Gestational sleep apnea: have we been caught napping?

Karan, Suzanne; Ginosar, Yehuda

doi:10.1016/j.ijoa.2016.03.001

Cited by 13 publications

(9 citation statements)

References 29 publications

(21 reference statements)

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“…There is a potential ethical concern regarding randomisation of HSAT-positive participants (identified from stage 2 as having OSA) to either a PAP (intervention) or a no-PAP (control) group. However, this concern is minimised by the following arguments: (A) HSAT, or a formal sleep study, is not a standard care for investigating FGR, and the diagnosis of OSA is rarely made in pregnancy; hence, the diagnosis is only made as a result of this study 23 24 ; (B) PAP is not a standard care for sleep disturbance in pregnancy as many practitioners and participants rightly or wrongly assume that this will improve after delivery, 24 while PAP is seen as a long-term therapeutic intervention. After delivery, participants with AHI ≥5 will be given a standard IRB-approved letter along with their HSAT results.…”

Section: Methodsmentioning

confidence: 99%

“…22 Unfortunately, because few pregnant women are referred for polysomnography (PSG), it is likely that OSA and other sleep disorders are underdiagnosed, 23 with the OSA-related symptoms of snoring, disrupted sleep and fatigue being frequently attributed to transient features of normal pregnancy. 24 Recurrent apnoeic and hypopnoeic episodes are associated with intermittent oxygen desaturation and hypercapnia. Recurrent hypoxia leads to oxidative stress, sympathetic activation and inflammation that may be harmful to both the mother and her fetus.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sleep Apnea and Fetal Growth Restriction (SAFER) study: protocol for a pragmatic randomised clinical trial of positive airway pressure as an antenatal therapy for fetal growth restriction in maternal obstructive sleep apnoea

et al. 2021

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IntroductionFetal growth restriction (FGR) is a major contributor to fetal and neonatal morbidity and mortality with intrauterine, neonatal and lifelong complications. This study explores maternal obstructive sleep apnoea (OSA) as a potentially modifiable risk factor for FGR. We hypothesise that, in pregnancies complicated by FGR, treating mothers who have OSA using positive airway pressure (PAP) will improve birth weight and neonatal outcomes.Methods and analysisThe Sleep Apnea and Fetal Growth Restriction study is a prospective, block-randomised, single-blinded, multicentre, pragmatic controlled trial. We enrol pregnant women aged 18–50, between 22 and 31 weeks of gestation, with established FGR based on second trimester ultrasound, who do not have other prespecified known causes of FGR (such as congenital anomalies or intrauterine infection). In stage 1, participants are screened by questionnaire for OSA risk. If OSA risk is identified, participants proceed to stage 2, where they undergo home sleep apnoea testing. Participants are determined to have OSA if they have an apnoea-hypopnoea index (AHI) ≥5 (if the oxygen desaturation index (ODI) is also ≥5) or if they have an AHI ≥10 (even if the ODI is <5). These participants proceed to stage 3, where they are randomised to nightly treatment with PAP or no PAP (standard care control), which is maintained until delivery. The primary outcome is unadjusted birth weight; secondary outcomes include fetal growth velocity on ultrasound, enrolment-to-delivery interval, gestational age at delivery, birth weight corrected for gestational age, stillbirth, Apgar score, rate of admission to higher levels of care (neonatal intensive care unit or special care nursery) and length of neonatal stay. These outcomes are compared between PAP and control using intention-to-treat analysis.Ethics and disseminationThis study has been approved by the Institutional Review Boards at Washington University in St Louis, Missouri; Hadassah Hebrew University Medical Center, Jerusalem; and the University of Rochester, New York. Recruitment began in Washington University in November 2019 but stopped from March to November 2020 due to COVID-19. Recruitment began in Hadassah Hebrew University in March 2021, and in the University of Rochester in May 2021. Dissemination plans include presentations at scientific conferences and scientific publications.Trial registration numberNCT04084990.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sleep Apnea and Fetal Growth Restriction (SAFER) study: protocol for a pragmatic randomised clinical trial of positive airway pressure as an antenatal therapy for fetal growth restriction in maternal obstructive sleep apnoea

et al. 2021

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“…При этом патологические типы вариабельности АД тесно взаимосвязаны с синдромом обструктивного апноэ сна (отдельный клинический вариант МС), который сопровождается периодами гипоксии, окислительным стрессом и выбросом катехоламинов в ночное время [16]. Аналогичные нарушения дыхания при беременности, обозначаемые как гестационное сонное апноэ, формируются как у женщин с МС, так и в группе с ПЭ без сопутствующей соматической патологии, что, по-видимому, обусловлено срывом однотипных механизмов адаптации к возникающим при беременности изменениям дыхательной системы (смещение диафрагмы вверх растущей маткой, снижение на 20% функциональной остаточной емкости легких, повышенное кровенаполнение сосудов слизистой носа, ротоглотки, гортани под действием эстрогенов, ухудшение механики дыхания в результате увеличения и нагрубания молочных желез) [15,16]. Статистически более частая встречаемость инсомнии в группах с ПЭ по сравнению со II группой наглядно отражает сохранение центральных механизмов ауторегуляции у женщин с МС без ПЭ, несмотря на сниженный резерв адаптации.…”

Section: обсуждение основного результата исследованияunclassified

Dysmetabolic mechanisms of preeclampsia development

2020

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Background: An in-depth study of dismetabolic mechanisms in the genesis of pre-eclampsia (PE) has been updated because pregnancy is considered as a natural model of metabolic syndrome (MS), as well as the metabolic disorders are important in development of essential hypertension.Aims: to reveal clinical and laboratory parallels in pregnancy complicated by PE without MS and pregnancy proceeding on the background of MS to assess the role of metabolic disturbances in the development of PE.Materials and methods: 82 women with MS were examined in the dynamics of pregnancy and were divided into 2 groups depending on the implementation of PE: group I consisted of 50 women with PE on the background of MS, group II 32 women with MS without PE. We formed group III consisting of 44 pregnant women with PE without accompanying diseases to assess the pathogenetic value of metabolic disorders in the development of PE. The IV (control) group consisted of 30 healthy women with physiological pregnancy. Metabolic, hematological parameters, hormones, markers of the proinflammatory state, endothelial hemostasiological dysfunction, decidualization and placental angiogenesis, accumulation dynamics and distribution loci of adipose tissue were determined in all pregnant women.Results: In the groups of pregnant women with PE, changes similar to MS were revealed: pronounced diabetic and atherogenic disorders with the development of pathological insulin resistance, hyperinsulinemia and leptinemia, endothelial-platelet link hyperactivation, thrombotic and inflammatory status, visceral type of fat deposition, hyperuricemia, hypersympathicotonia. It is proved that in the hierarchy of mechanisms of PE formation, placental dysfunction is a secondary alteration factor, which additionally potentiates the insulin resistance increase and the effects of structural and functional destabilization of the vascular endothelium.Conclusions: The direction of metabolic changes during pregnancy, the common development of PE and MS indicate the important role of dismetabolic mechanisms in the formation of PE.

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“…In 2016, Drs. Suzanne Karan and Yehuda Ginosar [14] wrote an editorial for the International Journal of Obstetric Anesthesia, entitled, "Gestational Sleep Apnea: Have we been caught napping?" Let us not get caught napping, but rather share in the "Great Awakening, " to the strong body of evidence pointing out the central role of airway and breathing disorders in the comprehensive care of dental medicine, including the evaluation, diagnosis, and treatment of craniomandibular disorders.…”

Section: Dentistry's Great Awakening!mentioning

confidence: 99%

Dentistry’s Great Awakening

Wilkerson

2018

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Gestational sleep apnea: have we been caught napping?

Cited by 13 publications

References 29 publications

Sleep Apnea and Fetal Growth Restriction (SAFER) study: protocol for a pragmatic randomised clinical trial of positive airway pressure as an antenatal therapy for fetal growth restriction in maternal obstructive sleep apnoea

Sleep Apnea and Fetal Growth Restriction (SAFER) study: protocol for a pragmatic randomised clinical trial of positive airway pressure as an antenatal therapy for fetal growth restriction in maternal obstructive sleep apnoea

Dysmetabolic mechanisms of preeclampsia development

Dentistry’s Great Awakening

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