the feasibility of a behavioral sleep intervention for insomnia, delivered through group prenatal care and the relationship of this intervention to improvements in insomnia symptoms and sleep quality. PARTICIPANTS Women receiving prenatal care and reporting a pre-pregnancy BMI of ≥25 kg/m2 and sleep duration of <6.5 h per night. METHODS Participants were randomized to group prenatal care or group prenatal care with a behavioral sleep intervention, adapted from cognitive behavioral therapy for insomnia (CBT-I) online program Go! to Sleep®. In the second trimester (T1), late third trimester (T2) and 6-8 weeks postpartum (T3) study assessments were completed including the Insomnia Severity Index, Pittsburgh Sleep Quality Index, fasting glucose and insulin and weight and height. Data were analyzed using independent samples t-tests, chi-square tests, correlations, and two-way repeated measures ANOVA where appropriate. P < .05 was set as the level of significance. RESULTS From May 2014 to April 2015, 311 women were evaluated for inclusion and 53 women were randomized to participate (27 intervention; 26 control), 15% were lost to follow up. The intervention group had lower third trimester and postpartum levels of moderate to severe insomnia (T2 50.0% vs 85.0% (p = .018) and T3 13.6% vs 52.4% (p-.008)) and mean insomnia severity scores (T2 (14.7 (±6.6) vs 19.3 (± 6.0) p = .02) and T3 (9.7 (±5.4) vs 15.1(±7.2) p = .01)) when compared to the control group. CONCLUSION A randomized controlled trial of a behavioral sleep intervention for insomnia delivered through group prenatal care led to improvements in insomnia symptoms.
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Affiliation(s)
- Mary Ashley Cain
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida Morsani College of Medicine , Tampa, Florida, USA
| | - Jessica Brumley
- Department of Obstetrics and Gynecology, Division of midwifery, University of South Florida Morsani College of Medicine , Tampa, Florida, USA
| | - Adetola Louis-Jacques
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida Morsani College of Medicine , Tampa, Florida, USA
| | - Michelle Drerup
- Department of sleep disorders, Cleveland Clinic Sleep Disorders Center , Cleveland, OH
| | - Marilyn Stern
- Department of Child and Family Studies, University of South Florida , Tampa
| | - Judette M Louis
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of South Florida Morsani College of Medicine , Tampa, Florida, USA
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12
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Dominguez JE, Krystal AD, Habib AS. Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management. Anesth Analg 2019; 127:1167-1177. [PMID: 29649034 DOI: 10.1213/ane.0000000000003335] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Among obese pregnant women, 15%-20% have obstructive sleep apnea (OSA) and this prevalence increases along with body mass index and in the presence of other comorbidities. Prepregnancy obesity and pregnancy-related weight gain are certainly risk factors for sleep-disordered breathing in pregnancy, but certain physiologic changes of pregnancy may also increase a woman's risk of developing or worsening OSA. While it has been shown that untreated OSA in postmenopausal women is associated with a range of cardiovascular, pulmonary, and metabolic comorbidities, a body of literature is emerging that suggests OSA may also have serious implications for the health of mothers and fetuses during and after pregnancy. In this review, we discuss the following: pregnancy as a vulnerable period for the development or worsening of OSA; the associations between OSA and maternal and fetal outcomes; the current screening modalities for OSA in pregnancy; and current recommendations regarding peripartum management of OSA.
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Affiliation(s)
| | - Andrew D Krystal
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.,Department of Psychiatry, University of California, San Francisco, San Francisco, California
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13
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Robertson N, Flatley C, Kumar S. An Epworth Sleep Score ≥11 is associated with emergency operative birth and poor neonatal composite outcome at term. Aust N Z J Obstet Gynaecol 2019; 60:49-54. [PMID: 31141170 DOI: 10.1111/ajo.12983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/02/2019] [Accepted: 03/25/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND During pregnancy, the Epworth Sleepiness Scale can be used as a surrogate marker for maternal sleep-disordered breathing, a condition that is becoming increasingly prevalent in obstetric populations and is associated with a multitude of pregnancy complications. AIMS The aim of this observational study was to investigate the relationship between the Epworth Sleepiness Scale score and indication and mode of delivery during pregnancy. MATERIALS AND METHODS The Epworth Sleepiness Scale was completed by 178 women at Mater Mothers' Hospital, Brisbane, Australia. RESULTS Women with a score ≥11 were less likely to achieve a spontaneous vaginal delivery (aOR 0.43, 95% CI 0.21-0.88, P = 0.02), and were more likely to have an instrumental (aOR 2.81, 95% CI 1.30-6.08, P = 0.01) or any operative birth (instrumental and caesarean section aOR 2.32, 95% CI 1.14-4.71, P = 0.02). These women were also more likely to have an operative birth for intrapartum fetal compromise (aOR 2.62, 95% CI 1.21-5.69, P = 0.015), as well as an infant with poor neonatal outcomes (aOR 2.77, 95% CI 1.09-7.03, P = 0.03). CONCLUSIONS These results show that symptoms of sleep-disordered breathing are associated with emergency operative birth, particularly when the indication for operative birth was intrapartum fetal compromise.
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Affiliation(s)
- Nicole Robertson
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Mater Mothers' Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Christopher Flatley
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Mater Mothers' Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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14
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Bourjeily G, Danilack VA, Bublitz MH, Muri J, Rosene-Montella K, Lipkind H. Maternal obstructive sleep apnea and neonatal birth outcomes in a population based sample. Sleep Med 2019; 66:233-240. [PMID: 31981755 DOI: 10.1016/j.sleep.2019.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/10/2018] [Accepted: 01/10/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Evaluate the association of OSA with birth outcomes including the risk of congenital anomalies and the need for a higher level of clinical care at delivery. METHODS Population-based study that linked newborn records with maternal records. Data from 95 perinatal centers across all geographic census divisions of the U.S. of women with a delivery diagnosis from 2010 to 2014 whose records could be linked to the corresponding newborn record. An International Classification of Diseases, ninth Revision (ICD-9) code for sleep apnea was used to identify exposure and outcome variables. Univariate and multivariate logistic regression analyses were performed with a model that included substance use, obesity, diabetes, maternal co-morbidities, and pregnancy complications. RESULTS In this study, 1,423,099 maternal records were linked to live newborn records. OSA was associated with a higher risk for congenital anomalies in offspring (aOR 1.26, 1.11 to 1.43), with the highest risk being that of musculoskeletal anomalies (aOR 1.89, 1.16 to 3.07) after adjusting for comorbidities and potential teratogens. Neonates born to mothers with OSA were more likely to be admitted to the intensive care unit (25.3% vs. 8.1%, p < 0.001), require resuscitation (aOR 2.76, 1.35 to 5.64) and have a longer hospital stay (aOR 2.25, 1.85 to 2.65). CONCLUSIONS Although our study does not establish causation, it is the first to demonstrate a higher risk of congenital anomalies and resuscitation at birth in neonates of mothers with OSA, emphasizing the importance of identifying OSA in pregnant women and women of reproductive age.
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Affiliation(s)
- Ghada Bourjeily
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, The Miriam Hospital, Providence, RI, USA.
| | - Valery A Danilack
- Brown University School of Public Health, Department of Epidemiology, Department of Obstetrics and Gynecology, Division of Research, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Margaret H Bublitz
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Janet Muri
- National Perinatal Information Center, Providence, RI, USA
| | - Karen Rosene-Montella
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Heather Lipkind
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Keshavarzi F, Mehdizadeh S, Khazaie H, Ghadami MR. Objective assessment of obstructive sleep apnea in normal pregnant and preeclamptic women. Hypertens Pregnancy 2018; 37:154-159. [DOI: 10.1080/10641955.2018.1498879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Farahnaz Keshavarzi
- Department of obstetrics and gynecology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shervin Mehdizadeh
- Department of obstetrics and gynecology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Rasoul Ghadami
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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16
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Pengo MF, Won CH, Bourjeily G. Sleep in Women Across the Life Span. Chest 2018; 154:196-206. [PMID: 29679598 PMCID: PMC6045782 DOI: 10.1016/j.chest.2018.04.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/26/2018] [Accepted: 04/02/2018] [Indexed: 02/07/2023] Open
Abstract
There are many ways in which women experience sleep differently from men. Women contending with distinct sleep challenges respond differently to sleep disorders, as well as sleep deprivation and deficiency, and face particular health outcomes as a result of poor sleep. Idiosyncrasies, including changes that occur with the biological life cycles of menstruation, pregnancy, and menopause, make the understanding of sleep in women an important topic to study. Each phase of a woman's life, from childhood to menopause, increases the risk of sleep disturbance in unique ways that may require distinct management. Indeed, new research is unraveling novel aspects of sleep pathology in women and the fundamental role that sex hormones play in influencing sleep regulation and arousals and possibly outcomes of sleep conditions. Moreover, studies indicate that during times of hormonal change, women are at an increased risk for sleep disturbances such as poor sleep quality and sleep deprivation, as well as sleep disorders such as OSA, restless legs syndrome, and insomnia. This article reviews sleep changes in female subjects from neonatal life to menopause.
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Affiliation(s)
- Martino F Pengo
- Sleep Disorder Center, Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Christine H Won
- Yale Center for Sleep Medicine, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Ghada Bourjeily
- Department of Medicine, Divisions of Pulmonary, Critical Care, Sleep Medicine and Obstetric Medicine, Warren Alpert Medical School of Brown University, Providence, RI.
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17
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Snoring and markers of fetal and placental wellbeing. Clin Chim Acta 2018; 485:139-143. [PMID: 29958890 DOI: 10.1016/j.cca.2018.06.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/30/2018] [Accepted: 06/25/2018] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Snoring, the symptom of partial airway obstruction during sleep, is a common complaint during pregnancy and is associated with adverse perinatal outcomes. Mechanisms underlying this association have not been studied. We investigated the relationship between snoring in pregnancy and maternal serum markers of feto-placental wellbeing. METHODS We conducted a secondary analysis of a cross sectional study designed to investigate perinatal outcomes of sleep-disordered breathing. Women admitted for delivery were systematically selected and answered a questionnaire about snoring using the Multivariable Apnea Prediction Index. Participants who had screening markers measured were included and divided into snorers and non -snorers. Markers measured included first and second trimester Down syndrome screening markers, reported as multiples of the median (MoM). An additional analysis was performed with snorers categorized as acute or chronic snorers based on duration of snoring in relation to pregnancy. RESULTS While significant differences were noted in co-morbid maternal medical conditions between snorers and non-snorers, there were no significant differences in the neonatal outcomes assessed between the two groups. No significant differences were noted in any of the first trimester (PAPP-A) or second trimester (AFP, uE3, hCG, inhibin-A) markers between snorers and non-snorers, p > 0.25. In addition, no significant differences in marker levels were noted between acute and chronic snorers. CONCLUSION Snoring is not associated with alterations in the markers of fetal or placental wellbeing tested here and suggests that there are alternative mechanisms underlying the association between snoring and adverse perinatal outcomes.
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Abstract
The spectrum of sleep-disordered breathing (SDB) ranges from mild snoring to obstructive sleep apnea, the most severe form of SDB. Current recommendations are to treat these women with continuous positive airway pressure despite limited data. SDB in early and mid-pregnancy is associated with preeclampsia and gestational diabetes. Pregnant women with a diagnosis of obstructive sleep apnea at delivery were at significantly increased risk of having cardiomyopathy, congestive heart failure, pulmonary embolism, and in-hospital death. These effects were exacerbated in the presence of obesity. Postpartum, these women are at risk for respiratory suppression and should be monitored.
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Affiliation(s)
- Jennifer E Dominguez
- Department of Anesthesiology, Obstetric Anesthesiology, Division of Women's Anesthesia, Duke University Medical Center, Mail Sort #9, DUMC Box 3094, Durham, NC 27710, USA
| | - Linda Street
- Division of Maternal Fetal Medicine, Department of OB/GYN, Medical College of Georgia, Augusta University, 1120 15th Street, BA-7410, Augusta, GA 30912, USA
| | - Judette Louis
- Division of Maternal Fetal Medicine, Department of OB/GYN, University of South Florida, 2 Tampa General Circle Suite 6050, Tampa, FL 33606, USA.
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19
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Okun ML, O'Brien LM. Concurrent insomnia and habitual snoring are associated with adverse pregnancy outcomes. Sleep Med 2018; 46:12-19. [DOI: 10.1016/j.sleep.2018.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 11/25/2022]
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20
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Dominguez JE, Habib AS, Krystal AD. A review of the associations between obstructive sleep apnea and hypertensive disorders of pregnancy and possible mechanisms of disease. Sleep Med Rev 2018; 42:37-46. [PMID: 29929840 DOI: 10.1016/j.smrv.2018.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 12/11/2022]
Abstract
Obesity is prevalent among pregnant women in the United States; 15-20% of obese pregnant women have obstructive sleep apnea. The prevalence of obstructive sleep apnea increases along with body mass index, age and in the presence of other co-morbidities. Untreated obstructive sleep apnea in women is associated with a range of cardiovascular, pulmonary and metabolic co-morbidities; recent studies suggest that women with obstructive sleep apnea in pregnancy may be at significantly greater risk of entering pregnancy with chronic hypertension and/or of developing hypertensive disorders of pregnancy: gestational hypertension; preeclampsia; or eclampsia. This has serious public health implications; hypertensive disorders of pregnancy are a major cause of maternal and neonatal morbidity and mortality and are associated with a greater lifetime risk for cardiovascular disease. The mechanisms that associated obstructive sleep apnea with hypertensive disorders of pregnancy have not been defined, but several pathways are scientifically plausible. In this review, we will present a comprehensive literature review of the following: the associations between obstructive sleep apnea and hypertensive disorders of pregnancy; the proposed mechanisms that may connect obstructive sleep apnea and hypertensive disorders of pregnancy; and the effectiveness of treatment at mitigating these adverse outcomes.
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Affiliation(s)
| | - Ashraf S Habib
- Duke Department of Anesthesiology, Durham, NC, 27710, USA
| | - Andrew D Krystal
- Duke Department of Psychiatry and Behavioral Sciences, Durham, NC 27710, USA; University of California, San Francisco Department of Psychiatry, San Francisco, CA 94143, USA
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21
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Racial/Ethnic Differences in Sleep Disorders and Reporting of Trouble Sleeping Among Women of Childbearing Age in the United States. Matern Child Health J 2018; 21:306-314. [PMID: 27439422 DOI: 10.1007/s10995-016-2115-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives Whether racial/ethnic differences in prevalence/reporting of sleep disorders exist in pregnant women/women of child-bearing age is unknown. Study objectives were to estimate prevalence of sleep disorders and to examine racial/ethnic differences in sleep disorders, reporting of sleep issues, and amount of sleep among women of child-bearing age (15-44 years) in the US. Methods Through a secondary analysis of the National Health and Nutrition Examination Survey 2005-2010 (3175 non-pregnant, 432 pregnant women in main analysis), prevalence of sleep disorders, reporting of sleep disorders to a physician/health professional, and amount of sleep were estimated overall, by pregnancy status, and by race/ethnicity stratified by pregnancy status. Racial/ethnic differences in reporting of trouble sleeping by pregnancy status were examined using univariate and multivariate logistic regression. Results Prevalence of diagnosed sleep disorders among women of childbearing age was 4.9 % [3.9 % pregnant; 5.1 % non-pregnant (p < 0.01)]. Significantly fewer pregnant and non-pregnant minority women reported adequate sleep (7-8 h) than non-Hispanic white (white) women (p < 0.05). Among non-pregnant women, odds of report of trouble sleeping were significantly higher for white compared to black (aOR 0.47 [95 % CI 0.36, 0.61]) or Mexican-American women (aOR 0.29 [95 % CI 0.21, 0.41]); non-pregnant minority women were also significantly less likely to report trouble sleeping than white women when controlling for amount of sleep. Among pregnant women, these same trends were found. Discussion Compared to white women, minority women, despite reporting less adequate sleep, are less likely to report trouble sleeping, providing evidence of an important health disparity.
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22
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Pamidi S, Kimoff RJ. Maternal Sleep-Disordered Breathing. Chest 2018; 153:1052-1066. [DOI: 10.1016/j.chest.2017.10.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 01/11/2023] Open
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Abstract
PURPOSE OF REVIEW This review aims to provide an update on recent advances in the diagnosis and treatment of obstructive sleep apnea (OSA) during pregnancy and its effect on maternal and fetal outcomes. RECENT FINDINGS Current OSA screening tools may not perform well in this population. There are some pieces of evidence linking poorer maternal and neonatal outcome with pregnant patients having OSA. At present, there are inadequate data on which to base fetal or maternal parameters for treatment of OSA, and no evidence that treatment in the short-term impacts maternal or neonatal outcomes. SUMMARY Further research is needed to help in the detection and treatment of OSA in pregnancy.
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24
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Wilson DL, Walker SP, Fung AM, Pell G, O'Donoghue FJ, Barnes M, Howard ME. Sleep-disordered breathing in hypertensive disorders of pregnancy: a BMI-matched study. J Sleep Res 2018; 27:e12656. [PMID: 29368415 DOI: 10.1111/jsr.12656] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/06/2017] [Indexed: 01/21/2023]
Abstract
Sleep-disordered breathing is more common in hypertensive disorders during pregnancy; however, most studies have not adequately accounted for the potential confounding impact of obesity. This study evaluated the frequency of sleep-disordered breathing in women with gestational hypertension and pre-eclampsia compared with body mass index- and gestation-matched normotensive pregnant women. Women diagnosed with gestational hypertension or pre-eclampsia underwent polysomnography shortly after diagnosis. Normotensive controls body mass index-matched within ±4 kg m-2 underwent polysomnography within ±4 weeks of gestational age of their matched case. The mean body mass index and gestational age at polysomnography were successfully matched for 40 women with gestational hypertension/pre-eclampsia and 40 controls. The frequency of sleep-disordered breathing in the cases was 52.5% compared with 37.5% in the control group (P = 0.18), and the respiratory disturbance index overall did not differ (P = 0.20). However, more severe sleep-disordered breathing was more than twice as common in women with gestational hypertension or pre-eclampsia (35% versus 15%, P = 0.039). While more than half of women with a hypertensive disorder of pregnancy meet the clinical criteria for sleep-disordered breathing, it is also very common in normotensive women of similar body mass index. This underscores the importance of adjusting for obesity when exploring the relationship between sleep-disordered breathing and hypertension in pregnancy. More severe degrees of sleep-disordered breathing are significantly associated with gestational hypertension and pre-eclampsia, and sleep-disordered breathing may plausibly play a role in the pathophysiology of pregnancy hypertension in these women. This suggests that more severe sleep-disordered breathing is a potential therapeutic target for reducing the prevalence or severity of hypertensive disorders in pregnancy.
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Affiliation(s)
- Danielle L Wilson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Vic., Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Vic., Australia.,Department of Medicine, University of Melbourne, Parkville, Vic., Australia
| | - Susan P Walker
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Vic., Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Vic., Australia
| | - Alison M Fung
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Vic., Australia
| | - Gabrielle Pell
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Vic., Australia
| | - Fergal J O'Donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Vic., Australia.,Department of Medicine, University of Melbourne, Parkville, Vic., Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Vic., Australia.,Department of Medicine, University of Melbourne, Parkville, Vic., Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Vic., Australia.,Department of Medicine, University of Melbourne, Parkville, Vic., Australia
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25
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Bublitz MH, Monteiro JF, Caraganis A, Martin S, Parker J, Larson L, Miller MA, Bourjeily G. Obstructive Sleep Apnea in Gestational Diabetes: A Pilot Study of the Role of the Hypothalamic-Pituitary-Adrenal Axis. J Clin Sleep Med 2018; 14:87-93. [PMID: 29198302 DOI: 10.5664/jcsm.6888] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 06/09/2017] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) in pregnancy is associated with gestational diabetes mellitus (GDM). This propensity toward heightened insulin resistance in OSA patients has not been well characterized and may be related to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. The aim of this study was to (1) assess the prevalence of OSA in pregnant women with GDM, (2) evaluate whether HPA axis dysregulation relates to OSA, and (3) investigate the relation between insulin resistance and OSA. We hypothesized that OSA is prevalent among pregnant women with GDM and that women with OSA will have higher levels of insulin resistance and dysregulation of the HPA axis. METHODS Twenty-five pregnant women in whom GDM was diagnosed were enrolled. Subjects answered sleep questionnaires and underwent in-home sleep studies using a level III device. The presence of OSA was defined by apnea-hypopnea index ≥ 5 events/h. Homeostasis Model Assessment of insulin resistance was derived from measurements of fasting glucose and C-peptide levels. Three salivary cortisol levels were obtained across 1 day to assess circadian variation. Multivariable linear regression analyses were used to assess associations between variables. RESULTS The sample consisted of 54% Caucasian pregnant women with a median body mass index of 36.1 and interquartile ratio of 10.6 kg/m2. OSA was diagnosed in 17% of participants. Circadian variation of cortisol was preserved in women with OSA. Women with OSA displayed blunted cortisol awakening responses. CONCLUSIONS OSA is prevalent in women with GDM. OSA is associated with preserved circadian variation and blunted cortisol awakening responses.
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Affiliation(s)
- Margaret H Bublitz
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | | | - Andrew Caraganis
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Susan Martin
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Jeffrey Parker
- Center for Sleep Disorders, Rhode Island Hospital, East Providence, Rhode Island
| | - Lucia Larson
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Margaret A Miller
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Ghada Bourjeily
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
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26
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Culebras A. Letter re: Long-term cerebral white and gray matter changes after preeclampsia. Neurology 2017; 89:1309. [PMID: 28923886 DOI: 10.1212/wnl.0000000000004402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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27
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Bourjeily G, Londono Palacio N, Rojas-Suárez JA. Síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) y embarazo. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El embarazo es una condición temporal de la vida en la que ocurren importantes cambios en la fisiología de la mujer, los cuales se resuelven, en gran medida, después del parto. Hay cambios físicos, hormonales y psicológicos, con un aumento progresivo de peso. Estos factores pueden predisponer a un trastorno respiratorio del sueño o a exacerbar alguno ya existente. La literatura científica sugiere una mayor prevalencia de ronquido en las mujeres embarazadas. Las bases de datos demuestran que en menos del 1% de los embarazos aparece el código del diagnóstico de apnea de sueño. Se ha relacionado la presencia tanto de ronquido como de apnea durante el embarazo con algunos desenlaces adversos que se tratan en este artículo, el cual busca sensibilizar a los médicos para que consideren este diagnóstico durante el embarazo.
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28
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Bourjeily G, Danilack VA, Bublitz MH, Lipkind H, Muri J, Caldwell D, Tong I, Rosene-Montella K. Obstructive sleep apnea in pregnancy is associated with adverse maternal outcomes: a national cohort. Sleep Med 2017; 38:50-57. [PMID: 29031756 DOI: 10.1016/j.sleep.2017.06.035] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/03/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Pregnancy and the obesity epidemic impacting women of reproductive age appear to predispose women to obstructive sleep apnea (OSA) in pregnancy. The aim of this study is to examine the association between OSA and adverse maternal outcomes in a national cohort. METHODS The National Perinatal Information Center in the US was used to identify women with a delivery discharge diagnosis of OSA from 2010 to 2014. We used the International Classification of Diseases, ninth Revision to classify OSA diagnosis and maternal outcomes. MEASUREMENTS The sample consisted of 1,577,632 gravidas with a rate of OSA of 0.12% (N = 1963). There was a significant association between OSA and preeclampsia (adjusted odds ratio (aOR) 2.22, 95% confidence interval (CI) 1.94-2.54), eclampsia (aOR 2.95, 1.08-8.02), and gestational diabetes (aOR 1.51, 1.34-1.72) after adjusting for a comprehensive list of covariates which includes maternal obesity. OSA status was also associated with a 2.5-3.5-fold increase in risk of severe complications such as cardiomyopathy, congestive heart failure, and hysterectomy. Length of hospital stay was significantly longer (5.1 + 5.6 vs 3.0 + 3.0 days, p < 0.001) and odds of an admission to an intensive care unit higher (aOR 2.74, 2.36-3.18) in women with OSA. CONCLUSIONS Compared to pregnant women without OSA, pregnant women with OSA have a significantly higher risk of pregnancy-specific complications such as gestational hypertensive conditions and gestational diabetes, and rare medical and surgical complications such as cardiomyopathy, pulmonary edema, congestive heart failure, and hysterectomy. OSA diagnosis was also associated with a longer hospital stay and significantly increased odds for admission to the intensive care unit.
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Affiliation(s)
- Ghada Bourjeily
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, The Miriam Hospital, Providence, RI, USA.
| | - Valery A Danilack
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA; Division of Research, Women & Infants Hospital, Providence, RI, USA
| | - Margaret H Bublitz
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Heather Lipkind
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Janet Muri
- National Perinatal Information Center, Providence, RI, USA
| | - Donna Caldwell
- National Perinatal Information Center, Providence, RI, USA
| | - Iris Tong
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Medicine, The Miriam Hospital, Providence, RI, USA
| | - Karen Rosene-Montella
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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29
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Trzepizur W, Khalyfa A, Qiao Z, Popko B, Gozal D. Integrated stress response activation by sleep fragmentation during late gestation in mice leads to emergence of adverse metabolic phenotype in offspring. Metabolism 2017; 69:188-198. [PMID: 28139216 DOI: 10.1016/j.metabol.2017.01.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/16/2016] [Accepted: 01/16/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Late gestational sleep fragmentation (SF) is highly prevalent particularly in obese women, and induces metabolic dysfunction in adult offspring mice. SF induces activation of the integrated stress response (ISR), which might be involved in metabolic disorders. We hypothesized that adult offspring of double mutant mice (DM) involving the critical ISR genes CHOP and GADD34 would be protected from developing obesity and insulin resistance following SF. METHODS Time-pregnant CHOP/GADD34 DM and wild type (WT) mice were randomly assigned to sleep control (SC) or SF conditions during the last 5days of gestation. At 24-weeks of age, body weight, fat mass, and HOMA-IR were assessed in the offspring. Tregs lymphocytes, Lyc6chigh, M1 and M2 macrophages were examined in visceral white adipose tissues (vWAT) using flow cytometry. The effects of plasma exosomes on adipocyte cell line proliferation, differentiation and insulin sensitivity were also evaluated. RESULTS SF-WT male showed significant increases in body weight, vWAT mass and HOMA-IR compared to SC-WT mice, while SF had no effect in SF-DM mice. Inflammatory macrophages (Ly-6chigh) and the ratio of M1/M2 macrophages were increased while FoxP3+ Tregs counts were decreased in SF-WT but not in SF-DM mice. Exosomes from SF-WT, but not from the SF-DM offspring increased pre-adipocyte proliferation and differentiation, and decreased in vitro adipocyte insulin sensitivity. CONCLUSION Activation of the ISR during late gestation, as induced by late gestational SF, appears to underlie some of the transgenerational modifications in metabolic genes ultimately contributing to a metabolic syndrome phenotype in adult offspring.
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Affiliation(s)
- Wojciech Trzepizur
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL 60637, USA
| | - Abdelnaby Khalyfa
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL 60637, USA
| | - Zhuanhong Qiao
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL 60637, USA
| | - Brian Popko
- Department of Neurology, The University of Chicago Center for Peripheral Neuropathy, The University of Chicago, Chicago, IL 60637, United States
| | - David Gozal
- Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL 60637, USA.
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Khalyfa A, Cortese R, Qiao Z, Ye H, Bao R, Andrade J, Gozal D. Late gestational intermittent hypoxia induces metabolic and epigenetic changes in male adult offspring mice. J Physiol 2017; 595:2551-2568. [PMID: 28090638 DOI: 10.1113/jp273570] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 01/05/2017] [Indexed: 01/09/2023] Open
Abstract
KEY POINTS Late gestation during pregnancy has been associated with a relatively high prevalence of obstructive sleep apnoea (OSA). Intermittent hypoxia, a hallmark of OSA, could impose significant long-term effects on somatic growth, energy homeostasis and metabolic function in offspring. Here we show that late gestation intermittent hypoxia induces metabolic dysfunction as reflected by increased body weight and adiposity index in adult male offspring that is paralleled by epigenomic alterations and inflammation in visceral white adipose tissue. Fetal perturbations by OSA during pregnancy impose long-term detrimental effects manifesting as metabolic dysfunction in adult male offspring. ABSTRACT Pregnancy, particularly late gestation (LG), has been associated with a relatively high prevalence of obstructive sleep apnoea (OSA). Intermittent hypoxia (IH), a hallmark of OSA, could impose significant long-term effects on somatic growth, energy homeostasis, and metabolic function in offspring. We hypothesized that IH during late pregnancy (LG-IH) may increase the propensity for metabolic dysregulation and obesity in adult offspring via epigenetic modifications. Time-pregnant female C57BL/6 mice were exposed to LG-IH or room air (LG-RA) during days 13-18 of gestation. At 24 weeks, blood samples were collected from offspring mice for lipid profiles and insulin resistance, indirect calorimetry was performed and visceral white adipose tissues (VWAT) were assessed for inflammatory cells as well as for differentially methylated gene regions (DMRs) using a methylated DNA immunoprecipitation on chip (MeDIP-chip). Body weight, food intake, adiposity index, fasting insulin, triglycerides and cholesterol levels were all significantly higher in LG-IH male but not female offspring. LG-IH also altered metabolic expenditure and locomotor activities in male offspring, and increased number of pro-inflammatory macrophages emerged in VWAT along with 1520 DMRs (P < 0.0001), associated with 693 genes. Pathway analyses showed that genes affected by LG-IH were mainly associated with molecular processes related to metabolic regulation and inflammation. LG-IH induces metabolic dysfunction as reflected by increased body weight and adiposity index in adult male offspring that is paralleled by epigenomic alterations and inflammation in VWAT. Thus, perturbations to fetal environment by OSA during pregnancy can have long-term detrimental effects on the fetus, and lead to persistent metabolic dysfunction in adulthood.
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Affiliation(s)
- Abdelnaby Khalyfa
- Section of Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Rene Cortese
- Section of Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Zhuanhong Qiao
- Section of Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Honggang Ye
- Section of Endocrinology and Metabolism, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Riyue Bao
- Center for Research Informatics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Jorge Andrade
- Center for Research Informatics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, IL, USA
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Lee J, Eklund EE, Lambert-Messerlian G, Palomaki GE, Butterfield K, Curran P, Bourjeily G. Serum Progesterone Levels in Pregnant Women with Obstructive Sleep Apnea: A Case Control Study. J Womens Health (Larchmt) 2017; 26:259-265. [PMID: 28103130 DOI: 10.1089/jwh.2016.5917] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pregnancy is a risk factor for sleep disordered breathing, including obstructive sleep apnea (OSA). Progesterone, one of the key hormones in pregnancy, a known respiratory drive stimulant, increases ventilation and may protect against OSA. We aimed to examine the relationship between circulating progesterone and OSA, after accounting for body weight and gestational age. METHODS A case control study was conducted of pregnant women with OSA and those at low risk for the disorder. Cases were identified by ICD-9 code and review of medical record. Controls were identified if they scored zero (never) for snoring, apnea, and gasping on the multivariable apnea prediction index questionnaire immediately following delivery. Subjects with available stored first and/or second trimester residual serum samples were then included in this study and serum analyzed for progesterone. Raw progesterone levels were adjusted for the effects of gestational age and maternal weight. RESULTS Twenty-seven cases and 64 controls with available serum were identified. Women with OSA had greater maternal weight and higher rates of related comorbidities, compared to controls. Progesterone levels correlated positively with gestational age and negatively with greater weight. Progesterone levels, adjusted for gestational age and maternal weight and expressed as multiples of median (MoM), were significantly lower in OSA cases compared to controls in both the first trimester (MoM = 0.71, confidence interval [95% CI] 0.60-0.83) relative to the MoM in controls of 1.00. In the second trimester levels were also lower in OSA cases (MoM = 0.84, 95% CI 0.73-0.96) compared to the MoM of 1.00 in controls. CONCLUSIONS Progesterone levels, after accounting for weight and gestational age, were lower in women with OSA than controls. Progesterone may play a protective role against OSA.
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Affiliation(s)
- Jennifer Lee
- 1 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island
| | - Elizabeth E Eklund
- 2 Department of Pathology and Laboratory Medicine, Women & Infants Hospital of Rhode Island , Providence, Rhode Island
| | - Geralyn Lambert-Messerlian
- 1 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island.,2 Department of Pathology and Laboratory Medicine, Women & Infants Hospital of Rhode Island , Providence, Rhode Island
| | - Glenn E Palomaki
- 1 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island.,2 Department of Pathology and Laboratory Medicine, Women & Infants Hospital of Rhode Island , Providence, Rhode Island
| | - Kristen Butterfield
- 3 Department of Clinical and Academic Quality Initiatives, Rhode Island Hospital , Providence, Rhode Island
| | - Patrizia Curran
- 4 Women's Medicine Collaborative, The Miriam Hospital , Providence, Rhode Island
| | - Ghada Bourjeily
- 1 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island.,4 Women's Medicine Collaborative, The Miriam Hospital , Providence, Rhode Island.,5 Department of Medicine, The Miriam Hospital , Providence, Rhode Island
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Bublitz MH, Bourjeily G. Sleep Disordered Breathing in Pregnancy and Adverse Maternal Outcomes-A True Story? ACTA ACUST UNITED AC 2017; 2:19-20. [PMID: 32864164 PMCID: PMC7451789 DOI: 10.17925/usrpd.2017.12.02.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pregnancy may predispose women to the development or worsening of sleep disordered breathing. Recent studies have shown a significant association between sleep disordered breathing and adverse pregnancy-related outcomes including gestational diabetes, preeclampsia, and severe maternal morbidity including pulmonary edema, cardiomyopathy, congestive heart failure, and admissions to the intensive care unit. More research is needed on the mechanisms linking sleep disordered breathing to adverse pregnancy outcomes. Large trials that examine the impact of therapy for sleep disordered breathing during pregnancy on pregnancy outcomes are also needed.
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Affiliation(s)
- Margaret H Bublitz
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, US.,Women's Medicine Collaborative, The Miriam Hospital, Providence, RI, US.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, US
| | - Ghada Bourjeily
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, US.,Women's Medicine Collaborative, The Miriam Hospital, Providence, RI, US
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33
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Carnelio S, Morton A, McIntyre HD. Sleep disordered breathing in pregnancy: the maternal and fetal implications. J OBSTET GYNAECOL 2016; 37:170-178. [PMID: 27924661 DOI: 10.1080/01443615.2016.1229273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sleep disordered breathing (SDB) which includes obstructive sleep apnoea (OSA) and upper airway resistance syndrome (UARS), has emerged as a risk factor for adverse maternal-foetal outcomes in pregnancy. Physiological changes of pregnancy predispose a woman 'at risk' towards developing SDB. The increasing incidence of OSA in pregnancy closely correlates with the population trends of obesity. Common screening tools validated in non-pregnant subjects including Epworth Sleepiness Scale (ESS) and Berlin Questionnaire (BQ) are poor predictors of SDB in pregnancy. Preeclampsia, gestational hypertension and gestational diabetes mellitus (GDM) are linked with SDB. Preeclampsia and OSA share common pathological associations. It is unclear if one predisposes the other. Foetal morbidity includes intrauterine growth restriction (IUGR), preterm delivery, low birth weight, neonatal intensive care unit (NICU) admission and Apgar score of less than seven at one minute. Continuous positive airway pressure (CPAP) is a well-documented treatment of SDB in pregnancy and has been shown to reverse some of the adverse events. It becomes imperative to diagnose and manage this condition as OSA causes substantial morbidity in the untreated pregnant patient and foetus. Three short clinical cases and a literature review on SDB on pregnancy are presented.
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Affiliation(s)
| | - Adam Morton
- b Department of Obstetric Medicine , Mater Health Services , Brisbane , Australia
| | - H David McIntyre
- b Department of Obstetric Medicine , Mater Health Services , Brisbane , Australia
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Zaremba S, Mueller N, Heisig AM, Shin CH, Jung S, Leffert LR, Bateman BT, Pugsley LJ, Nagasaka Y, Duarte IM, Ecker JL, Eikermann M. Elevated upper body position improves pregnancy-related OSA without impairing sleep quality or sleep architecture early after delivery. Chest 2016; 148:936-944. [PMID: 25905714 DOI: 10.1378/chest.14-2973] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND During pregnancy, upper airway resistance is increased, predisposing vulnerable women to pregnancy-related OSA. Elevation of the upper body increases upper airway cross-sectional area (CSA) and improves severity of OSA in a subgroup of nonpregnant patients (positional-dependent sleep apnea). We tested the hypothesis that elevated position of the upper body improves OSA early after delivery. METHODS Following institutional review board approval, we conducted a randomized, crossover study on two postpartum units of Massachusetts General Hospital. Women during the first 48 h after delivery were included. Polysomnography was performed in nonelevated and 45° elevated upper body position. Upper airway CSA was measured by acoustic pharyngometry in nonelevated, 45° elevated, and sitting body position. RESULTS Fifty-five patients were enrolled, and measurements of airway CSA obtained. Thirty patients completed polysomnography in both body positions. Elevation of the upper body significantly reduced apnea-hypopnea index (AHI) from 7.7 ± 2.2/h in nonelevated to 4.5 ± 1.4/h in 45° elevated upper body position (P = .031) during sleep. Moderate to severe OSA (AHI > 15/h) was diagnosed in 20% of postpartum patients and successfully treated by elevated body position in one-half of them. Total sleep time and sleep architecture were not affected by upper body elevation. Change from nonelevated to sitting position increased inspiratory upper airway CSA from 1.35 ± 0.1 cm2 to 1.54 ± 0.1 cm2 during wakefulness. Position-dependent increase in CSA and decrease in AHI were correlated (r = 0.42, P = .022). CONCLUSIONS Among early postpartum women, 45° upper body elevation increased upper airway CSA and mitigated sleep apnea. Elevated body position might improve respiratory safety in women early after delivery. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01719224; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Sebastian Zaremba
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Sleep Medicine, Department of Neurology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Noomi Mueller
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Anne M Heisig
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Christina H Shin
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Stefanie Jung
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Pediatric Surgery, DRK-Kinderklinik Siegen, Teaching Hospital of Philipps University, Marburg, Germany; Department of Pediatric Urology, DRK-Kinderklinik Siegen, Teaching Hospital of Philipps University, Marburg, Germany
| | - Lisa R Leffert
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Brian T Bateman
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Lori J Pugsley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Yasuko Nagasaka
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ingrid Moreno Duarte
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jeffrey L Ecker
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Anesthesia and Critical Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
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35
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Lapinsky SE, Nelson-Piercy C. The Lungs in Obstetric and Gynecologic Diseases. MURRAY AND NADEL'S TEXTBOOK OF RESPIRATORY MEDICINE 2016. [PMCID: PMC7152064 DOI: 10.1016/b978-1-4557-3383-5.00096-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Imitators of preeclampsia: A review. Pregnancy Hypertens 2016; 6:1-9. [DOI: 10.1016/j.preghy.2016.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/05/2016] [Accepted: 02/11/2016] [Indexed: 12/16/2022]
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37
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Ravishankar S, Bourjeily G, Lambert-Messerlian G, He M, De Paepe ME, Gündoğan F. Evidence of Placental Hypoxia in Maternal Sleep Disordered Breathing. Pediatr Dev Pathol 2015; 18:380-6. [PMID: 26186234 DOI: 10.2350/15-06-1647-oa.1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Sleep disordered breathing (SDB) represents a spectrum of disorders, including habitual snoring and obstructive sleep apnea (OSA). Sleep disordered breathing is characterized by chronic intermittent hypoxia, airflow limitation, and recurrent arousals, which may lead to tissue hypoperfusion, hypoxia, and inflammation. In this study, we aimed to examine whether SDB during pregnancy was associated with histopathologic evidence of chronic placental hypoxia and/or uteroplacental underperfusion. The placentas of women with OSA (n = 23) and habitual snoring (n = 78) as well as nonsnorer controls (n = 47) were assessed for histopathologic and immunohistochemical markers of chronic hypoxia and uteroplacental underperfusion. Fetal normoblastemia was significantly more prevalent in SDB placentas than in those of nonsnorer controls (34.6% and 56.5% in snorers and OSA, respectively, versus 6.4% in controls). Expression of the tissue hypoxia marker carbonic anhydrase IX (CAIX) was more common in OSA placentas than controls (81.5% and 91.3% in snorers and OSA, respectively, versus 57.5% in controls). Adjusting for confounders such as body mass index, diabetes mellitus, or chronic hypertension did not alter the results. The uteroplacental underperfusion scores were similar among the 3 groups. Our findings suggest that SDB during pregnancy is associated with fetoplacental hypoxia, as manifested by fetal normoblastemia and increased placental carbonic anhydrase IX immunoreactivity. The clinical implications and underlying mechanisms remain to be determined.
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Affiliation(s)
- Sanjita Ravishankar
- 1 Department of Pathology, Women and Infants Hospital, Providence, RI 02905, USA.,2 Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University, Providence, RI, 02905, USA
| | - Ghada Bourjeily
- 3 Department of Medicine, Miriam Hospital, Providence, RI, USA.,4 Department of Medicine, Alpert Medical School at Brown University, Providence, RI, 02905, USA
| | - Geralyn Lambert-Messerlian
- 1 Department of Pathology, Women and Infants Hospital, Providence, RI 02905, USA.,2 Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University, Providence, RI, 02905, USA
| | - Mai He
- 1 Department of Pathology, Women and Infants Hospital, Providence, RI 02905, USA.,2 Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University, Providence, RI, 02905, USA
| | - Monique E De Paepe
- 1 Department of Pathology, Women and Infants Hospital, Providence, RI 02905, USA.,2 Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University, Providence, RI, 02905, USA
| | - Füsun Gündoğan
- 1 Department of Pathology, Women and Infants Hospital, Providence, RI 02905, USA.,2 Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University, Providence, RI, 02905, USA
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38
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Abstract
Respiratory failure affects up to 0.2% of pregnancies, more commonly in the postpartum period. Altered maternal respiratory physiology affects the assessment and management of these patients. Respiratory failure may result from pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism or peripartum cardiomyopathy. Pregnancy may increase the risk or severity of other conditions, including thromboembolism, asthma, viral pneumonitis, and gastric acid aspiration. Management during pregnancy is similar to the nonpregnant patient. Endotracheal intubation in pregnancy carries an increased risk, due to airway edema and rapid oxygen desaturation following apnea. Few data are available to direct prolonged mechanical ventilation in pregnancy. Chest wall compliance is reduced, perhaps permitting slightly higher airway pressures. Optimizing oxygenation is important, but data on the use of permissive hypercapnia are limited. Delivery of the fetus does not always improve maternal respiratory function, but should be considered if benefit to the fetus is anticipated.
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Affiliation(s)
- Stephen E Lapinsky
- Mount Sinai Hospital and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
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39
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Won CHJ. Sleeping for Two: The Great Paradox of Sleep in Pregnancy. J Clin Sleep Med 2015; 11:593-4. [PMID: 25979097 DOI: 10.5664/jcsm.4760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 11/13/2022]
Affiliation(s)
- Christine H J Won
- Yale University School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT
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40
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Won C, Guilleminault C. Gender differences in sleep disordered breathing: implications for therapy. Expert Rev Respir Med 2015; 9:221-31. [PMID: 25739831 DOI: 10.1586/17476348.2015.1019478] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
There are gender differences in the upper airway function and respiratory stability in obstructive sleep apnea (OSA). Hormones are implicated in some gender-related differences, and these differences between men and women appear to mitigate as age increases. In addition, changes in the airway and lung function during pregnancy can contribute to snoring and OSA that might have an adverse effect on the mother and fetus. The limited data available suggest that although the prevalence and severity of OSA may be lower in women, the consequences of the disease are similar, if not worse. Women with OSA may have greater risk for hypertension and endothelial dysfunction, be more likely to develop comorbid conditions such as anxiety and depression and have increased mortality. Therefore, treatment options specifically targeting female presentations and pathophysiology of sleep-disordered breathing (SDB) are expected to result in improved outcomes in women.
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Affiliation(s)
- Christine Won
- Yale University School of Medicine, New Haven, CT, USA
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41
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Central sleep apnea in pregnant women with sleep disordered breathing. Sleep Breath 2015; 19:835-40. [DOI: 10.1007/s11325-014-1099-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
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Pulmonary Disorders in Pregnancy. MEDICAL MANAGEMENT OF THE PREGNANT PATIENT 2015. [PMCID: PMC7120384 DOI: 10.1007/978-1-4614-1244-1_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pregnancy is associated with some profound changes in the cardiovascular, respiratory, immune, and hematologic systems that impact the clinical presentation of respiratory disorders, their implications in pregnancy, and the decisions to treat. In addition, concerns for fetal well-being and safety of various interventions complicate the management of these disorders. In many circumstances, especially life-threatening ones, decisions are based upon a careful assessment of the risk benefit ratio rather than absolute safety of drugs and interventions. In this chapter, we review some of the common respiratory disorders that internists or obstetricians may be called upon to manage.
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44
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Khalyfa A, Mutskov V, Carreras A, Khalyfa AA, Hakim F, Gozal D. Sleep fragmentation during late gestation induces metabolic perturbations and epigenetic changes in adiponectin gene expression in male adult offspring mice. Diabetes 2014; 63:3230-41. [PMID: 24812424 PMCID: PMC4171662 DOI: 10.2337/db14-0202] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sleep fragmentation (SF) is a common condition among pregnant women, particularly during late gestation. Gestational perturbations promote the emergence of adiposity and metabolic disease risk in offspring, most likely through epigenetic modifications. Adiponectin (AdipoQ) expression inversely correlates with obesity and insulin resistance. The effects of SF during late gestation on metabolic function and AdipoQ expression in visceral white adipose tissue (VWAT) of offspring mice are unknown. Male offspring mice were assessed at 24 weeks after dams were exposed to SF or control sleep during late gestation. Increased food intake, body weight, VWAT mass, and insulin resistance, with reductions in AdipoQ expression in VWAT, emerged in SF offspring. Increased DNMT3a and -b and global DNA methylation and reduced histone acetyltransferase activity and TET1, -2, and -3 expression were detected in VWAT of SF offspring. Reductions in 5-hydroxymethylcytosine and H3K4m3 and an increase in DNA 5-methylcytosine and H3K9m2 in the promoter and enhancer regions of AdipoQ emerged in adipocytes from VWAT and correlated with AdipoQ expression. SF during late gestation induces epigenetic modifications in AdipoQ in male offspring mouse VWAT adipocytes along with a metabolic syndrome-like phenotype. Thus, altered gestational environments elicited by SF impose the emergence of adverse, long-lasting metabolic consequences in the next generation.
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Affiliation(s)
- Abdelnaby Khalyfa
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Vesco Mutskov
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Alba Carreras
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Ahamed A Khalyfa
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Fahed Hakim
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, Biological Sciences Division, The University of Chicago, Chicago, IL
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Lord C, Sekerovic Z, Carrier J. Sleep regulation and sex hormones exposure in men and women across adulthood. ACTA ACUST UNITED AC 2014; 62:302-10. [PMID: 25218407 DOI: 10.1016/j.patbio.2014.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/11/2014] [Indexed: 02/02/2023]
Abstract
This review aims to discuss how endogenous and exogenous testosterone exposures in men and estrogens/progesterone exposures in women interact with sleep regulation. In young men, testosterone secretion peaks during sleep and is linked to sleep architecture. Animal and human studies support the notion that sleep loss suppresses testosterone secretion. Testosterone levels decline slowly throughout the aging process, but relatively few studies investigate its impact on age-related sleep modifications. Results suggest that poorer sleep quality is associated with lower testosterone concentrations and that sleep loss may have a more prominent effect on testosterone levels in older individuals. In women, sex steroid levels are characterized by a marked monthly cycle and reproductive milestones such as pregnancy and menopause. Animal models indicate that estrogens and progesterone influence sleep. Most studies do not show any clear effects of the menstrual cycle on sleep, but sample sizes are too low, and research designs often inhibit definitive conclusions. The effects of hormonal contraceptives on sleep are currently unknown. Pregnancy and the postpartum period are associated with increased sleep disturbances, but their relation to the hormonal milieu still needs to be determined. Finally, studies suggest that menopausal transition and the hormonal changes associated with it are linked to lower subjective sleep quality, but results concerning objective sleep measures are less conclusive. More research is necessary to unravel the effects of vasomotor symptoms on sleep. Hormone therapy seems to induce positive effects on sleep, but key concerns are still unresolved, including the long-term effects and efficacy of different hormonal regimens.
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Affiliation(s)
- C Lord
- Département de psychologie, université de Montréal, Pavillon Marie-Victorin, 90, avenue Vincent-d'Indy, H2V 2S9 Montréal, Québec, Canada
| | - Z Sekerovic
- Département de psychologie, université de Montréal, Pavillon Marie-Victorin, 90, avenue Vincent-d'Indy, H2V 2S9 Montréal, Québec, Canada
| | - J Carrier
- Département de psychologie, université de Montréal, Pavillon Marie-Victorin, 90, avenue Vincent-d'Indy, H2V 2S9 Montréal, Québec, Canada; Center for advanced research in sleep medicine, hôpital du Sacré-Cœur de Montréal, 5400, boulevard Gouin-Ouest, H4J 1C5 Montréal, Québec, Canada; Institut universitaire de gériatrie de Montréal, université de Montréal, Pavillon Côte des neiges, 4565, chemin Queen-Mary, H3W1W5 Montréal, Québec, Canada.
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46
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Palagini L, Gemignani A, Banti S, Manconi M, Mauri M, Riemann D. Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome. Sleep Med 2014; 15:853-9. [DOI: 10.1016/j.sleep.2014.02.013] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/08/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
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47
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Jung S, Zaremba S, Heisig A, Eikermann M. Elevated body position early after delivery increased airway size during wakefulness, and decreased apnea hypopnea index in a woman with pregnancy related sleep apnea. J Clin Sleep Med 2014; 10:815-7. [PMID: 25024663 DOI: 10.5664/jcsm.3886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a patient with pregnancy related obstructive sleep apnea ([OSA]; apnea hypopnea index [AHI] 18/h) early after delivery, with improvement of AHI by 87% following 45-degree elevation in body position compared with the non-elevated position. Improvement associated with this position may be explained, at least in part, by an increased upper airway diameter (as measured during wakefulness). Sleep apnea in this patient resolved at 9 months postpartum. This observation suggests that 45-degree elevated body position may be an effective treatment of pregnancy related OSA during the postpartum period.
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Affiliation(s)
- Stefanie Jung
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA ; Department of Pediatric Surgery and Pediatric Urology, DRK- Kinderklinik Siegen, Teaching Hospital of Philipps University, Marburg, Germany
| | - Sebastian Zaremba
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA ; Sleep Medicine, Department of Neurology, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Anne Heisig
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA ; Department of Anesthesia and Critical Care, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Culebras A. Sleep apnea and stroke in young women: the many faces of the disorder. Sleep Med 2014; 15:377-8. [DOI: 10.1016/j.sleep.2014.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 02/17/2014] [Indexed: 11/29/2022]
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Lee EK, Gutcher ST, Douglass AB. Is sleep-disordered breathing associated with miscarriages? An emerging hypothesis. Med Hypotheses 2014; 82:481-5. [DOI: 10.1016/j.mehy.2014.01.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 01/29/2014] [Indexed: 12/17/2022]
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Romero R, Badr MS. A role for sleep disorders in pregnancy complications: challenges and opportunities. Am J Obstet Gynecol 2014; 210:3-11. [PMID: 24359866 DOI: 10.1016/j.ajog.2013.11.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 11/13/2013] [Indexed: 12/31/2022]
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