Impact of overnight oximetry findings on cardiac autonomic modulation in women during second trimester of uncomplicated pregnancy

Watanabe, Motoki; Shinohara, Hitomi; Kodama, Hiroyuki

doi:10.1111/jog.12634

Cited by 7 publications

(8 citation statements)

References 39 publications

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“…No women had an ODI ≥5.0 in our previous survey of uncomplicated pregnancies during the second trimester. 30 Therefore, the risk of OSA might increase during late pregnancies. 11,12 Patients A and B with ODI ≥5.0 and minimum SpO 2 of <90% were thought to undergo quite severe hypoxia during nocturnal sleep, and they both developed GH after 37 weeks of gestation.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal oxygen desaturation in the late third trimester of uncomplicated pregnancy for prediction of late‐onset gestational hypertension

Watanabe

Shinohara

Kodama

2020

J of Obstet and Gynaecol

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Aim This study aimed to determine whether 1‐night screening of oxygen desaturation in women with uncomplicated pregnancy about 1 month before the due date is useful to predict late‐onset gestational hypertension (GH) after 37 weeks of gestation. Methods We recruited 102 women with uncomplicated pregnancy between 34 and 36 weeks of gestation. These women then completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Berlin Questionnaire for obstructive sleep apnea, and recorded their oxygen saturation (SpO2) and physical acceleration profiles during nocturnal sleep for 1 night at home using a portable pulse oximeter and actigraph, respectively. Thereafter, their blood pressure was monitored weekly until delivery. Results Pulse oximetry data between 34 and 36 weeks of gestation revealed that three women had an oxygen desaturation index (ODI) ≥5.0 and seven had a minimum SpO2 < 90%. During follow‐up until delivery, two women with an ODI ≥5.0 and a minimum SaO2 <90% developed GH at 37 weeks of gestation. Among clinical measures at recruitment, body mass index (BMI) and pulse oximetry measures appeared available for the prediction of GH. The positive predictive values (95% confidence intervals) of the criteria using these measures were 0.67 (0.26–0.67) for ODI ≥5.0, 0.29 (0.10–0.35) for minimum SpO2 <90%, and 0.07 (0.02–0.07) for BMI ≥25.0. Conclusion For the prediction of late‐onset GH after 37 weeks of gestation, pulse oximetry measures about 1 month before the due date are particularly useful because of their high positive predictive values.

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Section: Discussionmentioning

confidence: 99%

Nocturnal oxygen desaturation in the late third trimester of uncomplicated pregnancy for prediction of late‐onset gestational hypertension

Watanabe

Shinohara

Kodama

2020

J of Obstet and Gynaecol

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“…The paper by Watanabe et al. 16 tried to answer this question hypothesizing that autonomic modulations might be associated with (and possibly be a predictor of) SDB.…”

Section: Impact Of Overnight Oximetry Findings On Cardiac Autonomic Mmentioning

confidence: 99%

“…Watanabe et al. 16 correctly analyzed LF and HF which reflect the combination of the sympathetic and the parasympathetic nervous system influences and vagal activity respectively; however, no data are available on very LF (measures rhythms between every 25 s and every 5 min) which is particularly exaggerated by SDB. Moreover, other sleep disturbances can influence the sympathetic–parasympathetic balance; sleep deprivation for instance is very common among pregnant women.…”

Section: Impact Of Overnight Oximetry Findings On Cardiac Autonomic Mmentioning

confidence: 99%

Sleep disordered breathing in pregnancy: Food for thought

et al. 2016

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The last few years have witnessed a number of publications linking sleep disordered breathing to adverse pregnancy and neonatal outcomes in various populations. Associations with preeclampsia, gestational diabetes and growth restriction have been consistent across many studies. Though the manuscripts reviewed here consist mostly of preliminary data and need further confirmation, the studies have highlighted new directions in the assessment of the impact of sleep disordered breathing and pregnancy, and paved the way for new fields of research in this area. KeywordsSleep disordered breathing, hypertension, complications, neonatal medicine, aging, pregnancy Date received: 12 January 2016; accepted: 15 January 2016 Throughout the course of pregnancy, the respiratory system undergoes a significant number of physiologic changes. Some of the changes such as the reduction in functional residual capacity and upper airway patency, along with reduced oxygen reserve may predispose to sleep-disordered breathing (SDB). This spectrum of sleep-related breathing disorders ranges from uncomplicated snoring to obstructive sleep apnea (OSA) and obesity hypoventilation syndrome. Though central sleep apnea does not appear to be prevalent among pregnant women suspected of SDB, 1 obstructive disorders occur more frequently. Both snoring and OSA are common in pregnancy, and both are associated with adverse pregnancy outcomes such as preeclampsia, 2 gestational diabetes, 3 and reductions in birth weight. 4 The past few years have witnessed the emergence of a fair number of studies evaluating SDB in pregnancy, but the three studies published in 2015 and discussed here represent a new focus of this research and are certainly thought provoking.Association between maternal symptoms of SDB and fetal telomere length Data evaluating long-term outcomes in neonates born to mothers with SDB are lacking. The goal of this study 5 was to analyze the effects of maternal SDB on accelerated aging of the neonate, using fetal telomere length as a surrogate marker. Telomeres are the tips of chromosomes; they consist of protein complexes and non-coding DNA. Telomere shortening occurs with aging and constitutes a good marker because it is closely related to basic biological mechanisms, records the number of past cell divisions, is reproducible, and is associated with adverse lifestyle and other risk factors 6 such as obesity and smoking. Some limited data also link telomere length with sleep apnea in the nonpregnant population, 7 independently of cardiovascular and metabolic conditions. Emerging literature is suggesting an association between telomere length in adults and mortality. Thus, this study was conducted with the hypothesis that in-utero exposure to maternal SDB will be associated with shorter telomere length at birth.The subjects enrolled in this study included 67 women; age 18-44 years old, mostly socioeconomically disadvantaged and ethnically diverse, who were delivering full-term live births and whose fetuses were not showing evidence...

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“…A previous small study showed higher levels of interleukin (IL)-6 and IL-8, in 4 women with GDM and OSA compared to 21 women without OSA [ 12 ]. Moreover, a small study found decreased heart rate variability in pregnant women, a non-invasive marker of attenuation of parasympathetic activity [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Systemic inflammation and sympathetic activation in gestational diabetes mellitus with obstructive sleep apnea

et al. 2022

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Background Although some evidence suggests an association between obstructive sleep apnea (OSA) and gestational diabetes mellitus (GDM), its consequences still remain largely unknown. We sought to determine whether OSA is associated with higher inflammation and sympathetic levels in GDM, and to relate them with insulin resistance and perinatal outcomes. Methods OSA was identified by polysomnography and defined as an apnea–hypopnea index of ≥ 5 h−1. Plasma cytokines (TNF-α, IL-1β, IL-6, IL-8, IL-10), metanephrine, and normetanephrine were determined by immunoassays. Results We included 17 patients with GDM and OSA and 34 without OSA. Women with GDM and OSA had higher normetanephrine concentrations [81 IQR (59–134) vs. 68 (51–81) pg/mL]. No differences in the inflammatory profile were found, while IL-1β was higher in patients with mean nocturnal oxyhemoglobin saturation ≤ 94%. We found positive correlations between increased sympathetic activation and IL-1β, with obstructive apneas, while time in REM showed an inverse relationship with IL-1β and metanephrine. Furthermore, IL-10 was inversely related with time in sleep stages 1–2, and with the arousal index, and it was positively related with time in slow-wave sleep. Significant correlations were also found between IL-1β and insulin resistance. There were no significant differences in neonatal characteristics; however, we found inverse relationships between IL-10 and birth weight (BW), and percentile of BW. Conclusions OSA increased sympathetic activity, and IL-1β concentration was higher in patients with GDM with lower nocturnal oxygenation, all of which were related with obstructive events, and time in REM. Moreover, IL-1β was related with insulin resistance, and IL-10 inversely correlated with neonatal BW.

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Impact of overnight oximetry findings on cardiac autonomic modulation in women during second trimester of uncomplicated pregnancy

Cited by 7 publications

References 39 publications

Nocturnal oxygen desaturation in the late third trimester of uncomplicated pregnancy for prediction of late‐onset gestational hypertension

Nocturnal oxygen desaturation in the late third trimester of uncomplicated pregnancy for prediction of late‐onset gestational hypertension

Sleep disordered breathing in pregnancy: Food for thought

Systemic inflammation and sympathetic activation in gestational diabetes mellitus with obstructive sleep apnea

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