Self-Reported Snoring, Maternal Obesity and Neck Circumference as Risk Factors for Pregnancy-Induced Hypertension and Preeclampsia

Ursavaş, Ahmet; Karadağ, Mehmet; Nalci, Nazan; Ercan, İlker; Gozu, R. Oktay

doi:10.1159/000107735

Cited by 77 publications

(63 citation statements)

References 52 publications

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“…1 SDB, independent of maternal BMI, is associated with an increased risk of hypertension in pregnancy, as well as maternal morbidity. 73,78,[80][81][82][83][84][85][86] In one study, preeclampsia, a hypertensive syndrome in pregnancy, was significantly more common among snorers than non-snorers (10% versus 4%, p < 0.05), as was gestational hypertension (14% versus 6%, p < 0.01). 87 This was recently corroborated in a report by O'Brien and colleagues, who found that pregnancy-onset snoring was independently associated with gestational hypertension (OR 2.36 [1.48-3.77], p < 0.001) and preeclampsia (OR 1.59 [1.06-2.37], p = 0.024) in 1,719 third-trimester pregnant women.…”

Section: Sleep Related Breathing Disorders In Pregnancymentioning

confidence: 99%

Sleep and Pregnancy-Induced Hypertension: A Possible Target for Intervention?

Haney

Buysse²,

Okun³

2013

Journal of Clinical Sleep Medicine

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Sleep disturbances in the general population are associated with elevated blood pressure. This may be due to several mechanisms, including sympathetic activation and hypothalamic-pituitary-adrenal (HPA) axis disturbance. Elevated blood pressure in pregnancy can have devastating effects on both maternal and fetal health and is associated with increased risk for preeclampsia and poor delivery outcomes. Preliminary evidence suggests that mechanisms linking sleep and blood pressure in the general population may also hold in the pregnant population. However, the effects of disturbed sleep on physiologic mechanisms that may directly infl uence blood pressure in pregnancy have not been well studied. The role that sleep disturbance plays in gestational blood pressure elevation and its subsequent consequences warrant further investigation. This review evaluates the current literature on sleep disturbance and elevated blood pressure in pregnancy and proposes possible treatment interventions. T he association between sleep disturbances and elevated blood pressure has been extensively studied in the general population. However, relatively few studies have investigated this relationship in the pregnant population. Pregnancy predisposes women to a variety of sleep disturbances.1,2 Similar to non-pregnant individuals, sleep disturbance in pregnancy may be a risk factor for elevated blood pressure, which can lead to maternal and fetal morbidity . 3,4Gestational hypertension, defi ned as a blood pressure higher than 140/90 diagnosed after 20 weeks of gestation, is associated with fetal growth restriction and abruptio placentae and can predispose to preeclampsia, as well as cardiovascular disease later in lif e. 1,[4][5][6] There are few studies evaluating the link between sleep and blood pressure during pregnancy. In this paper, we fi rst review the relationship between sleep and blood pressure in non-pregnant adults. We then outline factors that predispose pregnant women to poor sleep. We conclude with a review of the emerging literature on the associations between sleep and blood pressure in pregnancy. SLEEP AND BLOOD PRESSURE IN THE NON-PREGNANT POPULATIONIn the U.S. the average sleep duration has decreased by 1.5-2 h/night, with > 30% of Americans sleeping < 6 h/night. 7This phenomenon and the concurrent increase in hypertension intimated a possible link between sleep duration and blood pressure. Recently, a series of epidemiological papers have noted an association between sleep duration (both short and long) and elevated blood press ure [8][9][10][11] ; for example, the Sleep Heart Health Study reported that participants who slept < 5 or ≥ 9 h/night had a greater frequency of hypertension than individuals sleeping

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Section: Sleep Related Breathing Disorders In Pregnancymentioning

confidence: 99%

Sleep and Pregnancy-Induced Hypertension: A Possible Target for Intervention?

Haney

Buysse²,

Okun³

2013

Journal of Clinical Sleep Medicine

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“…Although studies have reported that snoring occurs in 14-45% of pregnant females [13][14][15], the incidence of SDB remains unknown. A few studies suggest a significant association between habitual snoring and gestational hypertensive disorders [16]. Others have assessed a potential association with neonatal outcomes [14,17], with some showing growth restriction in snorers compared with non-snorers [14] and others failing to show a correlation [17].…”

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confidence: 99%

Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing

Bourjeily

Raker²,

Chalhoub³

et al. 2010

Eur Respir J

209

230

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The physiological changes of pregnancy may predispose females to develop sleepdisordered breathing (SDB) or protect against it. Studies evaluating outcomes of SDB symptoms in pregnancy are scarce. The goal of this study was to evaluate the prevalence of SDB symptoms in pregnancy and their relationship with pregnancy and neonatal outcomes.A cross-sectional survey of randomly selected immediate postpartum females was performed using the multivariable apnoea prediction index. Record review, including demographics and medical history, was performed. Main outcome measures included pregnancy and neonatal outcomes.1,000 subjects were recruited. Mean¡SD age was 29.1¡6.1 yrs. Factors used in the regression analysis included age, body mass index, diabetes, chronic hypertension, multifetal gestations, smoking and renal disease. Snoring was present in 35.1% of subjects. Symptoms of SDB were associated with a higher likelihood of pregnancy-induced hypertension and pre-eclampsia (adjusted OR 2.3, 95% CI 1.4-4.0), gestational diabetes (adjusted OR 2.1, 95% CI 1.3-3.4) and unplanned Caesarean deliveries (adjusted OR 2.1, 95% CI 1.4-3.2) after multivariable regression analysis. Gasping may have been associated with a higher likelihood of preterm delivery, after adjusting for age and multifetal pregnancies (adjusted OR 1.8, 95% CI 1.1-3.2) but this association appeared to be mediated by pre-eclampsia.Symptoms of SDB are common in pregnancy and associated with a higher likelihood of gestational hypertensive disorders, gestational diabetes and unplanned Caesarean deliveries.

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“…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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Self-Reported Snoring, Maternal Obesity and Neck Circumference as Risk Factors for Pregnancy-Induced Hypertension and Preeclampsia

Cited by 77 publications

References 52 publications

Sleep and Pregnancy-Induced Hypertension: A Possible Target for Intervention?

Sleep and Pregnancy-Induced Hypertension: A Possible Target for Intervention?

Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing

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

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