Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing

Bourjeily, Ghada; Raker, Christina; Chalhoub, Michel; Miller, Margaret A.

doi:10.1183/09031936.00021810

Cited by 209 publications

(241 citation statements)

References 47 publications

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“…Previously, the same authors found that snoring, gasping, and apneas, all three symptoms of SRBD, were associated with higher mean ESS scores [7]. Furthermore, they found that these symptoms are common in pregnancy and associated with a higher likelihood of gestational hypertensive disorders, gestational diabetes, and unplanned caesarean deliveries [8]. The question, therefore, that arises is whether EDS assessed by ESS increases the risk of adverse pregnancy outcomes.…”

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confidence: 99%

Epworth Sleepiness Scale scores and adverse pregnancy outcomes

2013

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Sleep disturbances generally increase with the onset of pregnancy and continue to increase in frequency as pregnancy progresses [1][2][3][4]. Although these disturbances may arise as a consequence of numerous physiologic and hormonal changes accompanying pregnancy, it is important for clinicians to consider the possible presence of primary sleep-related breathing disorders (SRBD), such as snoring and sleep apnea [5]. Sleep apnea, snoring, and excessive sleepiness are identified as the most frequently sleep disturbances among pregnant women. There is conflictive evidence in regard to whether sleep-disordered breathing increases in prevalence during pregnancy, but existing research indicates that such disorders may enhance the risk of potentially adverse maternal-fetal outcomes by increasing the likelihood of preterm birth, preeclampsia, and gestational diabetes [6].In this issue of Sleep and Breathing, Ghada Bourjeily and colleagues of The Warren Alpert Medical School of Brown University in their paper "Epworth Sleepiness Scale scores and adverse pregnancy outcomes" tried to investigate whether excessive daytime sleepiness (EDS) in snorers and non-snorers contributed to adverse pregnancy outcomes such as gestational hypertensive disorders, gestational diabetes, or mode of delivery. The authors found that there is an increased association between pregnant women with higher Epworth Sleepiness Scale (ESS) score and planned caesarean delivery. Although retrospective, this study extends previous observations that EDS and snoring are risk factors for gestational diabetes by showing that when higher cut off values of ESS were used, the risk of gestational diabetes was significantly elevated and sevenfold higher than women below the cutoff point, even after adjusting for confounders. However, in this study, neither gestational diabetes nor hypertensive disorder was associated with EDS, when EDS was defined as an ESS >10.In the literature, studies that address SRBD in pregnant women are scarce with the only available data come from case studies, case series, small cohort studies, and a few small longitudinal studies. As no large population-based epidemiological studies have been performed, the prevalence of obstructive sleep apnea in pregnant women is not known. Previously, the same authors found that snoring, gasping, and apneas, all three symptoms of SRBD, were associated with higher mean ESS scores [7]. Furthermore, they found that these symptoms are common in pregnancy and associated with a higher likelihood of gestational hypertensive disorders, gestational diabetes, and unplanned caesarean deliveries [8]. The question, therefore, that arises is whether EDS assessed by ESS increases the risk of adverse pregnancy outcomes. In this new study, Bourjeily et al. attempted to answer this question. However, the fact that their major findings were that EDS was not associated with adverse pregnancy outcomes both in snorers and in non-snorers but severe EDS (ESS >16) increases the risk of gestational diabetes is still not clea...

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confidence: 99%

Epworth Sleepiness Scale scores and adverse pregnancy outcomes

2013

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“…In addition, higher rates of unplanned Caesarean deliveries were found to be associated with both loud snoring [Bourjeily et al 2011] and OSA [Louis et al 2010]. Associations of snoring with critical fetal outcomes have also been shown including growth restriction in some studies [Franklin et al 2000;Micheli et al 2011 ] but not others [Bourjeily et al 2010;Loube et al 1996;Tauman et al 2011b]; preterm birth [Bourjeily et al 2010] and induced preterm birth [Louis et al 2010] were found in snorers and patients with OSA, respectively. This outcome may have been mediated by preeclampsia.…”

Section: Discussionmentioning

confidence: 97%

“…Snoring in pregnancy has been associated with key adverse pregnancy outcomes such as gestational hypertensive disorders [Bourjeily et al 2010;Calaora-Tournadre et al 2006;Franklin et al 2000;Perez-Chada et al 2007;Ursavas et al 2008] (OR 1.8-2.3 in most studies) [Bourjeily et al 2011] and gestational diabetes (aOR 2.1, 95% CI 1.3-3.4) [Bourjeily et al 2011;Facco et al 2010]. In addition, higher rates of unplanned Caesarean deliveries were found to be associated with both loud snoring [Bourjeily et al 2011] and OSA [Louis et al 2010].…”

Section: Discussionmentioning

confidence: 99%

Patient and provider perceptions of sleep disordered breathing assessment during prenatal care: a survey-based observational study

Bourjeily

Raker

Paglia

et al. 2012

Ther Adv Respir Dis

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Objectives: Screening for sleep disordered breathing (SDB) remains poor in the general population, despite evidence for association with adverse outcomes and improvement of certain outcomes with therapy. Data from the past decade have suggested an association between snoring and adverse pregnancy outcomes including gestational hypertensive disorders. However, it is unclear how often SDB is screened for in pregnancy. The objective of this study was to evaluate whether, and how, symptoms of SDB are assessed during prenatal care. Methods: This study was designed as a survey-based observational study. Within 48 hours of delivery, English-speaking patients were surveyed regarding prenatal conversations with obstetric providers about symptoms of SDB. During a similar time period, obstetric providers completed an anonymous questionnaire regarding how often they discussed the same symptoms during prenatal visits. Results: A total of 776 patients and 80 providers performing the majority of deliveries at the same hospital answered the survey. Nurse providers asked about sleep quality significantly more often than physician providers; however, responses to questions about snoring were similar in both groups. Resident physicians were the least likely to ask about sleep quality. Less than 3% of providers reported asking about snoring, closely matching patient responses. A total of 44% of patients surveyed were overweight and 21.7% were obese. Although 32% of patients snored, only 5% were asked about snoring during a prenatal visit. Obese women and women with a history of gestational hypertensive disorders were more likely to report being asked about snoring. Conclusions: Based on patient and obstetric provider recollections of discussions, the issue of SDB is poorly assessed during routine prenatal care, despite an increasing prevalence of overweight and obesity in the pregnant population.

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“…2 Recent data from a large pregnancy cohort showed that having OSA increases the risk of low birth weight, preterm birth, Cesarean section and preeclampsia. The two articles by Ebert et al 12 and Okun et al 13 in this issue of Journal of Clinical Sleep Medicine (JCSM) address the need to scientifi cally unravel this sleeping in pregnancy paradox.…”

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confidence: 99%

“…1 Meanwhile, there is growing evidence linking sleep disturbances with adverse pregnancy outcomes. [2][3][4] The message is clear: good sleep is important for a healthy pregnancy.…”

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confidence: 99%

Sleeping for Two: The Great Paradox of Sleep in Pregnancy

Won

2015

Journal of Clinical Sleep Medicine

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Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing

Cited by 209 publications

References 47 publications

Epworth Sleepiness Scale scores and adverse pregnancy outcomes

Epworth Sleepiness Scale scores and adverse pregnancy outcomes

Patient and provider perceptions of sleep disordered breathing assessment during prenatal care: a survey-based observational study

Sleeping for Two: The Great Paradox of Sleep in Pregnancy

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