Association between Sleep-Disordered Breathing during Pregnancy and Maternal and Fetal Outcomes: An Updated Systematic Review and Meta-Analysis

Liu, Liwen; Zhao, Kai; Jin, Hua; Li, Shenghui

doi:10.3389/fneur.2018.00091

Cited by 64 publications

(49 citation statements)

References 58 publications

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“…The identity of PVAT is unknown but suggested molecules include hydrogen peroxide, hydrogen sulphate, angiotensins 1-7 and angiotensin II, NO, methyl palmitate, leptin, and adiponectin (Ramirez et al 2017;Xia & Li, 2017). Adiponectin has significant anti-contractile activity in PVAT, as suggested by the reduced anti-contractile activity of PVAT in adiponectin-deficient mice (Lynch et al 2013). Blocking adiponectin receptors inhibits the anti-contractile activity of PVAT (Greenstein et al 2009).…”

Section: Figure 10 Metabolic and Vascular Effects Of Gestational Intmentioning

confidence: 99%

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Gestational intermittent hypoxia induces endothelial dysfunction, reduces perivascular adiponectin and causes epigenetic changes in adult male offspring

Badran

Yassin

Lin

et al. 2019

The Journal of Physiology

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Key points Obstructive sleep apnoea (OSA) is characterized by intermittent hypoxia, which causes oxidative stress and inflammation and increases the risk of cardiovascular disease. OSA during pregnancy causes adverse maternal and fetal outcomes. The effects of pre‐existing OSA in pregnant women on cardiometabolic outcomes in the offspring are unknown. We evaluated basic metabolic parameters, as well as aortic vascular and perivascular adipose tissue (PVAT) function in response to adiponectin, and examined DNA methylation of adiponectin gene promoter in PVAT in 16‐week‐old adult offspring exposed to gestational intermittent hypoxia (GIH). GIH decreased body weights at week 1 in both male and female offspring, and caused subsequent increases in body weight and food consumption in male offspring only. Adult female offspring had normal levels of lipids, glucose and insulin, with no endothelial dysfunction. Adult male offspring exhibited dyslipidaemia, insulin resistance and hyperleptinaemia. Decreased endothelial‐dependent vasodilatation, loss of anti‐contractile activity of PVAT and low circulating PVAT adiponectin levels, as well as increased pro‐inflammatory gene expression and DNA methylation of adiponectin gene promoter, occurred in adult male offspring. Our results suggest that male offspring of women with OSA could be at risk of developing cardiometabolic disease during adulthood. Abstract Perturbations during pregnancy can program the offspring to develop cardiometabolic diseases later in life. Obstructive sleep apnoea (OSA) is a chronic condition that frequently affects pregnancies and leads to adverse fetal outcomes. We assessed the offspring of female mice experiencing gestational intermittent hypoxia (GIH), a hallmark of OSA, for changes in metabolic profiles, aortic nitric oxide (NO)‐dependent relaxations, perivascular adipose tissue (PVAT) anti‐contractile activities and the responses to adiponectin, and DNA methylation of the adiponectin gene promoter in PVAT tissue. Pregnant mouse dams were exposed to intermittent hypoxic cycles (FnormalIO2 21–12%) for 18 days. GIH resulted in lower body weights of pups at week 1, followed by significant weight gain by week 16 of age in male but not female offspring. Plasma lipids, leptin and insulin resistance were higher in GIH male adult offspring. Endothelium‐dependent relaxation in response to ACh and the anti‐contractile activity of PVAT in the abdominal aorta was reduced in GIH adult male offspring. Incubation of arteries from GIH adult male offspring with adiponectin restored the anti‐contractile activity of PVAT. Both circulating and PVAT tissue homogenate levels of adiponectin, as well as gene expression of adiponectin in PVAT, were lower in GIH male offspring, along with an increased gene expression of inflammatory cytokines. Pyrosequencing of adiponectin gene promoter in PVAT showed increased DNA methylation in GIH male offspring. Our results indicate that GIH leads to vascular disease in adult male offspring through PVAT dysfunction, which was associate...

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Section: Figure 10 Metabolic and Vascular Effects Of Gestational Intmentioning

confidence: 99%

“…OSA is associated with pre‐eclampsia, gestational diabetes and low birth weight (Li et al . ). The impact of OSA on the cardiovascular function of adult offspring exposed to GIH has not been described previously.…”

Section: Introductionmentioning

confidence: 97%

Gestational intermittent hypoxia induces endothelial dysfunction, reduces perivascular adiponectin and causes epigenetic changes in adult male offspring

Badran

Yassin

Lin

et al. 2019

The Journal of Physiology

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“…SDB, RLS/ WED, shorter or longer sleep durations, poor sleep quality, and EDS have been reported to be associated with gestational diabetes and hypertensive disorders during pregnancy [6,[8][9][10][11][12]. Moreover, these maternal sleep/wake problems affect cesarean delivery, preterm birth rates, rates of children born small-and large-for-gestational-age, and admission rates to the neonatal intensive care unit [6,8,[11][12][13][14]. However, findings are inconsistent, and discrepancies among studies are thought to be influenced by methodological differences across studies [6,8,12,13,15].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of sleep/wake problems and delivery outcomes among pregnant Japanese women without gestational complications

Umeno

Kato

Nagaura

et al. 2020

BMC Pregnancy Childbirth

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Background: Frequently observed sleep/wake problems among pregnant women need comprehensive evaluation. This study was conducted to clarify the sleep/wake problems among pregnant women without gestational complications during the second and third trimester and the effects of sleep/wake problems on delivery outcomes. Methods: A total of 88 Japanese pregnant women participated in this study. In their second and third trimester, subjective sleep quality, insomnia severity, excessive daytime sleepiness (EDS), and restless legs syndrome/Willis-Ekbom disease (RLS/ WED) were assessed using questionnaires; also, sleep disordered breathing (SDB) was screened using a pulse oximeter. Results: From the second to the third trimester, an increasing tendency of sleep/wake problems was observed. During the third trimester, the percentages of women experiencing decreased subjective sleep quality, difficulty maintaining sleep (DMS), EDS, RLS/WED, and 3% oxygen desaturation index (ODI) values ≥5/h were 62.5, 45.5, 48.9, 9.1, and 29.5%, respectively. In a logistic regression analysis for EDS in the third trimester, the adjusted odds ratio (95% confidence interval) of total sleep duration < 6 h, moderate to severe DMS, and 3% ODI values ≥5/h were 3.25 (1.16-9.10), 4.74 (1.60-14.00), and 0.90 (0.28-2.89), respectively. Although short sleep durations, decreased subjective sleep quality, EDS, and SDB did not affect delivery outcomes or the infant's condition, the percentage of women undergoing cesarean sections in the severe insomnia group was significantly higher (p = 0.008). Conclusions: Sleep/wake problems were frequent during pregnancy, especially during the third trimester. EDS among pregnant women was associated with shorter sleep durations and DMS rather than SDB. The effect of factors related to insomnia on delivery outcomes should thus be considered a crucial problem among pregnant Japanese women without gestational complications in clinical practice.

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“…Due to the hormone‐related physiological changes in immunity and metabolism, poor sleep, characterized by chronic sleep deprivation and sleep disorders, was highly prevalent in pregnant women (Wilkerson & Uhde, ; Yang et al, ). As suggested by studies, poor sleep has potentially increased the risk of pregnancy complications, such as gestational diabetes mellitus and pregnancy‐induced hypertension (Li, Zhao, Hua, & Li, ; Palagini et al, ; Wilkerson & Uhde, ). Meanwhile, a number of studies support that poor sleep, in general, may have negative effect on the fetus resulting in altered gestational length and growth restriction (Abeysena, Jayawardana, & Seneviratne Rde, ; Abeysena, Jayawardana, & Seneviratne Rde, ; Kajeepeta et al, ).…”

Section: Introductionmentioning

confidence: 99%

Exploring associations of maternal sleep during periconceptional period with congenital heart disease in offspring

Zhao

Xia

et al. 2019

Birth Defects Research

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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 propensityscore-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. K E Y W O R D S case-control study, congenital heart disease, daytime nap, maternal sleep, pregnancy Anda Zhao and Kena Zhao contributed equally to this work.

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Association between Sleep-Disordered Breathing during Pregnancy and Maternal and Fetal Outcomes: An Updated Systematic Review and Meta-Analysis

Cited by 64 publications

References 58 publications

Gestational intermittent hypoxia induces endothelial dysfunction, reduces perivascular adiponectin and causes epigenetic changes in adult male offspring

Gestational intermittent hypoxia induces endothelial dysfunction, reduces perivascular adiponectin and causes epigenetic changes in adult male offspring

Characteristics of sleep/wake problems and delivery outcomes among pregnant Japanese women without gestational complications

Exploring associations of maternal sleep during periconceptional period with congenital heart disease in offspring

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