Perinatal Outcomes Associated With Obstructive Sleep Apnea in Obese Pregnant Women

Louis, Judette; Auckley, Dennis; Miladinović, Branko; Shepherd, Anna; Mencin, Patricia; Kumar, Deepak; Mercer, Brian M.; Redline, Susan

doi:10.1097/aog.0b013e31826eb9d8

Cited by 201 publications

(261 citation statements)

References 32 publications

Supporting

Mentioning

247

Contrasting

Unclassified

Order By: Relevance

“…[17][18][19] Our data are also consistent with Louis and colleagues' recent analysis of the performance of the ARES device in pregnant women. 24 In their study, which used the ARES 3% AHI, the ARES concordance correlation coefficient with PSG was rho c = 0.70 (95% CI 0.47-0.92), which is very similar to the agreement observed in the present study (rho c = 0.74 (95% CI 0.43-0.89).…”

Section: Discussionsupporting

confidence: 80%

“…Specificity, sensitivity, positive predictive value, negative predictive value, and κ coefficients were computed to determine whether AHIs and RDIs measured with PSG and the ARES AHI measures from the ARES Unicorder provided diagnostic consistency. We also calculated the Lin concordance correlation coefficient (rho c ) 22,23 to allow us to compare our data to the findings of Louis et al, 24 who also tested the ARES Unicorder in pregnant women. Alpha < 0.05 was considered statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7] SDB in pregnancy has a negative impact on fetal outcomes. 8,9 A retrospective analysis compared 57 pregnant women with sleep apnea to 57 obese controls and 57 normal weight controls and showed higher rates of low birth weight and prematurity in women with OSA compared to obese and normal weight controls. 10 Another study linking nation-wide population-based datasets in Taiwan showed that women with OSA (n = 791) were at an increased risk for preterm birth and small for gestational age compared to women without a diagnosis of OSA (n = 3,955), even after adjusting for multiple confounders.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

See 2 more Smart Citations

Validation of the Apnea Risk Evaluation System (ARES) Device Against Laboratory Polysomnography in Pregnant Women at Risk for Obstructive Sleep Apnea Syndrome

Sharkey

Waters

Millman

et al. 2014

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objective: To assess the validity of using the Apnea Risk Evaluation System (ARES) Unicorder for detecting obstructive sleep apnea (OSA) in pregnant women. Methods: Sixteen pregnant women, mean age (SD) = 29.8 (5.4) years, average gestational age (SD) = 28.6 (6.3) weeks, mean body mass index (SD) = 44.7 (6.9) kg/m 2 with signs and symptoms of OSA wore the ARES Unicorder during one night of laboratory polysomnography (PSG). PSG was scored according to AASM 2007 criteria, and PSG AHI and RDI were compared to the ARES 1%, 3%, and 4% AHIs calculated with the ARES propriety software. Results: Median PSG AHI and PSG RDI were 3.1 and 10.3 events/h of sleep, respectively. Six women had a PSG AHI ≥ 5 events/h of sleep and 11 had a PSG RDI ≥ 5 events/h of sleep. PSG AHI and RDI were strongly correlated with the ARES AHI measures. When compared with polysomnographic diagnosis of OSA, the ARES 3% algorithm provided the best balance between sensitivity (1.0 for PSG AHI, 0.91 for PSG RDI) and specifi city (0.5 for PSG AHI, 0.8 for PSG RDI) for detecting sleep disordered breathing in our sample. Conclusions:The ARES Unicorder demonstrated reasonable consistency with PSG for diagnosing OSA in this small, heterogeneous sample of obese pregnant women. S C I E N T I F I C I N V E S T I G A T I O N SP regnancy results in physiological changes that increase the risk of sleep disordered breathing (SDB). For instance, mechanical changes in gravid women-such as rapid weight gain and increased intra-abdominal pressure-result in decreased functional residual capacity and reduced oxygen reserve 1 and increase the risk of upper airway collapsibility. Other risk factors for SDB in pregnancy include increases in nasal congestion, Mallampati score, and snoring, andparticularly in pregnant patients who develop preeclampsiadecreases in upper airway size. [2][3][4][5][6][7] SDB in pregnancy has a negative impact on fetal outcomes. 8,9 A retrospective analysis compared 57 pregnant women with sleep apnea to 57 obese controls and 57 normal weight controls and showed higher rates of low birth weight and prematurity in women with OSA compared to obese and normal weight controls.10 Another study linking nation-wide population-based datasets in Taiwan showed that women with OSA (n = 791) were at an increased risk for preterm birth and small for gestational age compared to women without a diagnosis of OSA (n = 3,955), even after adjusting for multiple confounders. 11SDB also results in adverse outcomes in pregnant women. 12,13 In our recent study of 1,000 postpartum women, symptoms of SDB during pregnancy (measured with the multivariable apnea ) were associated with a greater than two-fold increased risk of gestational hypertensive disorders, gestational diabetes, and unplanned Caesarean deliveries. Validation of the Apnea Risk Evaluation System (ARES) Device13 Furthermore, from a physiologic standpoint, the impact of apneic episodes in pregnancy seems to be more potent than in non-pregnant women. In response to apneas, pregnant patients show a m...

show abstract

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

See 1 more Smart Citation

Validation of the Apnea Risk Evaluation System (ARES) Device Against Laboratory Polysomnography in Pregnant Women at Risk for Obstructive Sleep Apnea Syndrome

Sharkey

Waters

Millman

et al. 2014

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

show abstract

“…The AHI measured by the sleep monitor in the study and by polysomnography, the gold standard, has been previously reported as having good agreement. 25 Detailed methods on sleep study measures have been published previously. …”

Section: Sleep Apnea Measuresmentioning

confidence: 99%

Sleep Apnea Is Associated with Hearing Impairment: The Hispanic Community Health Study/Study of Latinos

Chopra

Jung

Kaplan

et al. 2016

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

Study Objective: Sleep apnea (SA) may promote hearing impairment (HI) through ischemia and inflammation of the cochlea. Our objective was to assess an independent association between SA and HI in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants. Methods: We used data from the HCHS/SOL, a multicenter population-based study of self-identifying Hispanic/Latinos 18-to 74-y-old adults from four US urban communities. We performed home SA testing and in-clinic audiometry testing in all participants. SA was defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. HI was defined as a mean hearing threshold > 25 dB hearing level in either ear at the frequencies: 3,000 to 8,000 Hz for high-frequency HI (HF-HI) and 500 to 2,000 Hz for low-frequency HI (LF-HI). Combined-frequency HI (CF-HI) was defined as both conditions present, and Any-HI was considered as HI in either low or high frequencies. Results: Of 13,967 participants, 9.9% had SA and 32.3% had Any-HI. Adjusted for risk factors for HI, those with SA had a 30% higher odds of Any-HI (95% confidence interval [CI] = 8% to 57%), 26% higher odds of HF-HI (CI = 3% to 55%), 127% higher odds of LF-HI (CI = 21% to 326%), and 29% higher odds of CF-HI (CI = 0% to 65%). A dose-response association was observed between AHI severity and Any-HI (versus no SA, OR for AHI ≥ 15 and < 30 = 1.22, CI = 0.96 to 1.54, and OR for AHI ≥ 30 = 1.46, CI = 1.11 to 1.91, p = 0.002). Conclusion: SA is associated with HF-HI and LF-HI, independent of snoring and other confounders. Commentary: A commentary on this article appears in this issue on page 641.

show abstract

“…33 The presence of OSA in a cohort of 175 obese pregnant women was associated with more frequent pre-eclampsia, neonatal intensive care unit admissions, and cesarean deliveries. 34 Another study on 128 second-trimester and 120 third-trimester pregnant women and their newborns suggested that poor sleep quality was significantly associated with greater risk of vacuum-assisted delivery. 35 An emerging theory suggests that SDB, with its accompanying sleep fragmentation and intermittent hypoxemia, may contribute to miscarriage risk, making SDB treatment a possible intervention for subsequent pregnancies.…”

Section: Consequences Of Sleep Disorders In Pregnancymentioning

confidence: 99%

Sleep Abnormalities in Pregnancy: Review

Eser¹,

Kaygusuz²,

Gümüş³

et al. 2015

Turkiye Klinikleri J Gynecol Obst

View full text Add to dashboard Cite

A AB BS S T TR RA AC CT T Pregnancy and sleep disorders are strongly correlated. Sleep disorders commonly experienced in pregnancy include insomnia, restless legs syndrome, excessive daytime sleepiness and sleep disordered breathing, for example sleep apnea. Causes can be physical discomfort, hormonal changes, alterations in respiratory physiology and psychological and emotional upheaval. Incidence of the different types of sleep disorders varies depending on pregnancy trimester. The first trimester is associated with excessive daytime sleepiness, although this can continue throughout pregnancy. Physical factors such as nausea and vomiting and hormonal changes are important causes. By the second trimester, hormonal changes are stabilising but women may still suffer sleep problems due to enlarged abdomen causing low back pain, abrupt fetal movements, heartburn and nocturia. In the third trimester, the majority of women suffer from sleep problems. Incidence of insomnia and restless legs syndrome reach their maximum. Sleep disordered breathing issues including sleep apnea, snoring and hypoventilation are also more common, influenced by rising progesterone levels, disordered and periodic breathing, excessive weight gain and altered neck circumference. Sleep disorders in pregnancy have been associated with adverse maternal and fetal outcomes. Treatment options include improving sleep hygiene, exercise, positional therapy, continuous positive airway pressure, behavioural therapies and, where the sleep disorders are refractory to these types of interventions, short-term pharmacological treatment with suitable hypnotics. Postpartum, many of the pregnancy-associated sleep disorders resolve, however many women continue to experience excessive daytime sleepiness and both pre-and post-partum sleep disorders have been linked to incidence of post-natal depression.K Ke ey y W Wo or rd ds s: : Sleep; pregnancy; sleep disorders Ö ÖZ ZE ET T Gebelik ve uyku bozuklukları arasında kuvvetli bir ilişki vardır. Gebelikte sıklıkla yaşanan uyku bozuklukları insomnia, huzursuz bacak sendromu, gündüz aşırı uyku hali ve uyku apnesi gibi uykuda nefes bozukluklarıdır. Nedenleri fiziksel rahatsızlık, hormonal değişiklikler, solunum fizyolojisindeki değişimler, psikolojik ve duygusal sarsıntılardır. Çeşitli tipteki uyku bozukluklarının insidansı trimesterlere göre değişiklik göstermektedir. İlk trimester gündüz aşırı uyku hali ile ilişkilidir, ancak bu durum gebelik boyunca devam edebilir. Bulantı kusma gibi fiziksel faktörler ve hormonal değişiklikler önemli nedenlerdir. İkinci trimesterle birlikte hormonal değişiklikler stabilize olur fakat kadınlar, genişlemiş karnın neden olduğu sırt ağrısına, ani fetüs hareketlerine, mide yanması ve noktüriye bağlı olarak, uyku problemlerinden hala şikayetçi olabilirler. Üçüncü trimesterde kadınların büyük çoğunluğu uyku problemleri yaşayabilirler. İnsomnia ve huzursuz bacak sendromu insidansı maksimum seviyeye ulaşır. Yükselen progesteron düzeyleri, düzensiz ve periyodik solunum, aşırı kilo alımı ve deği...

show abstract

Perinatal Outcomes Associated With Obstructive Sleep Apnea in Obese Pregnant Women

Cited by 201 publications

References 32 publications

Validation of the Apnea Risk Evaluation System (ARES) Device Against Laboratory Polysomnography in Pregnant Women at Risk for Obstructive Sleep Apnea Syndrome

Validation of the Apnea Risk Evaluation System (ARES) Device Against Laboratory Polysomnography in Pregnant Women at Risk for Obstructive Sleep Apnea Syndrome

Sleep Apnea Is Associated with Hearing Impairment: The Hispanic Community Health Study/Study of Latinos

Sleep Abnormalities in Pregnancy: Review

Contact Info

Product

Resources

About