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Suzuki T, Hosomichi J, Maeda H, Ishida Y, Usumi-Fujita R, Moro M, Jariyatheerawong K, Ono T. Gestational intermittent hypoxia reduces mandibular growth with decreased Sox9 expression and increased Hif1a expression in male offspring rats. Front Physiol 2024; 15:1397262. [PMID: 38919850 PMCID: PMC11196756 DOI: 10.3389/fphys.2024.1397262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/03/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction Maternal obstructive sleep apnea (OSA) during pregnancy is the risk factor for impaired fetal growth with low birth weight in the offspring. However, it is unclear whether gestational intermittent hypoxia (IH, a hallmark of maternal OSA) has long-term detrimental consequences on the skeletal development of offspring. This study aimed to investigate postnatal maxillofacial bone growth and cartilage metabolism in male and female offspring that were exposed to gestational IH. Methods Mother rats underwent IH at 20 cycles/h (nadir, 4% O2; peak, 21% O2; 0% CO2) for 8 h per day during gestational days (GD) 7-20, and their male and female offspring were analyzed postnatally at 5 and 10 weeks of age. All male and female offspring were born and raised under normoxic conditions. Results There was no significant difference in whole-body weight and tibial length between the IH male/female offspring and their control counterparts. In contrast, the mandibular condylar length was significantly shorter in the IH male offspring than in the control male offspring at 5 and 10 weeks of age, while there was no significant difference in the female offspring. Real-time polymerase chain reaction (PCR) showed that gestational IH significantly downregulated the mRNA level of SOX9 (a chondrogenesis marker) and upregulated the mRNA level of HIF-1α (a hypoxia-inducible factor marker) in the mandibular condylar cartilage of male offspring, but not in female offspring. Conclusion Gestational IH induced underdeveloped mandibular ramus/condyles and reduced mRNA expression of SOX9, while enhancing mRNA expression of HIF-1α in a sex-dependent manner.
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Affiliation(s)
- Takumi Suzuki
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Jun Hosomichi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Hideyuki Maeda
- Department of Legal Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuji Ishida
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Risa Usumi-Fujita
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Manaka Moro
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Korkuan Jariyatheerawong
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Davis EP, Demers CH, Deer L, Gallop RJ, Hoffman MC, Grote N, Hankin BL. Impact of prenatal maternal depression on gestational length: post hoc analysis of a randomized clinical trial. EClinicalMedicine 2024; 72:102601. [PMID: 38680516 PMCID: PMC11053273 DOI: 10.1016/j.eclinm.2024.102601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Background Shortened gestation is a leading cause of childhood morbidity and mortality with lifelong consequences for health. There is a need for public health initiatives on increasing gestational age at birth. Prenatal maternal depression is a pervasive health problem robustly linked via correlational and epidemiological studies to shortened gestational length. This proof-of-concept study tests the impact of reducing prenatal maternal depression on gestational length with analysis of a randomized clinical trial (RCT). Methods Participants included 226 pregnant individuals enrolled into an RCT and assigned to receive either interpersonal psychotherapy (IPT) or enhanced usual care (EUC). Recruitment began in July 2017 and participants were enrolled August 10, 2017 to September, 8 2021. Depression diagnosis (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM 5) and symptoms (Edinburgh Postnatal Depression Scale and Symptom Checklist) were evaluated at baseline and longitudinally throughout gestation to characterize depression trajectories. Gestational dating was collected based on current guidelines via medical records. The primary outcome was gestational age at birth measured dichotomously (≥39 gestational weeks) and the secondary outcome was gestational age at birth measured continuously. Posthoc analyses were performed to test the effect of reducing prenatal maternal depression on gestational length. This trial is registered with ClinicalTrials.gov (NCT03011801). Findings Steeper decreases in depression trajectories across gestation predicted later gestational age at birth, specifically an increase in the number of full-term babies born ≥39 gestational weeks (EPDS linear slopes: OR = 1.54, 95% CI 1.10-2.16; and SCL-20 linear slopes: OR = 1.67, 95% CI 1.16-2.42). Causal mediation analyses supported the hypothesis that participants assigned to IPT experienced greater reductions in depression symptom trajectories, which in turn, contributed to longer gestation. Supporting mediation, the natural indirect effect (NIE) showed that reduced depression trajectories resulting from intervention were associated with birth ≥39 gestational weeks (EPDS, OR = 1.65, 95% CI 1.02-2.66; SCL-20, OR = 1.85, 95% CI 1.16-2.97). Interpretation We used a RCT design and found that reducing maternal depression across pregnancy was associated with lengthened gestation. Funding This research was supported by the NIH (R01 HL155744, R01 MH109662, R21 MH124026, P50 MH096889).
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Affiliation(s)
- Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Catherine H. Demers
- Department of Psychology, University of Denver, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - LillyBelle Deer
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Robert J. Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
| | - M. Camille Hoffman
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Nancy Grote
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Benjamin L. Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Sanapo L, Hackethal S, Bublitz MH, Sawyer K, Garbazza C, Nagasunder A, Gonzalez M, Bourjeily G. Maternal sleep disordered breathing and offspring growth outcome: A systematic review and meta-analysis. Sleep Med Rev 2024; 73:101868. [PMID: 37956482 PMCID: PMC11000747 DOI: 10.1016/j.smrv.2023.101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/22/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
Sleep disordered breathing is extremely common in pregnancy and is a risk factor for maternal complications. Animal models demonstrate that intermittent hypoxia causes abnormal fetal growth. However, there are conflicting data on the association between maternal sleep disordered breathing and offspring growth in humans. We investigated this association by conducting a systematic review and meta-analysis. Sixty-three manuscripts, and total study population of 67, 671, 110 pregnant women were included. Thirty-one studies used subjective methods to define sleep disordered breathing, 24 applied objective methods and eight used international codes. Using a random effects model, habitual snoring, defined by subjective methods, and obstructive sleep apnea, diagnosed by objective methods, were associated with an increased risk for large for gestational age (OR 1.46; 95%CI 1.02-2.09 and OR 2.19; 95%CI 1.63-2.95, respectively), while obstructive sleep apnea, identified by international codes, was associated with an increased risk for small for gestational age newborns (OR 1.28; 95%CI 1.02-1.60). Our results support that maternal sleep disordered breathing is associated with offspring growth, with differences related to the type of disorder and diagnostic methods used. Future studies should investigate underlying mechanisms and whether treatment of sleep disordered breathing ameliorates the neonatal growth.
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Affiliation(s)
- Laura Sanapo
- Women's Medicine Collaborative, The Miriam Hospital, Providence, RI, USA; Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
| | - Sandra Hackethal
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Margaret H Bublitz
- Women's Medicine Collaborative, The Miriam Hospital, Providence, RI, USA; Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | | | - Corrado Garbazza
- Centre for Chronobiology, University of Basel, Basel, Switzerland; Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | | | - Marian Gonzalez
- Women's Medicine Collaborative, The Miriam Hospital, Providence, RI, USA
| | - Ghada Bourjeily
- Women's Medicine Collaborative, The Miriam Hospital, Providence, RI, USA; Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA; Department of Health Services, Policy and Practice, School of Public Health at Brown University, Providence, Rhode Island, USA
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Wang R, Feng W, Wang Y, Jiang Y, Lin Y, Chen X. Maternal obstructive sleep apnea aggravates metabolic dysfunction-associated fatty liver disease via HMGB1-TLR4 signaling-mediated endoplasmic reticulum stress in male offspring rats. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166889. [PMID: 37730152 DOI: 10.1016/j.bbadis.2023.166889] [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: 07/03/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
AIMS/HYPOTHESIS Maternal obstructive sleep apnea (MOSA) may inflict long-term metabolic effects on offspring. We hypothesize that MOSA increases the propensity for metabolic dysregulation in offspring and thus facilitates the development of metabolic dysfunction-associated fatty liver disease (MAFLD). This study aims to test the hypothesis and explore the underlying mechanism. METHODS The MOSA rat model of upper airway obstruction was established and fecundated. The postweaning male offspring (n = 171) from both the control group and MOSA group were randomly fed the normal chow diet (NCD, n = 89) or high-fat diet (HFD, n = 82) for the next 5 months. Liver function, lipid profile, glucose, and insulin levels were measured. Expression levels of fibrosis-related proteins and endoplasmic reticulum (ER) stress-related proteins in liver tissues were assessed using immunohistochemistry and western blotting. RESULTS MOSA increased body and liver weight in male offspring, along with augmented liver organ coefficient. Serum levels of aminotransferases, low-density lipoprotein, high-density lipoprotein, triglycerides, total cholesterol, total bile acid, fasting glucose, and insulin increased significantly. MOSA exacerbated HFD-induced hepatic steatosis and fibrosis. These effects were driven by the overactivated double-stranded RNA-activated protein kinase (PKR)-like eukaryotic initiation factor 2(PERK)-activating transcription factor (ATF)4-C/EBP homologous protein (CHOP) signaling pathway-induced ER stress, and hyperacetylation and release of high mobility group box-1(HMGB1) elicited above signaling in a TLR4-dependent manner. CONCLUSIONS These findings indicate that MOSA can exert prolonged adverse effects manifested as metabolic dysfunction in male offspring. Therefore, surveillance and management of OSA during pregnancy may be necessary to prevent and alleviate MAFLD in offspring.
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Affiliation(s)
- Ruhua Wang
- Department of Gastroenterology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Wei Feng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510180, China
| | - Yan Wang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yonghong Jiang
- Department of Gastroenterology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Yiguang Lin
- Central Laboratory, Fist Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, China..
| | - Xueqing Chen
- Department of Gastroenterology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China.
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Kember AJ, Elangainesan P, Ferraro ZM, Jones C, Hobson SR. Common sleep disorders in pregnancy: a review. Front Med (Lausanne) 2023; 10:1235252. [PMID: 37671402 PMCID: PMC10475609 DOI: 10.3389/fmed.2023.1235252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023] Open
Abstract
In this review, we provide a comprehensive overview of common sleep disorders during pregnancy, including their characterization, prevalence, risk factors, and possible contribution to maternal and fetal outcomes. We conducted a quasi-systematic literature search of the MEDLINE database and identified 744 studies from 1991 through 2021, inclusive, that met our inclusion criteria. We synthesized the existing literature on sleep disorders during pregnancy and highlighted controversies, research gaps, and needed clinical developments. Our review covers a range of sleep disorders, including insomnia, obstructive sleep apnea, restless legs syndrome, and circadian rhythm disorders. We discuss the prevalence of these disorders in pregnancy and their potential impact on maternal and fetal health outcomes. We also explore the relationship between sleep disorders, pre-pregnancy comorbidities such as obesity, and pregnancy-related conditions such as gestational diabetes mellitus and preeclampsia. In addition to summarizing the existing literature on sleep disorders during pregnancy, we also highlight opportunities for further research in this area. We suggest that future studies should strive to employ validated and objective measurement tools for sleep disorders and prioritize utilization of longitudinal methods with participant follow-up through postpartum, mid-life, menopause, and beyond. We also put forward investigation into the impact of circadian rhythm disruption on reproductive physiology and early pregnancy outcomes as an area of important work. Overall, our review provides valuable insights on sleep and reproduction and into common sleep disorders during pregnancy and their potential impact on maternal and fetal health outcomes.
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Affiliation(s)
- Allan J. Kember
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Shiphrah Biomedical Inc., Toronto, ON, Canada
| | - Praniya Elangainesan
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
| | - Zachary M. Ferraro
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Claire Jones
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Reproductive Endocrinology and Infertility, Mount Sinai Hospital, Toronto, ON, Canada
| | - Sebastian R. Hobson
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada
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6
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Peltonen H, Paavonen EJ, Saarenpää-Heikkilä O, Vahlberg T, Paunio T, Polo-Kantola P. Sleep disturbances and depressive and anxiety symptoms during pregnancy: associations with delivery and newborn health. Arch Gynecol Obstet 2023; 307:715-728. [PMID: 35461389 PMCID: PMC9984335 DOI: 10.1007/s00404-022-06560-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/01/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Sleep disturbances and mood symptoms are common in late pregnancy; according to the literature, they can affect delivery and newborn outcomes. This study evaluated the effect of sleep and mood symptoms on delivery and newborn health, because there are insufficient and partly contradictory studies on the topic. METHODS A cohort of 1414 mothers in their third trimester was enrolled in this prospective cross-sectional questionnaire study. Validated questionnaires were assessed for the measurement of sleep disturbances and depressive and anxiety symptoms. The data on delivery and newborn outcomes were obtained from hospital medical records. RESULTS Sleep disturbances were very common. A higher insomnia score (β = - 0.06, p = 0.047) and longer sleep need (β = 0.07, p = 0.047) were related to delivery at a lower gestational age. In addition, a higher insomnia score (β = - 28.30, p = 0.010) and lower general sleep quality (β = - 62.15, p = 0.025) were associated with lower birth weight, but longer sleep duration and longer sleep need with a higher birth weight (β = 28.06, p = 0.019; β = 27.61, p = 0.028, respectively). However, the findings regarding birth weight lost their significance when the birth weight was standardized by gestational weeks. Concerning Apgar scores and umbilical artery pH, no associations were found. Snoring was associated with a shorter duration of the first phase of delivery (β = - 78.71, p = 0.015) and total duration of delivery (β = - 79.85, p = 0.016). Mothers with higher insomnia, depressive, or anxiety symptoms were more often treated with oxytocin (OR 1.54 95% CI 1.00-2.38, p = 0.049, OR 1.76, 95% CI 1.02-3.04, p = 0.049 and OR 1.91, CI 95% 1.28-2.84, p < 0.001, respectively) and those with higher depressive and anxiety symptoms were delivered more often with elective cesarean section (OR 4.67, 95% CI 2.04-12.68, p < 0.001 and OR 2.22, 95% CI 1.03-4.79, p = 0.042). CONCLUSIONS Maternal sleep disturbances and mood symptoms during pregnancy are associated with delivery and newborn health. However, nearly, all the outcomes fell within a normal range, implying that the actual risks are low.
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Affiliation(s)
- Hilla Peltonen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
| | - E Juulia Paavonen
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Outi Saarenpää-Heikkilä
- Centre for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Tiina Paunio
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.,Sleep Research Unit, University of Turku, Turku, Finland
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7
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Senaratna CV, Priyadarshanie N, Fernando S, Goonewardena S, Piyumanthi P, Perret J, Lodge C, Hamilton GS, Dharmage SC. Longitudinal Sleep Study in Pregnancy: Cohort Profile and Prevalence and Risk Factors for Sleep Symptoms in the First Trimester. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2070. [PMID: 36767435 PMCID: PMC9915362 DOI: 10.3390/ijerph20032070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Sleep disorders could influence pregnancy outcomes but evidence for longitudinal associations is scarce. We established a prospective cohort of women to determine incident sleep issues and their adverse health outcomes during pregnancy and beyond, and present here the baseline cohort profile. Antenatal women in gestational weeks 8-12 were recruited (n = 535) and followed-up in each trimester and at 5-6 weeks postpartum (no attrition). Sleep symptoms and disorders were measured using STOP-Bang and Berlin questionnaires and Pittsburgh Sleep Quality Index. Incident health outcomes were extracted from clinical records. At the time of recruitment, habitual snoring was present in 13.8% of participants; "excessive sleepiness during the day" (EDS) in 42.8%; short (<7 h) sleep duration in 46.4%; "having trouble sleeping" in 15.3%; and "poor subjective sleep quality" in 8.6%. Habitual snoring was strongly associated with irregular menstrual periods for one year preceding pregnancy (p = 0.014) and higher BMI (p < 0.001). Higher age was associated with less "trouble sleeping" (OR 0.9, p = 0.033) and longer sleep duration was associated with better "subjective sleep quality" (OR 0.8, p = 0.005). Sleep issues were highly prevalent at baseline and associated with age, irregular menstruation, and obesity. This cohort will provide a robust platform to investigate incident sleep disorders during pregnancy and their effects on adverse pregnancy outcomes and long-term health of women and their offspring.
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Affiliation(s)
- Chamara V. Senaratna
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
- Non-Communicable Diseases Research Centre, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
- Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Nirmala Priyadarshanie
- Department of Nursing & Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Dehiwala-Mount Lavinia 10390, Sri Lanka
| | - Sharaine Fernando
- Department of Physiology, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Sampatha Goonewardena
- Department of Community Medicine, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Pramodya Piyumanthi
- Non-Communicable Diseases Research Centre, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Jennifer Perret
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Caroline Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Garun S. Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Melbourne, VIC 3168, Australia
- School of Clinical Sciences, Monash University, Melbourne, VIC 3800, Australia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
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8
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Robertson A, Makris A, Johnson P, Middleton S, Norman M, Sullivan C, Hennessy A. Delivery outcomes as a result of snoring as determined by standard sleep surveys. Obstet Med 2022; 15:253-259. [PMID: 36523878 PMCID: PMC9745590 DOI: 10.1177/1753495x211064107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 11/15/2021] [Indexed: 11/15/2023] Open
Abstract
Background Sleep-disordered breathing (SDB), is an umbrella term that encompasses obstructive sleep apnea (OSA), central sleep apnea (CSA) and hypoventilation. is common but studies in the pregnant population are limited. Data suggests relationships between OSA and preeclampsia, but the relationship between snoring and pregnancy outcomes is unknown. Methods A prospective study of 2224 singleton pregnancies was undertaken. Women were questioned using the Berlin Questionnaire (BQ- 2 or more categories where the score is positive.) and the Epworth Sleepiness Scale (ESS >10/24), the results compared with pregnancy outcomes with regard to hypertension in pregnancy. Results Women having symptoms raising the possibility of OSA defined by the BQ with a score >7 was 45.5%, and using ESS with a score >10, was 36%. The birth and neonatal outcomes for self-reported snoring and increased daytime sleepiness showed increased adverse outcomes notably increased caesarean section rates and low APGAR scores but not birth before 37 weeks of gestation. Conclusion Using questionnaires designed for the general population, the prevalence of possible undiagnosed OSA is high in the pregnant population. The increased adverse delivery and neonatal outcomes for self-reported snoring and increased daytime sleepiness with these tools indicated the need for further investigation of the links between snoring SDB and pregnancy outcomes.
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Affiliation(s)
- A Robertson
- Western Sydney University
NSW, Australia
- Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW,
Australia
| | - A Makris
- Liverpool Hospital, Liverpool, NSW, Australia
| | - P Johnson
- David Reid Laboratory, University of Sydney, NSW, Australia
| | - S Middleton
- Liverpool Hospital, Liverpool, NSW, Australia
| | - M Norman
- David Reid Laboratory, University of Sydney, NSW, Australia
| | - C Sullivan
- David Reid Laboratory, University of Sydney, NSW, Australia
| | - A Hennessy
- Western Sydney University
NSW, Australia
- Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW,
Australia
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9
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Snoring may transmit infectious aerosols from the upper to the lower respiratory tract. Med Hypotheses 2022; 168:110966. [PMID: 36317052 PMCID: PMC9605781 DOI: 10.1016/j.mehy.2022.110966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/25/2022]
Abstract
Migration to the lungs of an initial upper airway infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or other respiratory pathogens can lead to pneumonia, associated with progression from mild to severe symptoms. Chemical pneumonitis or bacterial pneumonia may be caused by the ‘macroaspiration’ of large volumes of oropharyngeal or gastroesophageal secretions into the lower respiratory tract. ‘Microaspiration’, i.e., a similar mechanism but involving much smaller amounts of oropharyngeal secretions, is considered the pathogenetic mechanism for most pneumonias, including that associated with COVID-19. Here, we hypothesize an alternative mechanism: Rather than by microaspiration, these fluids enter the lungs as microdroplets that are generated by snoring and then carried by the inspired airstream. Laboratory measurements indicate that snoring generates (a) comparable numbers and sizes of oral fluid droplets as loud speaking and (b) total fluid quantities that are similar to those reported for microaspiration. Snoring propensity is strongly correlated to known risk factors for severe COVID-19, including male gender, age, obesity, diabetes, obstructive sleep apnea, and pregnancy. Therefore, more research is urgently needed to determine if various methods that decrease snoring can prevent progression to pneumonia after initial infection of the upper airways.
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10
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Maxwell M, Sanapo L, Monteiro K, Bublitz M, Avalos A, Habr N, Bourjeily G. Impact of nasal dilator strips on measures of sleep-disordered breathing in pregnancy. J Clin Sleep Med 2022; 18:477-483. [PMID: 34432628 PMCID: PMC8804998 DOI: 10.5664/jcsm.9624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Women with sleep-disordered breathing (SDB) in pregnancy are at a greater risk of developing serious adverse perinatal outcomes. However, the pathogenesis of SDB in pregnancy is poorly understood. As nasal congestion is common in pregnancy, nasal obstruction may contribute to SDB in this population. This study aims to assess the impact of nasal dilator strips (NDS) on measures of SDB and their potential for use as a placebo condition. METHODS Pregnant women ≥ 18 years old, body mass index ≥ 27 kg/m2, and habitual snoring were enrolled. Participants completed 2 consecutive level III home sleep apnea tests and used NDS during the second test. Objective measures including respiratory event index and pulse transit time drop index, a measure of increased arterial stiffness, were compared across tests. Subjective assessments of participants' perceived impact of NDS use was also obtained. RESULTS 54 women, 59% White, 60% in the third trimester were enrolled. Median time between the 2 studies was 1 day (interquartile range [IQR] 4). There was no significant change between the night without NDS use and the night with NDS use in respiratory event index (5.30 [IQR 6.20] vs 4.80 [IQR 6.78], P = .8) or pulse transit time drop index (6.8 [IQR 13.3] vs 6.6 [IQR 15.8], P = .360). Subjective measures of sleep did not differ between the 2 nights. CONCLUSIONS Despite the high prevalence of pregnancy-associated rhinitis, NDS do not have a significant impact on measures of SDB. Results from this study support the use of NDS as an appropriate placebo in prenatal clinical trials. CITATION Maxwell M, Sanapo L, Monteiro K, et al. Impact of nasal dilator strips on measures of sleep-disordered breathing in pregnancy. J Clin Sleep Med. 2022;18(2):477-483.
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Affiliation(s)
- Mariko Maxwell
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Laura Sanapo
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island,Department of Medicine, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Kristina Monteiro
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Maggie Bublitz
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island,Department of Medicine, Warren Alpert Medical School at Brown University, Providence, Rhode Island,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ashanti Avalos
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Naya Habr
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Ghada Bourjeily
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island,Department of Medicine, Warren Alpert Medical School at Brown University, Providence, Rhode Island,Address correspondence to: Ghada Bourjeily, MD, Professor of Medicine, Department of Medicine, Divisions of Pulmonary, Critical Care and Sleep Medicine, and Obstetric Medicine, Lifespan Hospitals, Warren Alpert Medical School of Brown University, 146 West River Street, Suite 1F, Providence, RI 02904;
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11
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Mengye Y, Fangfang N, Qingxia M, Yan Z, Yangqian J, Hong L. Sleep quality is associated with the weight of newborns after in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI). Sleep Breath 2022; 26:2059-2068. [DOI: 10.1007/s11325-021-02498-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022]
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12
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O’Brien LM. Sleep in Pregnancy. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Kalmbach DA, O’Brien LM, Pitts DS, Sagong C, Arnett LK, Harb NC, Cheng P, Drake CL. Mother-to-Infant Bonding is Associated with Maternal Insomnia, Snoring, Cognitive Arousal, and Infant Sleep Problems and Colic. Behav Sleep Med 2022; 20:393-409. [PMID: 34047659 PMCID: PMC8627527 DOI: 10.1080/15402002.2021.1926249] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Emerging evidence links maternal and infant sleep problems to impairments in the mother-to-infant bond, but the independence and directionality of these associations remain unclear. The present study characterized concurrent and prospective effects of maternal sleep disturbances and poor infant sleep on the mother-infant relationship. As common sequalae of problematic sleep, nocturnal cognitive hyperarousal and daytime sleepiness were investigated as facilitating mechanisms. PARTICIPANTS Sixty-seven pregnant women enrolled in a prospective study on maternal sleep. METHODS Sociodemographic information and clinical symptoms were measured prenatally then weekly across the first two postpartum months. Women reported insomnia symptoms, sleep duration, snoring, daytime sleepiness, nocturnal cognitive arousal (broadly focused and perinatal-specific), perseverative thinking, depression, infant colic, infant sleep quality, and mother-infant relationship quality. Mixed effects models were conducted to test hypotheses. RESULTS Prenatal snoring and weak maternal-fetal attachment augured poorer postpartum bonding. Poor infant sleep was associated with increased odds for maternal insomnia and short sleep. Impairments in the mother-to-infant bond were linked to maternal insomnia, nocturnal perinatal-focused rumination, daytime sleepiness, depression, and poor infant sleep. Postnatal insomnia predicted future decreases in mother-infant relationship quality, and nocturnal cognitive hyperarousal partially mediated this association. CONCLUSIONS Both maternal and infant sleep problems were associated with poorer mother-to-infant bonding, independent of the effects of maternal depression and infant colic. Perseverative thinking at night, particularly on infant-related concerns, was linked to impaired bonding, rejection and anger, and infant-focused anxiety. Improving maternal and infant sleep, and reducing maternal cognitive arousal, may improve the maternal-to-infant bond.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan.,Pulmonary & Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Louise M O’Brien
- Departments of Obstetrics & Gynecology, and Neurology, University of Michigan Medical School, Ann Arbor, Michigan
| | - D’Angela S Pitts
- Department of Obstetrics & Gynecology, Henry Ford Health System, Detroit, Michigan
| | - Chaewon Sagong
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Lily K Arnett
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Nicholas C Harb
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
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14
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Sharma M, Bapodara S, Tiwari J, Acharya UR. Automated sleep apnea detection in pregnant women using wavelet-based features. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Moghadam ZB, Rezaei E, Rahmani A. Sleep Disorders During Pregnancy and Postpartum: A Systematic Review. SLEEP MEDICINE RESEARCH 2021. [DOI: 10.17241/smr.2021.00983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to asses previous research results about bio-physiological alterations during pregnancy and postpartum, and make clear outlook about prevalence and related factors of sleep disorders during pregnancy and postpartum. In this review, the articles that published from 2000 to 2019 were reviewed. Related articles were searched from databases in English language. After evaluation of inclusion and exclusion criteria, articles were chosen and reviewed based on the University of York strategies. Sleep disorders in present study were classified according to the International Classification of Sleep Disorders-3. The search revealed 4449 articles, after evaluating and assessing qualified articles, finally 56 article selected to review. According to the results of this review, The prevalence of sleep disorders was almost 76%–97% in whole pregnancy. The most common sleep disorders included central disorders of hyper somnolence (waking up in the middle of the night, daytime sleepiness, sleeplessness) or insomnia, sleep-related movement disorders (restless legs syndrome), sleep related breathing disorders (obstructive sleep apnea), and parasomnia. In addition, sleep disorder may continue 3–12 months postpartum (33.2%). Sleep disorders induced by physiological processes (fetal movement, excessive weight gain, male sex of the fetus, and multiparty), health-related risks (metabolism disorders, cardiovascular diseases, and mood disorders), and physical or sexual abuse in childhood. In addition, these disorders could have maternal outcomes that can be greatest trigger to postpartum psychiatric disorders and fetal outcomes that have harmful sequences during childhood (sexual, fertility, emotional, and cognitive problems). Health care providers should evaluate the mothers’ sleep quality because sleep disorder leads to harmful consequences in fetuses and children.
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16
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White KM, Dunietz GL, Pitts DS, Kalmbach DA, Lucchini M, O'Brien LM. Burden of sleep disturbance in non-Hispanic Black pregnant women. J Clin Sleep Med 2021; 18:1319-1325. [PMID: 34964433 PMCID: PMC9059580 DOI: 10.5664/jcsm.9854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Non-Hispanic Black pregnant women disproportionately experience poor perinatal outcomes compared to other racial/ethnic groups. Sleep disruption has emerged as a risk factor for adverse pregnancy outcomes but there are limited data in minority pregnant women. We examined the prevalence of habitual snoring and its timing of onset with several key sleep-wake disturbances and their associations with perinatal outcomes in a cohort of non-Hispanic Black pregnant women. METHODS Third trimester non-Hispanic Black pregnant women were recruited from a large, academic medical center and screened for habitual snoring - and its timing relative to pregnancy - sleep quality, symptoms of insomnia, excessive daytime sleepiness, as well as daytime function. Clinical diagnoses of hypertensive disorders of pregnancy were obtained along with delivery outcomes. RESULTS In 235 women the vast majority (80%) reported three or more sleep-wake disturbances, and almost half had at least five disturbances. Sixteen percent endorsed pre-pregnancy snoring and 20% pregnancy-onset snoring. Women with pregnancy-onset snoring had significantly increased odds of poor sleep quality aOR 8.2, trouble staying asleep aOR 3.6, waking up too early aOR 2.7, excessive daytime sleepiness aOR 2.3, and poor daytime function aOR 8.7 but no relationship with perinatal outcomes. In contrast, pre-pregnancy snoring was related to chronic hypertension, pre-term delivery and fetal growth restriction; aOR 2.6, aOR 2.8, and aOR 5.1 respectively. CONCLUSIONS Sleep-wake disturbances confer a significant burden to pregnant non-Hispanic Black women, an infrequently studied yet disproportionately affected population. Contributions of maternal sleep to racial disparities in perinatal health should be a priority for public health research.
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Affiliation(s)
- Kaylin M White
- Department of Epidemiology, School of Public Health, Emory University, Atlanta, GA
| | - Galit L Dunietz
- Division of Sleep Medicine, Department of Neurology, Michigan Medicine, Ann Arbor, MI
| | - D'Angela S Pitts
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Henry Ford Health System, Detroit, MI
| | - David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York City, NY
| | - Louise M O'Brien
- Division of Sleep Medicine, Department of Neurology, Michigan Medicine, Ann Arbor, MI.,Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Michigan Medicine, Ann Arbor, MI
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17
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Passarella E, Czuzoj-Shulman N, Abenhaim HA. Maternal and fetal outcomes in pregnancies with obstructive sleep apnea. J Perinat Med 2021; 49:1064-1070. [PMID: 34523292 DOI: 10.1515/jpm-2020-0551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is linked to many health comorbidities. We aimed to ascertain if OSA correlates with a rise in poor obstetrical outcomes. METHODS Employing the United States' Healthcare Cost and Utilization Project - National Inpatient Sample, we performed our retrospective cohort study including all women who delivered between 2006 and 2015. ICD-9 codes were used to characterize women as having a diagnosis of OSA. Temporal trends in pregnancies with OSA were studied, baseline features were evaluated among gravidities in the presence and absence of OSA, and multivariate logistic regression analysis was utilized in assessing consequences of OSA on patient and newborn outcomes. RESULTS Of a total 7,907,139 deliveries, 3,115 belonged to patients suffering from OSA, resulting in a prevalence of 39 per 100,000 deliveries. Rates rose from 10.14 to 78.12 per 100,000 deliveries during the study interval (p<0.0001). Patients diagnosed with OSA were at higher risk of having pregnancies with preeclampsia, OR 2.2 (95% CI 2.0-2.4), eclampsia, 4.1 (2.4-7.0), chorioamnionitis, 1.4 (1.2-1.8), postpartum hemorrhage, 1.4 (1.2-1.7), venous thromboembolisms, 2.7 (2.1-3.4), and to deliver by caesarean section, 2.1 (1.9-2.3). Cardiovascular and respiratory complications were also more common among these women, as was maternal death, 4.2 (2.2-8.0). Newborns of OSA patients were at elevated risk of being premature, 1.3 (1.2-1.5) and having congenital abnormalities, 2.3 (1.7-3.0). CONCLUSIONS Pregnancies with OSA were linked to an elevated risk of poor maternal and neonatal outcomes. During pregnancy, OSA patients should receive attentive follow-up care in a tertiary hospital.
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Affiliation(s)
- Eloise Passarella
- Obstetrics & Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Haim A Abenhaim
- Obstetrics & Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada
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18
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Nazar G, Astorquiza C, Cabezón R. El paciente roncador: evaluación y alternativas terapéuticas. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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19
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Du M, Liu J, Han N, Zhao Z, Luo S, Wang H. Exploring the mediating role of serum retinol-binding protein 4 in the relationship between sleep quality and insulin resistance in pregnant women. Diabetes Res Clin Pract 2021; 176:108866. [PMID: 34023339 DOI: 10.1016/j.diabres.2021.108866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/19/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
AIMS We aimed to explore the mediating role of plasma retinol-binding protein 4 (RBP4) in the relationship between sleep quality and insulin resistance (IR) among pregnant women. METHODS We conducted a cross-sectional study including 263 pregnant women in the first trimester. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI). The ELISA and homeostasis model assessment (HOMA) was used to analyze plasma RBP4 and estimate IR. The mediating model was used to analyze the mediating role of RBP4 in the relationship between PSQI score and IR. RESULTS In the multivariable linear regression model, the three terms were positively related with each other, PSQI score was positively associated with IR levels (β = 0.55, p < 0.05). In the mediating model, RBP4 levels mediated completely the relationship between PSQI scores and IR levels (β = 0.29, p < 0.0001). The indirect effect of RBP4 in the relation between sleep quality and IR explained 89.10% of total effect. CONCLUSIONS RPB4 may play a complete mediating role in the relation between sleep quality and insulin resistance in early pregnancy. Improvements in sleep quality in the first trimester may provide a pathway to reduce plasma RBP4, which is beneficial for less IR and GDM prevention.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing 100871, China.
| | - Na Han
- Maternal and Child Health Hospital of Tongzhou District, Beijing 101101, China
| | - Zhiling Zhao
- Maternal and Child Health Hospital of Tongzhou District, Beijing 101101, China
| | - Shusheng Luo
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
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20
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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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21
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Cortese R, Khalyfa A, Bao R, Gozal D. Gestational sleep apnea perturbations induce metabolic disorders by divergent epigenomic regulation. Epigenomics 2021; 13:751-765. [PMID: 33929266 DOI: 10.2217/epi-2020-0435] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: Late-gestational sleep fragmentation (LG-SF) and intermittent hypoxia (LG-IH), two hallmarks of obstructive sleep apnea, lead to metabolic dysfunction in the offspring. We investigated specific biological processes that are epigenetically regulated by LG-SF and LG-IH. Materials & methods: We analyzed DNA methylation profiles in offspring visceral white adipose tissues by MeDIP-chip followed by pathway analysis. Results: We detected 1187 differentially methylated loci (p < 0.01) between LG-SF and LG-IH. Epigenetically regulated genes in LG-SF offspring were associated with lipid and glucose metabolism, whereas those in LG-IH were related to inflammatory signaling and cell proliferation. Conclusion: While LG-SF and LG-IH will result in equivalent phenotypic alterations in offspring, each paradigm appears to operate through epigenetic regulation of different biological processes.
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Affiliation(s)
- Rene Cortese
- Department of Child Health, Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Abdelnaby Khalyfa
- Department of Child Health, Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Riyue Bao
- Hillman Cancer Center, UPMC, Pittsburgh, PA 15232, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - David Gozal
- Department of Child Health, Child Health Research Institute, School of Medicine, University of Missouri, Columbia, MO 65212, USA
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22
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Redhead K, Walsh J, Galbally M, Newnham JP, Watson SJ, Eastwood P. Obstructive sleep apnea is associated with depressive symptoms in pregnancy. Sleep 2021; 43:5648018. [PMID: 31782959 DOI: 10.1093/sleep/zsz270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/23/2019] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES In pregnancy, the prevalence of both obstructive sleep apnea (OSA) and depression increases. Research reveals an association in the general population with up to 45% of patients diagnosed with OSA having depressive symptoms. Therefore, this study aimed to investigate the relationship between OSA and depression in pregnant women. METHODS One hundred and eighty-nine women ≥26 weeks pregnant were recruited from a tertiary perinatal hospital. This cross-sectional study measured OSA (Apnea Hypopnea Index, AHI, using an ApneaLink device) and symptoms of depression (Edinburgh Postnatal Depression Scale, EPDS). Data were collected from medical records including participant age, ethnicity, parity, BMI, smoking status, history of depression, and use of antidepressants. RESULTS Of the consenting women, data from 124 were suitable for analysis. Twenty women (16.1%) had OSA (AHI ≥ 5 events/h) and 11 (8.8%) had depressive symptoms (EPDS > 12). Women with OSA were more likely to have depressive symptoms after adjusting for covariates, odds ratio = 8.36, 95% CI [1.57, 44.46]. OSA was also related to higher EPDS scores and these were greater in women with a history of depression. CONCLUSIONS During late pregnancy women with OSA had eight times the odds of having depressive symptoms. Furthermore, an interaction was found between OSA and history of depression. Specifically, in women with no history of depression, OSA increases depressive symptoms. In women with a history of depression, OSA has an even stronger effect on depressive symptomology. This suggests screening for OSA in pregnancy may identify women prone to future depressive episodes and allow for targeted interventions.
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Affiliation(s)
- Karen Redhead
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jennifer Walsh
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Megan Galbally
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.,Psychology Discipline, Murdoch University, Murdoch, Western Australia, Australia
| | - John P Newnham
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia.,Division of Obstetrics and Gynaecology, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Stuart J Watson
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.,Psychology Discipline, Murdoch University, Murdoch, Western Australia, Australia
| | - Peter Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
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23
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Fetal Heart Rate Decelerations in Women with Sleep-Disordered Breathing. Reprod Sci 2021; 28:2602-2609. [PMID: 33847976 DOI: 10.1007/s43032-021-00563-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
Emerging literature has shown that women with sleep-disordered breathing (SDB) have increased risk for gestational hypertension/preeclampsia and gestational diabetes. Case reports suggest an association between maternal apnea and fetal heart rate deceleration but data are lacking on how maternal sleep impacts fetal health. Since decelerations may be associated with adverse outcomes, we sought to determine whether fetal heart rate decelerations were associated with SDB. A cohort study of third trimester pregnant women with a singleton fetus was conducted. Participants underwent a home sleep test with continuous portable electronic fetal monitoring. SDB was defined as a respiratory disturbance index (RDI)≥10 events/hour. The temporality between a respiratory event and fetal heart rate decelerations was determined to be present if a deceleration occurred < 30 s after a respiratory event. Forty women were included with mean (±SD) age, BMI, and gestational age of 32.0±5.5 years, 37.1±8.0 kg/m2, and 34.6±2.4 weeks respectively. Overall, n=23 (57.5%) women had SDB. Thirty-seven late decelerations were observed in 18 women; of these, 84% were temporally associated with a respiratory event. Nine of the 18 women (50%) had SDB. Ten prolonged decelerations were observed in 6 women of which nine (90%) were temporally associated with a respiratory event. Five of the six women (83%) had an RDI≥10. These initial data suggest that, in this population, the majority of both late and prolonged fetal heart rate decelerations occur with a maternal respiratory event. Since respiratory events are characteristic of maternal SDB, this raises the possibility that SDB may influence fetal well-being.
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24
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Sleep-disordered breathing in pregnancy: a developmental origin of offspring obesity? J Dev Orig Health Dis 2021; 12:237-249. [PMID: 32425147 PMCID: PMC9951118 DOI: 10.1017/s2040174420000355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sleep-disordered breathing (SDB) worsens over pregnancy, and obstructive sleep apnea is associated with serious maternal complications. Intrauterine exposures that provoke insulin resistance (IR), inflammation, or oxidative stress may have long-term offspring health consequences. In obesity, worsening maternal SDB appears to be an exposure that increases the risk for both small- or large-for-gestational-age (SGA, LGA, respectively), suggesting distinct outcomes linked to a common maternal phenotype. The aim of this paper is to systematically review and link data from both mechanistic rodent models and descriptive human studies to characterize the impact of maternal SDB on fetal development. A systematic review of the literature was conducted using PubMed, Embase, and CINAHL (01/2000-09/2019). Data from rodent (9 studies) and human models (48 studies, 5 meta-analyses) were included and reviewed using PRISMA guidelines. Evidence from rodent models suggests that intermittent maternal hypoxia results in mixed changes in birth weight (BW) followed by accelerated postnatal growth, while maternal sleep fragmentation results in normal BW followed by later metabolic derangement. Human studies support that maternal SDB is associated with both SGA and LGA, both of which may predispose offspring to later obesity. Evidence also suggests a link between SDB, inflammation, and oxidative stress that may impact maternal metabolism and/or placental function. SDB is common in pregnancy and affects fetal growth and development. Given that SDB has significant potential to adversely influence the intrauterine metabolic environment, larger, prospective studies in humans are urgently needed to fully elucidate the effects of this exposure on offspring metabolic risk.
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O'Brien LM, Levine RS, Dunietz GL. The Berlin Questionnaire in pregnancy predominantly identifies obesity. J Clin Sleep Med 2021; 17:1553-1561. [PMID: 33709910 DOI: 10.5664/jcsm.9244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is common in pregnant women and is a risk factor for poor perinatal outcomes. The Berlin Questionnaire (BQ) is a validated OSA screening tool that is often used in pregnancy. However, its poor performance in this population is likely attributed to the scoring paradigm that primarily identifies obesity. Moreover, the associations between the BQ and pregnancy outcomes are often those same outcomes that are obesity-related. Therefore, this study examined associations between each of the three BQ domains, independently and jointly, in relation to gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP). METHODS Pregnant third-trimester women were recruited from a tertiary medical center and completed the BQ, which includes three independent domains: snoring; sleepiness; and obesity/high blood pressure. Medical records were accessed for diagnoses of GDM and HDP. RESULTS Of the 1,588 pregnant women, 44% had a positive BQ score. Women with a positive score for domains of snoring exclusively, sleepiness exclusively, or their combination did not have an increased risk for GDM or HDP. However, women without snoring or sleepiness, but with a positive score on the BMI/BP domain had increased odds of GDM (OR 2.0, 95%CI 1.3-3.3) and HDP (OR 2.9, 95%CI 1.6-5.5). Further, any positive score in domain combinations that included BMI/BP had increased odds of GDM and HDP compared with negative scores in all domains. In addition, presence of obesity without hypertension, snoring, or sleepiness, the odds of GDM and HDP were similarly increased. CONCLUSIONS The poor performance of the BQ in screening for OSA risk, may be attributed to its predominant reliance on identification of obesity.
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Affiliation(s)
- Louise M O'Brien
- Division of Sleep Medicine, Department of Neurology.,Department of Obstetrics and Gynecology
| | - Rivkah S Levine
- Department of Statistics, University of Michigan, Ann Arbor, MI
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Hawkins M, Parker CB, Redline S, Larkin JC, Zee PP, Grobman WA, Silver RM, Louis JM, Pien GW, Basner RC, Chung JH, Haas DM, Nhan-Chang CL, Simhan HN, Blue NR, Parry S, Reddy U, Facco F. Objectively assessed sleep-disordered breathing during pregnancy and infant birthweight. Sleep Med 2021; 81:312-318. [PMID: 33756281 DOI: 10.1016/j.sleep.2021.02.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) in pregnancy is associated with adverse maternal outcomes. The relationship between SDB and infant birthweight is unclear. This study's primary aim is to determine if objectively measured SDB in pregnancy is associated with infant birthweight. METHODS We measured SDB objectively in early (6-15 weeks' gestation) and mid (22-31 weeks' gestation) pregnancy in a large cohort of nulliparous women. SDB was defined as an Apnea-Hypopnea Index ≥5 and in secondary analyses we also examined measures of nocturnal hypoxemia. We used a modified Poisson regression approach to estimate relative risks (RR) of large-for-gestational-age (LGA: >90th percentile for gestational age) and small-for-gestational-age (SGA: <10th percentile for gestational age) birthweights. RESULTS The prevalence of early-pregnancy SDB was nearly 4%. The incidence of mid-pregnancy SDB was nearly 6.0%. The prevalence of LGA and SGA was 7.4% and 11.9%, respectively. Early-pregnancy SDB was associated with a higher risk of LGA in unadjusted models (RR 2.2, 95% CI 1.3-3.5) but not BMI-adjusted models (aRR 1.0, 95% CI 0.6-1.8). Mid-pregnancy SDB was not associated with SGA or LGA. Mid-pregnancy nocturnal hypoxemia (% of sleep time <90% oxygen saturation) and increasing nocturnal hypoxemia from early to mid-pregnancy were associated with a higher risk of LGA in BMI-adjusted models. SDB and nocturnal hypoxemia were not associated with SGA. CONCLUSIONS SDB in pregnancy was not associated with an increased risk of LGA or SGA birthweight, independent of BMI. Some measures nocturnal hypoxemia were associated with an increase in LGA risk, independent of BMI. ClinicalTrials.gov Registration number NCT02231398.
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Affiliation(s)
- Marquis Hawkins
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA.
| | | | - Susan Redline
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Jacob C Larkin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Phyllis P Zee
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - William A Grobman
- Department of Obstetrics, Gynecology-Maternal Fetal Medicine & Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Judette M Louis
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Grace W Pien
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Robert C Basner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Judith H Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, CA, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN11, USA
| | | | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nathan R Blue
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Uma Reddy
- Department of Obstetrics, Gynecology & Reproductive Services, Yale University, New Haven, CT, USA
| | - Francesca Facco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Snoring and depression symptoms in pregnant women. Sleep Health 2021; 7:155-160. [PMID: 33582047 DOI: 10.1016/j.sleh.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Pregnant patients are vulnerable to both depression and sleep-disordered breathing, and both convey risks for maternal and fetal outcomes. Previous research has indicated that sleep-disordered breathing is associated with depression, but further information related to the risk of depression based on timing of onset of snoring is needed. DESIGN When presenting to clinic for their initial prenatal visit, pregnant patients completed a packet of questionnaires, which included measures related to depression (Edinburgh Postnatal Depression Scale) and snoring. Habitual snoring was defined as snoring 3 or more nights per week. RESULTS In total, 1367 women were included and 34.1% reported habitual snoring, either chronic (24.4%) or pregnancy-onset (9.8%), with increased frequency of pregnancy-onset habitual snoring in later stages of pregnancy. Unadjusted analyses suggested increased odds of depressive symptoms in chronic and pregnancy-onset habitual snoring groups relative to nonsnorers (odds ratio [OR]: 2.01, 95% confidence interval [CI]: 1.39, 2.92, P < .01; OR: 2.50, 95% CI: 1.54, 4.07, P < .01, respectively). These findings were maintained after adjusting for maternal age, marital status, gestational age, and parity (chronic habitual snoring OR: 1.69, 95% CI: 1.14, 2.53, P < .01; pregnancy-onset habitual snoring OR: 2.79, 95% CI: 1.35, 5.78, P < .01). CONCLUSIONS Maternal snoring may be a risk factor for prenatal depressive symptoms. Pregnancy-onset habitual snoring confers additional risk for depression compared to not snoring during pregnancy.
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Lu Q, Zhang X, Wang Y, Li J, Xu Y, Song X, Su S, Zhu X, Vitiello MV, Shi J, Bao Y, Lu L. Sleep disturbances during pregnancy and adverse maternal and fetal outcomes: A systematic review and meta-analysis. Sleep Med Rev 2021; 58:101436. [PMID: 33571887 DOI: 10.1016/j.smrv.2021.101436] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
Sleep disturbances are highly prevalent in pregnancy and are frequently overlooked as a potential cause of significant morbidity. The association between sleep disturbances and pregnancy outcomes remains largely controversial and needs to be clarified to guide management. To evaluate the association between sleep disturbances and maternal complications and adverse fetal outcomes, we performed a systematic search of PubMed, Embase and Web of Science for English-language articles published from inception to March 6, 2020, including observational studies of pregnant women with and without sleep disturbances assessing the risk of obstetric complications in the antenatal, intrapartum or postnatal period, and neonatal complications. Data extraction was completed independently by two reviewers. We utilized the Newcastle-Ottawa Scales to assess the methodological quality of included studies and random-effect models to pool the associations. A total of 120 studies with 58,123,250 pregnant women were included. Sleep disturbances were assessed, including poor sleep quality, extreme sleep duration, insomnia symptoms, restless legs syndrome, subjective sleep-disordered breathing and diagnosed obstructive sleep apnea. Significant associations were found between sleep disturbances in pregnancy and a variety of maternal complications and adverse fetal outcomes. Overall sleep disturbances were significantly associated with pre-eclampsia (odds ratio = 2.80, 95% confidence interval: 2.38-3.30), gestational hypertension (1.74, 1.54-1.97), gestational diabetes mellitus (1.59, 1.45-1.76), cesarean section (1.47, 1.31-1.64), preterm birth (1.38, 1.26-1.51), large for gestational age (1.40, 1.11-1.77), and stillbirth (1.25, 1.08-1.45), but not small for gestational age (1.03, 0.92-1.16), or low birth weight (1.27, 0.98-1.64). Sleep disturbances were related to higher morbidities in pregnant women who are 30 y or older and overweight before pregnancy. The findings indicate that sleep disturbances, which are easily ignored and treatable for both pregnant women and clinical services, deserve more attention from health care providers during prenatal counseling and health care services.
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Affiliation(s)
- Qingdong Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China
| | - Xiaoyan Zhang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yunhe Wang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China
| | - Jinqiao Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China
| | - Yingying Xu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China
| | - Xiaohong Song
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Sizhen Su
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing 100191, China
| | - Ximei Zhu
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing 100191, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China.
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China.
| | - Lin Lu
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing 100191, China; Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China.
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Du M, Liu J, Han N, Zhao Z, Yang J, Xu X, Luo S, Wang H. Maternal sleep quality during early pregnancy, risk factors and its impact on pregnancy outcomes: a prospective cohort study. Sleep Med 2021; 79:11-18. [PMID: 33454523 DOI: 10.1016/j.sleep.2020.12.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES We aimed to assess the prevalence of poor sleep quality during early pregnancy and its risk factors, and to explore the association between sleep quality and adverse pregnancy outcomes. METHODS This was a prospective birth cohort study that included 4352 pregnant women. Sleep quality were assessed using the Pittsburgh Sleep Quality Index (PSQI). The risk factors for poor sleep quality were analyzed by a logistic regression model. Log-binomial regression models were used to analyze the association between sleep quality and pregnancy outcomes. RESULTS The prevalence of maternal poor sleep quality during early pregnancy was 34.14%. The multivariate logistic model showed that stillbirth history (OR = 2.45; 95% CI: 1.34, 4.47), history of induced abortion (OR = 1.26; 95% CI: 1.07, 1.49), general health-related quality of life (OR = 3.98; 95% CI: 2.97, 5.34), insufficient physical activity (OR = 1.18; 95% CI: 1.03, 1.36), smoking (OR = 1.59; 95% CI: 1.18, 2.15), and vegetarian (OR = 2.18; 95% CI: 1.54, 3.08) were risk factors for poor sleep quality, while taking folic acid consistently before pregnancy (OR = 0.83; 95% CI: 0.72,0.97) was the protective factor. After controlling for all the confounders, poor sleep quality during early pregnancy increased the risk of premature rupture of membranes by 12% (95% CI: 1.00, 1.25). CONCLUSION Pregnant women with a history of stillbirth and induced abortion, general health-related quality of life, insufficient physical activity, smoking, and a vegetarian diet tended to have poor sleep quality. More attention should be paid to healthy lifestyle of pregnant women to improve sleep quality and better pregnancy outcomes.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
| | - Na Han
- Maternal and Child Health Hospital of Tongzhou District, Beijing, China
| | - Zhiling Zhao
- Maternal and Child Health Hospital of Tongzhou District, Beijing, China
| | - Jie Yang
- Maternal and Child Health Hospital of Tongzhou District, Beijing, China
| | - Xiangrong Xu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Shusheng Luo
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
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Du M, Liu J, Han N, Zhao Z, Luo S, Wang H. Association between sleep duration in early pregnancy and risk of gestational diabetes mellitus: a prospective cohort study. DIABETES & METABOLISM 2020; 47:101217. [PMID: 33340649 DOI: 10.1016/j.diabet.2020.101217] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/18/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
AIMS As cohort studies of the impact of sleep duration during early pregnancy on gestational diabetes mellitus (GDM) are lacking, our study aimed to explore the association between sleep duration in the first trimester and GDM in one region of mainland China. METHODS For this prospective cohort study, sleep duration data were collected from 3692 pregnant women at the first prenatal care appointment before 14 weeks of gestation. Multivariable log-binomial regression models were used to analyze the association of sleep duration with GDM after adjusting for demographic characteristics, health status (such as family history of diabetes, history of GDM, prepregnancy body mass index, gestational weight gain) and lifestyle habits (such as physical activity, dietary intakes). RESULTS Our cohort included 166 (4.5%) short sleepers and 505 (14%) long sleepers. Shorter sleep duration was more likely to be observed in women aged ≥35 years who were multiparous, and had previous pregnancy, insufficient gestational weight gain, engaged in more vigorous physical activity, drank alcohol, were vegan and/or never took folic-acid supplements. Compared with normal sleepers (29%), the prevalence of GDM was significantly higher in short sleepers (38%; P = 0.01), but not in long sleepers (31%; P = 0.224). In the multivariable model, women with short sleep durations during early pregnancy had a 32% greater risk of GDM [adjusted risk ratio (aRR): 1.32, 95% CI: 1.06-1.63], whereas long sleepers did not (aRR: 1.09, 95% CI: 0.94-1.26). CONCLUSION Short sleep duration during early pregnancy is associated with an increased risk of GDM. This suggests that more attention should be paid to controlling the development of GDM in pregnant women with insufficient sleep.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Key Laboratory of Reproductive Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China.
| | - Na Han
- Maternal and Child Health Hospital of Tongzhou District, Beijing, China
| | - Zhiling Zhao
- Maternal and Child Health Hospital of Tongzhou District, Beijing, China
| | - Shusheng Luo
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China; Key Laboratory of Reproductive Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
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Robertson N, Okano S, Kumar S. Feto-placental Dopplers are not altered in women with obstructive sleep apnoea symptoms. Aust N Z J Obstet Gynaecol 2020; 60:877-883. [PMID: 32367552 DOI: 10.1111/ajo.13166] [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: 10/09/2019] [Accepted: 03/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Snoring, gasping or choking during sleep are common symptoms of sleep-disordered breathing and are associated with multiple adverse maternal and obstetric outcomes. The mechanisms responsible remain unknown; however, placental dysfunction is suspected. AIMS The aim of this study was to investigate feto-placental and fetal cardiac function in women with pregnancies complicated by obstructive sleep apnoea symptoms. MATERIALS AND METHODS This was a prospective observational cohort study at a large tertiary obstetric hospital in Australia. Women were asked to complete a questionnaire relating to the presence and severity of obstructive sleep apnoea symptoms. They also underwent an ultrasound scan where Doppler indices of various feto-placental vessels and fetal cardiac function were measured. Regional cerebral perfusion was also assessed. RESULTS A total of 255 women were included in the final analysis. Of these, 36.1% (92/255) of women reported no obstructive sleep apnoea symptoms; 63.9% (163/255) reported they experienced some form of obstructive sleep apnoea symptoms that included any frequency of snoring or choking/gasping, while 42.0% (107/255) complained of severe obstructive sleep apnoea symptoms (snoring ≥ 3 times a week or choking/gasping). There were no significant differences in feto-placental Dopplers or fetal cardiac function parameters in women with obstructive sleep apnoea symptoms. There were also no differences in regional cerebral blood flow between groups, or any correlation with severity of symptoms. CONCLUSIONS Our data challenge the current perspective that adverse perinatal outcomes in women with obstructive sleep apnoea symptoms are related primarily to placental dysfunction and 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
| | - Satomi Okano
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Statistics Unit, QIMR Berghofer Medical Research Institute, 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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Cronin RS, Wilson J, Gordon A, Li M, Culling VM, Raynes-Greenow CH, Heazell AEP, Stacey T, Askie LM, Mitchell EA, Thompson JMD, McCowan LME, O’Brien LM. Associations between symptoms of sleep-disordered breathing and maternal sleep patterns with late stillbirth: Findings from an individual participant data meta-analysis. PLoS One 2020; 15:e0230861. [PMID: 32214393 PMCID: PMC7098581 DOI: 10.1371/journal.pone.0230861] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/10/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep-disordered breathing (SDB) affects up to one third of women during late pregnancy and is associated with adverse pregnancy outcomes, including hypertension, diabetes, impaired fetal growth, and preterm birth. However, it is unclear if SDB is associated with late stillbirth (≥28 weeks' gestation). The aim of this study was to investigate the relationship between self-reported symptoms of SDB and late stillbirth. METHODS Data were obtained from five case-control studies (cases 851, controls 2257) from New Zealand (2 studies), Australia, the United Kingdom, and an international study. This was a secondary analysis of an individual participant data meta-analysis that investigated maternal going-to-sleep position and late stillbirth, with a one-stage approach stratified by study and site. Inclusion criteria: singleton, non-anomalous pregnancy, ≥28 weeks' gestation. Sleep data ('any' snoring, habitual snoring ≥3 nights per week, the Berlin Questionnaire [BQ], sleep quality, sleep duration, restless sleep, daytime sleepiness, and daytime naps) were collected by self-report for the month before stillbirth. Multivariable analysis adjusted for known major risk factors for stillbirth, including maternal age, body mass index (BMI kg/m2), ethnicity, parity, education, marital status, pre-existing hypertension and diabetes, smoking, recreational drug use, baby birthweight centile, fetal movement, supine going-to-sleep position, getting up to use the toilet, measures of SDB and maternal sleep patterns significant in univariable analysis (habitual snoring, the BQ, sleep duration, restless sleep, and daytime naps). Registration number: PROSPERO, CRD42017047703. RESULTS In the last month, a positive BQ (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 1.02-2.04), sleep duration >9 hours (aOR 1.82, 95% CI 1.14-2.90), daily daytime naps (aOR 1.52, 95% CI 1.02-2.28) and restless sleep greater than average (aOR 0.62, 95% CI 0.44-0.88) were independently related to the odds of late stillbirth. 'Any' snoring, habitual snoring, sleep quality, daytime sleepiness, and a positive BQ excluding the BMI criterion, were not associated. CONCLUSION A positive BQ, long sleep duration >9 hours, and daily daytime naps last month were associated with increased odds of late stillbirth, while sleep that is more restless than average was associated with reduced odds. Pregnant women may be reassured that the commonly reported restless sleep of late pregnancy may be physiological and associated with a reduced risk of late stillbirth.
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Affiliation(s)
- Robin S. Cronin
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- * E-mail: ,
| | - Jessica Wilson
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Adrienne Gordon
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - Minglan Li
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Vicki M. Culling
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Alexander E. P. Heazell
- Division of Developmental Biology & Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, England, United Kingdom
| | - Tomasina Stacey
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England, United Kingdom
| | - Lisa M. Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Edwin A. Mitchell
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John M. D. Thompson
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lesley M. E. McCowan
- Departments of Obstetrics and Gynaecology, and Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Louise M. O’Brien
- Departments of Neurology Sleep Disorders Center, and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
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Sleep Disordered Breathing, a Novel, Modifiable Risk Factor for Hypertensive Disorders of Pregnancy. Curr Hypertens Rep 2020; 22:28. [PMID: 32166454 DOI: 10.1007/s11906-020-1035-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Pathophysiology of hypertensive disorders of pregnancy (HDP), especially preeclampsia, has not been fully elucidated. Most trials aimed at the prevention of preeclampsia have failed to show significant benefit and investigation of novel, modifiable risk factors is sorely needed. Sleep disordered breathing (SDB), a group of disorders for which treatments are available, meets these criteria. SDB impacts about a third of all pregnancies and is associated with hypertension in the general non-pregnant population. RECENT FINDINGS Recent studies have shown a high prevalence of SDB, especially in complicated pregnancies. Several studies have shown that pregnant women with SDB have a higher risk for developing HDP, and these two disorders are associated with similar maternal long-term cardiovascular outcomes. Based on limited animal models of gestational intermittent hypoxia and human studies, SDB and HDP share similar risk factors and some pathophysiological mechanisms. However, there is paucity of studies addressing causality of this association and identifying therapeutic targets for intervention. Maternal SDB represents a novel and modifiable risk factor of HDP. Further studies are needed in order to establish the exact mechanisms underlying this association and to identify specific areas for clinical interventions.
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Daugherty SL, Carter JR, Bourjeily G. Cardiovascular Disease in Women Across the Lifespan: The Importance of Sleep. J Womens Health (Larchmt) 2020; 29:452-460. [PMID: 32096682 DOI: 10.1089/jwh.2020.8331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) and sleep disturbances are both common and associated with significant morbidity and mortality. Compared with men, women are more likely to report insufficient sleep. During the 2018 Research Conference on Sleep and the Health of Women sponsored by the National Heart, Lung, and Blood Institute, researchers in cardiology, integrative physiology and sleep medicine reviewed the current understanding of how sleep and sleep disturbances influence CVD in women across the lifespan. Women may be particularly vulnerable to the negative effects of sleep disturbances at important stages of their life, including during pregnancy and after menopause. The proposed pathways linking sleep disturbances and adverse cardiovascular outcomes in women are numerous and the complex interaction between them is not well understood. Future research focused on understanding the scope of sleep disorders in women, defining the underlying mechanisms, and testing interventions to improve sleep are critical for improving the cardiovascular health of all women.
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Affiliation(s)
- Stacie L Daugherty
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado.,Adult and Children Center for Outcomes Research and Delivery Sciences (ACCORDS), University of Colorado School of Medicine, Aurora, Colorado.,Colorado Cardiovascular Outcomes Research Group, Denver, Colorado
| | - Jason R Carter
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
| | - Ghada Bourjeily
- Divisions of Pulmonary, Critical Care and Sleep Medicine, and Obstetric Medicine, Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Maternal sleep disturbances in late pregnancy and the association with emergency caesarean section: A prospective cohort study. Sleep Health 2020; 6:65-70. [DOI: 10.1016/j.sleh.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/04/2019] [Accepted: 11/17/2019] [Indexed: 11/20/2022]
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Kalmbach DA, Cheng P, Sangha R, O’Brien LM, Swanson LM, Palagini L, Bazan LF, Roth T, Drake CL. Insomnia, Short Sleep, And Snoring In Mid-To-Late Pregnancy: Disparities Related To Poverty, Race, And Obesity. Nat Sci Sleep 2019; 11:301-315. [PMID: 31807103 PMCID: PMC6839586 DOI: 10.2147/nss.s226291] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/05/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To characterize sleep habits and parameters among women in mid-to-late pregnancy and to identify disparities associated with poverty, race, and obesity. DESIGN Cross-sectional. SETTING Large multi-site health system in Metro Detroit. PARTICIPANTS A total of 267 pregnant women (27.3% non-Hispanic black; gestational age: 27.99±1.20 weeks) completed online surveys on sleep quality, insomnia symptoms, sleep aid use, signs/symptoms of sleep-disordered breathing, and sociodemographics. Body mass index (BMI) and patient insurance were derived from medical records. RESULTS As high as 76.2% of the women reported global sleep disturbance, 30.6% endorsed snoring, 24.3% sleep <6 hrs/night, and over half screened positive for clinical insomnia. Yet, only 3.4% of the women reported an insomnia diagnosis and 3.0% reported a sleep apnea diagnosis. In unadjusted models, poverty, Medicaid coverage, self-identifying as black, and obesity before and during pregnancy (BMI ≥ 35) were associated with a wide range of sleep problems. However, adjusted models revealed specificity. Poverty was uniquely related to increased insomnia symptoms and trouble sleeping due to bad dreams. Obesity before pregnancy was related to poor sleep quality, snoring, sleep aids, and short sleep. Black women reported shorter sleep duration than white women but differed on no other sleep parameters. CONCLUSION Clinical signs of insomnia and sleep-disordered breathing are common in mid-to-late pregnancy, but most cases go undetected. Problematic sleep disproportionately affects women in poverty, who self-identify as black, and who are obese before pregnancy. Poverty-related sleep issues are linked to insomnia, obesity-related disparities center on sleep-related breathing and medication use, and racial disparities relate to short sleep.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
| | - Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
| | - Roopina Sangha
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA
| | - Louise M O’Brien
- Departments of Obstetrics &Gynecology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Laura Palagini
- Departments of Neuroscience and Psychiatry, University of Pisa, Pisa, Italy
| | - Luisa F Bazan
- Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
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Kalmbach DA, Cheng P, Ong JC, Ciesla JA, Kingsberg SA, Sangha R, Swanson LM, O'Brien LM, Roth T, Drake CL. Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination. Sleep Med 2019; 65:62-73. [PMID: 31710876 DOI: 10.1016/j.sleep.2019.07.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sleep problems and depression are highly prevalent in pregnancy. Nocturnal rumination has been linked to insomnia and depression in non-pregnant samples, but remains poorly characterized in pregnancy. This study explored relationships of depression and suicidal ideation with insomnia, short sleep, and nocturnal rumination in mid-to-late pregnancy. METHODS In this study, 267 pregnant women were recruited from obstetric clinics and completed online surveys on sleep, depression, and nocturnal rumination. RESULTS Over half (58.4%) of the sample reported clinical insomnia on the Insomnia Severity Index, 16.1% screened positive for major depression on the Edinburgh Postnatal Depression Scale (EPDS), and 10.1% endorsed suicidal ideation. Nocturnal rumination was more robustly associated with sleep onset difficulties than with sleep maintenance issues. Depressed women were at greater odds of sleep onset insomnia (OR = 2.80), sleep maintenance insomnia (OR = 6.50), high nocturnal rumination (OR = 6.50), and negative perinatal-focused rumination (OR = 2.70). Suicidal ideation was associated with depression (OR = 3.64) and negative perinatal-focused rumination (OR = 3.50). A four-group comparison based on insomnia status and high/low rumination revealed that pregnant women with insomnia and high rumination endorsed higher rates of depression (35.6%) and suicidal ideation (17.3%) than good-sleeping women with low rumination (1.2% depressed, 4.9% suicidal). Women with insomnia alone (depression: 3.9%, suicidal: 5.9%) or high rumination alone (depression: 10.7%, suicidal: 7.1%) did not differ from good-sleeping women with low rumination. CONCLUSIONS High rumination and insomnia are highly common in mid-to-late pregnancy and both are associated with depression and suicidal ideation. Depression and suicidal ideation are most prevalent in pregnant women with both insomnia and high rumination. CLINICALTRIALS. GOV IDENTIFIER NCT03596879.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA.
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Jason C Ong
- Departments of Neurology and Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Jeffrey A Ciesla
- Department of Psychological Sciences, Kent State University, Kent, OH, 44240, USA
| | - Sheryl A Kingsberg
- Departments of Reproductive Biology and Psychiatry, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Roopina Sangha
- Department of Obstetrics & Gynecology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Louise M O'Brien
- Departments of Obstetrics & Gynecology and Neurology, Ann Arbor, MI, 48105, USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
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Zhao A, Zhao K, Xia Y, Yin Y, Zhu J, Hong H, Li S. Exploring associations of maternal sleep during periconceptional period with congenital heart disease in offspring. Birth Defects Res 2019; 111:920-931. [PMID: 31206252 PMCID: PMC7432175 DOI: 10.1002/bdr2.1536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 12/28/2022]
Abstract
Background In general, the existing evidence points to a role for maternal sleep in pregnancy complications and fetal growth, however, little has been focused on birth defects. We aimed to explore the association between periconceptional poor sleep and the risk of congenital heart disease (CHD), and to examine if daytime napping could to some extent change the association. Methods A case–control study was conducted in Shanghai Children's Medical Center, in which, a total of 524 cases (262 simple CHD vs. 262 severe CHD), along with 262 controls. Results In the multivariable logistic analysis, poor sleep could increase the risk of both simple CHD (OR = 2.486, 95% CI = 1.619–3.818) and severe CHD (OR = 1.950, 95% CI = 1.269–2.997), while routine daytime nap could decrease risk of simple CHD (OR = 0.634, 95% CI = 0.435–0.923). In the stratified analysis, the concurrence with routine daytime nap could weaken the risk of simple CHD caused by poor sleep (OR = 3.183, 95% CI: 1.830–5.537 decreased to OR = 2.236, 95% CI: 1.200–4.165). The examinations were repeated in ventricular septal defect and tetralogy of Fallot, and the established associations can be verified. Moreover, all these findings were also similarly observed in both propensity‐score‐adjusted and propensity‐score‐matched analyses. Conclusions Poor maternal sleep around periconceptional period seems to be an independent risk factor for CHD. The concurrence with daytime nap could to some extent reduce the risk in simple CHD. The results individually and collectively put forward the importance of maternal sleep in embryonic heart development.
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Affiliation(s)
- Anda Zhao
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kena Zhao
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanqing Xia
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Yin
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianzhen Zhu
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifa Hong
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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O’Brien LM, Warland J, Stacey T, Heazell AEP, Mitchell EA. Maternal sleep practices and stillbirth: Findings from an international case-control study. Birth 2019; 46:344-354. [PMID: 30656734 PMCID: PMC7379524 DOI: 10.1111/birt.12416] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Late stillbirth, which occurs ≥28 weeks' gestation, affects 1.3-8.8 per 1000 births in high-income countries. Of concern, most occur in women without established risk factors. Identification of potentially modifiable risk factors that relate to maternal behaviors remains a priority in stillbirth prevention research. This study aimed to investigate, in an international cohort, whether maternal sleep practices are related to late stillbirth. METHODS An Internet-based case-control study of women who had a stillbirth ≥28 weeks' gestation within 30 days before completing the survey (n = 153) and women with an ongoing third-trimester pregnancy or who had delivered a live born child within 30 days (n = 480). Bivariate and multivariate logistic regressions were used to determine unadjusted and adjusted odds ratios (OR and aOR, respectively) with 95% confidence intervals (95% CIs) for stillbirth. RESULTS Sleeping >9 hours per night in the previous month was associated with stillbirth (aOR 1.75 [95% CI 1.10-2.79]), as was waking on the right side (2.27 [1.31-3.92]). Nonrestless sleep in the last month was also found to be associated with stillbirth (1.73 [1.03-2.99]), with good sleep quality in the last month approaching significance (1.64 [0.98-2.75]). On the last night of pregnancy, not waking more than one time was associated with stillbirth (2.03 [1.24-3.34]). No relationship was found with going to sleep position during pregnancy, although very few women reported settling in the supine position (2.4%). CONCLUSIONS Long periods of undisturbed sleep are associated with late stillbirth. Physiological studies of how the neuroendocrine and autonomic system pathways are regulated during sleep in the context of late pregnancy are warranted.
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Affiliation(s)
- Louise M. O’Brien
- Division of Sleep Medicine, Department of Neurology, and Department of Obstetrics and GynecologyMichigan MedicineAnn ArborMichigan
| | - Jane Warland
- Mothers, Babies and Families Research Group, School of Nursing and MidwiferyUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | | | - Alexander E. P. Heazell
- St. Mary’s Hospital, Manchester Academic Health Science CentreManchester University NHS Foundation TrustManchesterUK,Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Edwin A. Mitchell
- Department of Paediatrics, Child and Youth HealthUniversity of AucklandAucklandNew Zealand
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40
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Christian LM, Carroll JE, Porter K, Hall MH. Sleep quality across pregnancy and postpartum: effects of parity and race. Sleep Health 2019; 5:327-334. [PMID: 31122875 DOI: 10.1016/j.sleh.2019.03.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/07/2019] [Accepted: 03/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite high prevalence and clinical implications of disturbed sleep during pregnancy, information on changes in sleep across pregnancy and postpartum is incomplete. Moreover, predictors of differential patterns of sleep quality across the perinatal period are poorly defined. METHODS This study examined subjective sleep quality using the Pittsburgh Sleep Quality Index during each trimester of pregnancy and at 4-11 weeks postpartum among 133 women inclusive of nulliparous and multiparous African Americans and Whites. RESULTS At any given assessment, 53%-71% of women reported poor overall sleep quality (Pittsburgh Sleep Quality Index total score > 5). Moreover, 92% reported poor overall sleep quality during at least 1 assessment, including 88% at some time during gestation. Compared to nulliparous women, multiparous women reported poorer overall sleep quality, shorter sleep duration, and poorer sleep efficiency during the first trimester; poorer overall sleep quality and longer sleep latency in the second trimester; and more frequent sleep disturbances (eg, night time and early morning awakenings) during the third trimester. Among nulliparous as well as multiparous women, specific aspects of sleep (eg, subjective sleep quality, sleep disturbances, sleep efficiency) were poorer in African American compared to White women at different time points during pregnancy. No effects of race or parity were observed on sleep parameters at postpartum. CONCLUSIONS Poor sleep quality during pregnancy as well as early postpartum is highly prevalent among both African American and White women. Both multiparous status and African American race are associated with more disturbed sleep at some time points during pregnancy. These individual differences should be considered in future research and clinical efforts to promote perinatal sleep health.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health and the Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Judith E Carroll
- Department of Psychiatry & Biobehavioral Sciences, the Semel Institute for Neuroscience and Human Behavior, and the Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, USA
| | - Kyle Porter
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Martica H Hall
- Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
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Coleman J, Okere M, Seffah J, Kember A, O'Brien LM, Borazjani A, Butler M, Wells J, MacRitchie S, Isaac A, Chu K, Scott H. The Ghana PrenaBelt trial: a double-blind, sham-controlled, randomised clinical trial to evaluate the effect of maternal positional therapy during third-trimester sleep on birth weight. BMJ Open 2019; 9:e022981. [PMID: 31048420 PMCID: PMC6502032 DOI: 10.1136/bmjopen-2018-022981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the effect, on birth weight and birth weight centile, of use of the PrenaBelt, a maternal positional therapy device, during sleep in the home setting throughout the third trimester of pregnancy. DESIGN A double-blind, sham-controlled, randomised clinical trial. SETTING Conducted from September 2015 to May 2016, at a single, tertiary-level centre in Accra, Ghana. PARTICIPANTS Two-hundred participants entered the study. One-hundred-eighty-one participants completed the study. Participants were women, 18 to 35 years of age, with low-risk, singleton, pregnancies in their third-trimester, with body mass index <35 kg/m2 at the first antenatal appointment for the index pregnancy and without known foetal abnormalities, pregnancy complications or medical conditions complicating sleep. INTERVENTIONS Participants were randomised by computer-generated, one-to-one, simple randomisation to receive either the PrenaBelt or sham-PrenaBelt. Participants were instructed to wear their assigned device to sleep every night for the remainder of their pregnancy (approximately 12 weeks in total) and were provided a sleep diary to track their use. Allocation concealment was by unmarked, security-tinted, sealed envelopes. Participants and the outcomes assessor were blinded to allocation. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were birth weight and birth weight centile. Secondary outcomes included adherence to using the assigned device nightly, sleeping position, pregnancy outcomes and feedback from participants and maternity personnel. RESULTS One-hundred-sixty-seven participants were included in the primary analysis. The adherence to using the assigned device nightly was 56%. The mean ±SD birth weight in the PrenaBelt group (n=83) was 3191g±483 and in the sham-PrenaBelt group (n=84) was 3081g±484 (difference 110 g, 95% CI -38 to 258, p=0.14). The median (IQR) customised birth weight centile in the PrenaBelt group was 43% (18 to 67) and in the sham-PrenaBelt group was 31% (14 to 58) (difference 7%, 95% CI -2 to 17, p=0.11). CONCLUSIONS The PrenaBelt did not have a statistically significant effect on birth weight or birth weight centile in comparison to the sham-PrenaBelt. TRIAL REGISTRATION NUMBER NCT02379728.
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Affiliation(s)
- Jerry Coleman
- Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
- University of Ghana School of Medicine and Dentistry, Accra, Greater Accra, Ghana
| | - Maxfield Okere
- Biostatistics, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Joseph Seffah
- Obstetrics & Gynaecology, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
- University of Ghana School of Medicine and Dentistry, Accra, Greater Accra, Ghana
| | - Allan Kember
- Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Louise M O'Brien
- University of Michigan Department of Obstetrics and Gynaecology, Ann Arbor, Michigan, USA
| | - Ali Borazjani
- Global Innovations for Reproductive Health & Life, Cleveland, Ohio, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Michael Butler
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Jesse Wells
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Andre Isaac
- Innovative Canadians for Change, Edmonton, Alberta, Canada
| | - Kaishin Chu
- Method Squared Designhaus, Surrey, British Columbia, Canada
| | - Heather Scott
- Obstetrics & Gynaecology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
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Christian LM, Carroll JE, Teti DM, Hall MH. Maternal Sleep in Pregnancy and Postpartum Part I: Mental, Physical, and Interpersonal Consequences. Curr Psychiatry Rep 2019; 21:20. [PMID: 30826881 DOI: 10.1007/s11920-019-0999-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Sleep is a critical restorative behavior which occupies approximately one third of people's lives. Extensive data link sleep health with disease and mortality risk in the general population. During pregnancy and following childbirth, unique factors contribute to overall sleep health. In addition, there are unique implications of poor sleep during these time periods. RECENT FINDINGS Poor maternal sleep may contribute to risk for adverse birth outcomes as well as poor maternal physical and mental health in pregnancy, postpartum, and longer term during childrearing. Moreover, the extent to which notable racial disparities in sleep contribute to disparities in adverse perinatal health outcomes remains to be fully explicated. Part I of this two-part review details these implications of poor sleep for mental health, physical health outcomes, and relationship functioning, while Part II delves into biological mechanisms as well as treatment approaches.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA. .,The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Room 112, 460 Medical Center Drive, Columbus, OH, 43210, USA.
| | - Judith E Carroll
- Psychiatry and Biobehavioral Sciences, University of California - Los Angeles, Los Angeles, CA, USA
| | - Douglas M Teti
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA
| | - Martica H Hall
- Department of Psychiatry, The University of Pittsburgh, Pittsburgh, PA, USA
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Dunietz GL, Shedden K, Schisterman EF, Lisabeth LD, Treadwell MC, O’Brien LM. Associations of snoring frequency and intensity in pregnancy with time-to-delivery. Paediatr Perinat Epidemiol 2018; 32:504-511. [PMID: 30266041 PMCID: PMC6261672 DOI: 10.1111/ppe.12511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/19/2018] [Accepted: 08/17/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is linked to adverse pregnancy outcomes. However, little is known about the association of SDB with timing of delivery. We examined the association of snoring frequency, a key SDB marker, and snoring intensity, a correlate of SDB severity, with time-to-delivery among a cohort of pregnant women. METHODS In this prospective cohort study, 1483 third trimester pregnant women were recruited from the University of Michigan prenatal clinics. Women completed a questionnaire about their sleep, and demographic and pregnancy information was abstracted from medical charts. After exclusion of those with hypertension or diabetes, 954 women were classified into two groups by their snoring onset timing, chronic or pregnancy-onset. Within each of these groups, women were divided into four groups based on their snoring frequency and intensity: non-snorers; infrequent-quiet; frequent-quiet; or frequent-loud snorers. Cox proportional hazard regression models were used to investigate the association between snoring frequency and intensity and time-to-delivery, adjusting for maternal characteristics. RESULTS Chronic snoring was reported by half of the pregnant women, and of those, 7% were frequent-loud snorers. Deliveries before 38 weeks' gestation are completed occurred among 25% of women with chronic, frequent-loud snoring. Compared with pre-pregnancy non-snorers, women with chronic frequent-loud snoring had an increased hazard ratio for delivery (adjusted hazard ratio 1.60, 95% confidence interval 1.04, 2.45). CONCLUSIONS Snoring frequency and intensity is associated with time-to-delivery in women absent of hypertension or diabetes. Frequent-loud snoring may have a clinical utility to identify otherwise low-risk women who are likely to deliver earlier.
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Affiliation(s)
- Galit Levi Dunietz
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI 48109
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, MI 48109
| | - Enrique F. Schisterman
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institute of Health, Rockville, MD 20847
| | - Lynda D. Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109
| | | | - Louise M. O’Brien
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI 48109
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI 48109
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44
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Warland J, Dorrian J, Morrison JL, O'Brien LM. Maternal sleep during pregnancy and poor fetal outcomes: A scoping review of the literature with meta-analysis. Sleep Med Rev 2018; 41:197-219. [DOI: 10.1016/j.smrv.2018.03.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 01/15/2023]
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45
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Zhang Q, Berger FG, Love B, Banister CE, Murphy EA, Hofseth LJ. Maternal stress and early-onset colorectal cancer. Med Hypotheses 2018; 121:152-159. [PMID: 30396471 DOI: 10.1016/j.mehy.2018.09.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/10/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023]
Abstract
Early-onset colorectal cancer (EOCRC) is defined as colorectal cancer (CRC) diagnosed before the age of 50. Alarmingly, there has been a significant increase in EOCRC diagnoses' worldwide over the past several decades. Emerging data suggest EOCRCs have distinguishing clinical, pathological, biological and molecular features; and thus, are a fundamentally different subtype of CRCs. Unfortunately, there is no simple explanation for the causes of EOCRC. Scientifically rigorous studies are needed to determine what may be driving the challenging epidemiology of EOCRC. We contend here that a reasonable hypothesis is that prenatal risk factors such as maternal stress and associated sleeping disorders influence offspring epigenetic make-up, and shape immune system and gut health contributing to an increased risk for EOCRC.
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Affiliation(s)
- Qi Zhang
- Department of Drug Discovery and Biomedical Science, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Franklin G Berger
- Department of Biology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Bryan Love
- Department of Clinical Pharmacy & Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Carolyn E Banister
- Department of Drug Discovery and Biomedical Science, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Elizabeth A Murphy
- Department of Pathology, Microbiology and Immunology, University of South Carolina, Columbia, SC, USA
| | - Lorne J Hofseth
- Department of Drug Discovery and Biomedical Science, College of Pharmacy, University of South Carolina, Columbia, SC, USA.
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Dunietz GL, Shedden K, Lisabeth LD, Treadwell MC, O’Brien LM. Maternal Weight, Snoring, and Hypertension: Potential Pathways of Associations. Am J Hypertens 2018; 31:1133-1138. [PMID: 29788196 DOI: 10.1093/ajh/hpy085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/15/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are linked to excessive maternal weight and frequent snoring. However, pathways between maternal excessive weight, pregnancy-onset snoring, and HDP are only partially estimated. We examined and quantified the total and direct associations between excessive maternal weight and incident HDP and their indirect pathway through pregnancy-onset snoring. METHODS Third trimester pregnant women enrolled from prenatal clinics of a large tertiary medical center. Sleep data were collected through a questionnaire. Demographic and pregnancy information and first trimester maternal weight were abstracted from medical charts. After exclusion of women with prepregnancy hypertension and/or chronic snoring, causal mediation analysis was used to estimate the total and direct association between maternal weight and incident HDP and their indirect association through pregnancy-onset snoring. The proportion of the mediated association through pregnancy-onset snoring from the total association of maternal weight and HDP was also quantified. RESULTS After excluding those with chronic hypertension and/or snoring, the final sample included 1,333 pregnant women. In adjusted analysis, excessive maternal weight was directly associated with incident HDP; odds ratio (OR) = 1.87 (95% confidence interval (CI) 1.30, 2.70). Pregnancy-onset snoring significantly mediated the association between maternal weight and incident HDP; OR = 1.08 (95% CI 1.01, 1.17). The mediated pathway accounted for 15% of the total association between maternal weight and incident HDP. CONCLUSIONS Pregnancy-onset snoring mediates the association between maternal weight and incident HDP in women without prepregnancy snoring or hypertension. These findings demonstrate the relative contributions of excessive maternal weight and pregnancy-onset snoring to incident HDP.
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Affiliation(s)
- Galit Levi Dunietz
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Lynda D Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Marjorie C Treadwell
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Louise M O’Brien
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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Kember AJ, Scott HM, O'Brien LM, Borazjani A, Butler MB, Wells JH, Isaac A, Chu K, Coleman J, Morrison DL. Modifying maternal sleep position in the third trimester of pregnancy with positional therapy: a randomised pilot trial. BMJ Open 2018; 8:e020256. [PMID: 30158217 PMCID: PMC6119420 DOI: 10.1136/bmjopen-2017-020256] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate whether the percentage of time spent supine during sleep in the third trimester of pregnancy could be reduced using a positional therapy device (PrenaBelt) compared with a sham device. DESIGN A double-blind, randomised, sham-controlled, cross-over pilot trial. SETTING Conducted between March 2016 and January 2017, at a single, tertiary-level centre in Canada. PARTICIPANTS 23 participants entered the study. 20 participants completed the study. Participants were low-risk, singleton, third-trimester pregnant women aged 18 years and older with body mass index <35 kg/m2 at the first antenatal appointment for the index pregnancy and without known fetal abnormalities, pregnancy complications or medical conditions complicating sleep. INTERVENTIONS A two-night, polysomnography study in a sleep laboratory. Participants were randomised by computer-generated, one-to-one, simple randomisation to receive either a PrenaBelt or a sham-PrenaBelt on the first night and were crossed over to the alternate device on the second night. Allocation concealment was by unmarked, security-tinted, sealed envelopes. Participants, the recruiter and personnel involved in setting up, conducting, scoring and interpreting the polysomnogram were blinded to allocation. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the percentage of time spent supine during sleep. Secondary outcomes included maternal sleep architecture, respiration, self-reported sleep position and feedback. RESULTS The median percentage of sleep time supine was reduced from 16.4% on the sham night to 3.5% on the PrenaBelt night (pseudomedian=5.8, p=0.03). We were unable to demonstrate differences in sleep architecture or respiration. Participants underestimated the time they spent sleeping supine by 7.0%, and six (30%) participants indicated they would make changes to the PrenaBelt. There were no harms in this study. CONCLUSIONS This study demonstrates that the percentage of sleep time supine during late pregnancy can be significantly reduced via positional therapy. TRIAL REGISTRATION NUMBER NCT02377817; Results.
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Affiliation(s)
- Allan J Kember
- Dalhousie Medical School, Halifax, Nova Scotia, Canada
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Global Innovations for Reproductive Health & Life, Cleveland, Ohio, USA
| | - Heather M Scott
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Louise M O'Brien
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ali Borazjani
- Global Innovations for Reproductive Health & Life, Cleveland, Ohio, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | | | | | - Andre Isaac
- Innovative Canadians for Change, Edmonton, Alberta, Canada
| | - Kaishin Chu
- Method Squared Designhaus, Surrey, British Columbia, Canada
| | - Jerry Coleman
- Obstetrics and Gynaecology Department, Korle Bu Teaching Hospital, Accra, Ghana
- School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Debra L Morrison
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Brown NT, Turner JM, Kumar S. The intrapartum and perinatal risks of sleep-disordered breathing in pregnancy: a systematic review and metaanalysis. Am J Obstet Gynecol 2018; 219:147-161.e1. [PMID: 29454869 DOI: 10.1016/j.ajog.2018.02.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/04/2018] [Accepted: 02/08/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE DATA Sleep-disordered breathing is an increasingly common condition in nonobstetric populations and is associated with significant morbidity. The incidence of sleep-disordered breathing in pregnancy is unknown, and it is likely that many cases go undiagnosed. STUDY A systematic review and metaanalysis was undertaken to determine whether pregnant women who receive a diagnosis of sleep-disordered breathing are more likely to have adverse intrapartum and perinatal outcomes compared with control subjects. STUDY APPRAISAL AND SYNTHESIS METHODS PubMed, Embase, and Cinahl databases were searched for full-text publications in English of sleep-disordered breathing and human pregnancy up to June 2017. Only studies that reported on sleep-disordered breathing in relation to gestational age or birthweight at delivery, preterm birth, mode of delivery, cord pH, Apgar score, nursery admission, stillbirth or perinatal death, meconium at delivery, or wound complications were included. RESULTS A total of 1576 results were identified; 33 studies met inclusion criteria. Women with sleep-disordered breathing were older (mean difference, 1.66; 95% confidence interval, 1.04-2.28) and had a higher body mass index (mean difference, 3.31; 95% confidence interval, 2.30-4.32) than those who did not. Maternal sleep-disordered breathing was associated significantly with preterm birth (<37 weeks gestation; odds ratio, 1.86; 95% confidence interval, 1.50-2.31) and low birthweight (<2500 g; odds ratio, 1.67; 95% confidence interval, 1.00-2.78). These women were also less likely to have a vaginal delivery (odds ratio, 0.61; 95% confidence interval, 0.48-0.78) and to be at a higher risk of having an assisted vaginal delivery (odds ratio, 1.88; 95% confidence interval, 1.10-3.21) or a cesarean delivery (odds ratio, 1.81; 95% confidence interval, 1.55-2.11). The risk of both elective (odds ratio, 1.38; 95% confidence interval, 1.09 - 1.76) and emergency cesarean (odds ratio, 2.52; 95% confidence interval, 1.20-5.29) was increased. In addition, women with sleep-disordered breathing were at a higher risk of having an infant with a 5-minute Apgar score <7 (odds ratio, 2.14; 95% confidence interval, 1.24-3.71), stillbirth or perinatal death (odds ratio, 2.02; 95% confidence interval, 1.25-3.28), and neonatal nursery admission (odds ratio, 1.90; 95% confidence interval, 1.38-2.61). CONCLUSION Maternal sleep-disordered breathing is associated with increased risks of adverse intrapartum and perinatal outcomes.
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KNEITEL AW, TREADWELL MC, O’BRIEN LM. Effects of maternal obstructive sleep apnea on fetal growth: a case-control study. J Perinatol 2018; 38:982-988. [PMID: 29785058 PMCID: PMC6092194 DOI: 10.1038/s41372-018-0127-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 04/01/2018] [Accepted: 04/12/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate whether maternal obstructive sleep apnea (OSA) is associated with changes in fetal growth trajectory. STUDY DESIGN Retrospective review of pregnant women who underwent overnight polysomnography. Fetal growth was estimated using sonographic biometric measurements obtained during routine prenatal care. Customized estimated fetal weight and birth weight centiles were calculated and impaired fetal growth was defined as birth weight <10th centile or a slowing of fetal growth by >33% during the last trimester. Logistic regression models were used to determine the relationship between maternal OSA and altered fetal growth after adjusting for potential covariates. RESULTS There were 48 women without and 31 women with OSA. There were no differences in the proportion of infants with birth weight <10th centile between women with and without OSA (23 vs. 25%, p = 1.0), However, the presence of maternal OSA was predictive of impaired fetal growth (aOR 3.9, 95% CI 1.2-12.6). Logistic regression models were repeated using only a slowing of fetal growth in the 3rd trimester (excluding birth weight <10th centile) and OSA predicted a slowing in fetal growth across the 3rd trimester (aOR 3.6, 95% CI 1.4-9.4). Fourteen additional women were treated with positive airway pressure during pregnancy; fetal growth was not significantly different in these women compared to controls. CONCLUSION Obstructive sleep apnea is independently associated with altered fetal growth, which appears to be ameliorated with use of positive airway pressure.
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Affiliation(s)
- Anna W. KNEITEL
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | | | - Louise M. O’BRIEN
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI,Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI
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Tsai SY, Lee PL, Lee CN. Snoring and Blood Pressure in Third-Trimester Normotensive Pregnant Women. J Nurs Scholarsh 2018; 50:522-529. [PMID: 30033630 DOI: 10.1111/jnu.12416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the association between snoring, sleep quality, quantity, and blood pressure in third-trimester normotensive pregnant women. DESIGN This study was a cross-sectional analysis of two cohorts of healthy pregnant women recruited from a prenatal clinic in a medical center in Northern Taiwan. METHODS A total of 322 women reported sociodemographic and health characteristics in a structured interview and wore a wrist actigraph on their nondominant wrist for 7 consecutive days to assess objective sleep patterns. The women's resting blood pressures were measured while seated in the clinic by trained personnel using an electronic sphygmomanometer. FINDINGS One hundred thirty-three (41.3%) women reported snoring. Ninety-three women (28.9%) had <6 hr of nighttime sleep, with only 95 (29.5%) women averaging 7 or more hours of nighttime sleep. In the univariate analyses, snoring was positively associated with systolic and diastolic blood pressure as well as mean arterial pressure levels (p < .05). In the multivariate analyses, snoring remained as a significant predictor of higher diastolic blood pressure (β = 2.07, p < .05) and mean arterial pressure levels (β = 2.00, p < .05), after adjustment for age, parity, gestational age, body mass index before pregnancy, and sleep quantity and quality by actigraphy. CONCLUSIONS Snoring is a highly prevalent condition experienced by healthy third-trimester pregnant women and is associated with elevated blood pressure. CLINICAL RELEVANCE Clinical assessment and screening of snoring are of utmost importance in obstetric nursing practice to potentially prevent or reduce the associated adverse cardiovascular consequences in women during pregnancy.
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Affiliation(s)
- Shao-Yu Tsai
- Lambda Beta at Large, Associate Professor, School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Lin Lee
- Assistant Professor, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan; Director, Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; Attending Physician, Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Nan Lee
- Professor, Department of Obstetrics and Gynecology, National Taiwan University, Taipei, Taiwan
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