The intrapartum and perinatal risks of sleep-disordered breathing in pregnancy: a systematic review and metaanalysis

Brown, Nicole; Turner, Jessica; Kumar, Sailesh

doi:10.1016/j.ajog.2018.02.004

Cited by 66 publications

(67 citation statements)

References 61 publications

(184 reference statements)

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“…of adverse pregnancy outcomes 1,[29][30][31]. The results of our study and that of others suggest that a high ESS score is associated with intrapartum complications.…”

supporting

confidence: 68%

“…A recent report from the UK showed that one in 20 stillbirths and neonatal deaths were related to labour . Although SDB is an established risk factor for cardiac and metabolic conditions outside of pregnancy, various systematic reviews now suggest that it is also related to a plethora of adverse pregnancy outcomes . The results of our study and that of others suggest that a high ESS score is associated with intrapartum complications.…”

supporting

confidence: 56%

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An Epworth Sleep Score ≥11 is associated with emergency operative birth and poor neonatal composite outcome at term

Robertson

Flatley

Kumar

2019

Aust NZ J Obst Gynaeco

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Background During pregnancy, the Epworth Sleepiness Scale can be used as a surrogate marker for maternal sleep‐disordered breathing, a condition that is becoming increasingly prevalent in obstetric populations and is associated with a multitude of pregnancy complications. Aims The aim of this observational study was to investigate the relationship between the Epworth Sleepiness Scale score and indication and mode of delivery during pregnancy. Materials and Methods The Epworth Sleepiness Scale was completed by 178 women at Mater Mothers’ Hospital, Brisbane, Australia. Results Women with a score ≥11 were less likely to achieve a spontaneous vaginal delivery (aOR 0.43, 95% CI 0.21–0.88, P = 0.02), and were more likely to have an instrumental (aOR 2.81, 95% CI 1.30–6.08, P = 0.01) or any operative birth (instrumental and caesarean section aOR 2.32, 95% CI 1.14–4.71, P = 0.02). These women were also more likely to have an operative birth for intrapartum fetal compromise (aOR 2.62, 95% CI 1.21–5.69, P = 0.015), as well as an infant with poor neonatal outcomes (aOR 2.77, 95% CI 1.09–7.03, P = 0.03). Conclusions These results show that symptoms of sleep‐disordered breathing are associated with emergency operative birth, particularly when the indication for operative birth was intrapartum fetal compromise.

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“…of adverse pregnancy outcomes 1,[29][30][31]. The results of our study and that of others suggest that a high ESS score is associated with intrapartum complications.…”

supporting

confidence: 68%

supporting

confidence: 56%

An Epworth Sleep Score ≥11 is associated with emergency operative birth and poor neonatal composite outcome at term

Robertson

Flatley

Kumar

2019

Aust NZ J Obst Gynaeco

Self Cite

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“…[2][3][4] In pregnancy, OSA is associated with gestational diabetes mellitus (GDM), hypertensive disorders, preterm birth and reduced birthweight. 5 In pregnancy, pre-existing OSA can worsen, but OSA can also present de novo. 5 Multiple pregnancy is associated with many of the same adverse perinatal outcomes as OSA, including preterm birth, intrauterine growth restriction, GDM and hypertensive disorders.…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnoea in multiple pregnancy

Dave

Cole

Rees

2019

Aust NZ J Obst Gynaeco

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Obstructive sleep apnoea (OSA) during pregnancy has been associated with gestational diabetes mellitus, hypertension and low birth weight. Multiple pregnancy is associated with similar adverse perinatal outcomes. Multiple pregnancy rates have risen with increased access to assisted conception; simultaneously, advancing maternal age and weight are also driving a rise in the incidence of OSA in pregnancy. The intersection of OSA and multiple pregnancy would be presumed to have significant maternal and fetal morbidity; however, specific data are sparse. We review the current state of knowledge on OSA in multiple pregnancy. K E Y W O R D Smultiple pregnancy, multifetal pregnancy, preeclampsia, obesity, obstructive sleep apnoea

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“…Similar to the metabolic and cardiovascular associations of SDB in the non‐pregnant population, maternal SDB has been associated with a range of adverse pregnancy outcomes including gestational diabetes, gestational hypertension and pre‐eclampsia . Adverse outcomes in the offspring of women with SDB have also been reported, including pre‐term birth and low birthweight . It is not known whether this is a direct effect of SDB or a consequence of the maternal complications associated with SDB which can influence foetal growth and timing of delivery.…”

Section: Sdb With Adverse Pregnancy Outcomes: Potential Mechanismsmentioning

confidence: 99%

Sleep disordered breathing in pregnancy: A review of the pathophysiology of adverse pregnancy outcomes

2020

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Sleep disordered breathing (SDB) is a common obesity-related co-morbidity with strong associations to cardiometabolic disease. The risk of SDB is increased during pregnancy, particularly among obese pregnant women. Accumulating evidence suggests that an association exists between maternal SDB and the development of adverse pregnancy outcomes, particularly gestational diabetes and hypertensive disorders of pregnancy. Intermittent hypoxia, a central characteristic of SDB, has been shown in animal and clinical studies to dysregulate several biological pathways. This includes the promotion of oxidative stress, increased inflammation, activation of the hypothalamic-pituitary-adrenal axis, increased sympathetic activity and impaired glucose and insulin metabolism. This review considers how, during pregnancy, these pathophysiological processes are plausible mechanisms through which SDB may contribute to an increased risk of adverse outcomes, for the mother and perhaps also the offspring. However, a lack of robust evidence specific to the pregnant population, including limited evaluation of the placental function in affected pregnancies, limits our ability to draw definite conclusions on mechanisms contributing to adverse pregnancy outcomes and, indeed, the strength of association between SDB and certain pregnancy complications. K E Y W O R D Spregnancy, sleep apnoea, sleep disordered breathing 2 of 13 | JOHNS et al.

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The intrapartum and perinatal risks of sleep-disordered breathing in pregnancy: a systematic review and metaanalysis

Abstract: Maternal sleep-disordered breathing is associated with increased risks of adverse intrapartum and perinatal outcomes.

Cited by 66 publications

References 61 publications

An Epworth Sleep Score ≥11 is associated with emergency operative birth and poor neonatal composite outcome at term

An Epworth Sleep Score ≥11 is associated with emergency operative birth and poor neonatal composite outcome at term

Obstructive sleep apnoea in multiple pregnancy

Sleep disordered breathing in pregnancy: A review of the pathophysiology of adverse pregnancy outcomes

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