Sleep disordered breathing and the risk of severe maternal morbidity in women with preeclampsia: A population-based study.
Sleep disordered breathing and the risk of severe maternal morbidity in women with preeclampsia: A population-based study.
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睡眠不足的呼吸和先兆子痫女性严重孕产妇发病的风险：一项基于人群的研究。
DOI：
10.1016/j.preghy.2022.10.013
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发表时间：
2022-12
影响因子：
2.2
通讯作者：
Bourjeily, Ghada
中科院分区：
文献类型：
--
作者：
Malhame, Isabelle;Bublitz, Margaret H.;Wilson, Danielle;Sanapo, Laura;Rochin, Elizabeth;Bourjeily, Ghada
关键词：
阻塞性睡眠呼吸暂停（OSA）可能会加重先兆子痫中广泛的内皮功能障碍，可能会恶化临床结局。我们的目的是评估阻塞性睡眠呼吸暂停综合征是否与子痫前期妇女的严重孕产妇发病率、心血管发病率和医疗保健利用的风险增加有关。我们利用美国国家围产期信息中心（2010-2014）的数据进行了一项回顾性队列研究。该队列包括患有先兆子痫的女性。我们使用逻辑回归分析评估OSA与预后之间的关系，并确定经人口统计学因素和合并症调整的比值比（ORadj）和相关的95%置信区间（CI）。主要结局是死亡率和严重孕产妇发病率的复合终点，包括入住重症监护室（ICU）、急性肾衰竭、肺水肿、肺栓塞、充血性心力衰竭、心肌病和卒中。次要结局包括心血管事件子集以及医疗保健利用增加（包括剖宫产、早产、ICU住院和住院时间延长）。总共有71，159名妇女患有先兆子痫，其中包括270名（0.4%）患有OSA。患有先兆子痫和OSA的女性比没有OSA的女性更可能发生重度孕产妇发病率（ORadj 2.65，95% CI [1.94-3.61]）。此外，合并OSA的女性比未合并OSA的女性有更严重的心血管发病率（ORadj 5.05，95% CI [2.28-11.17]）。因此，OSA与先兆子痫妇女的医疗保健利用增加相关（ORadj. 2.26，95% CI [1.45-3.52]）。在患有先兆子痫的女性中，OSA增加了严重孕产妇发病率、心血管发病率和医疗保健利用的风险。
Obstructive sleep apnea (OSA) may exacerbate the widespread endothelial dysfunction seen in preeclampsia, potentially worsening clinical outcomes. We aimed to assess whether OSA is associated with an increased risk of severe maternal morbidity, cardiovascular morbidity, and healthcare utilization among women with preeclampsia. We performed a retrospective cohort study utilizing data from the National Perinatal Information Center (2010–2014) in the United States. The cohort comprised women with preeclampsia. We estimated the association between OSA and the outcomes using logistic regression analyses and determined odds ratio adjusted for demographic factors and comorbidities (ORadj) and associated 95% confidence intervals (CI). The primary outcome was a composite of mortality and severe maternal morbidity comprising intensive care unit (ICU) admission, acute renal failure, pulmonary edema, pulmonary embolism, congestive heart failure, cardiomyopathy, and stroke. Secondary outcomes comprised the subset of cardiovascular events, as well as increased healthcare utilization (including Cesarean delivery, preterm birth, ICU admission, and prolonged length of hospital stay). In total, 71,159 women had preeclampsia, including 270 (0.4%) with OSA. Women with preeclampsia and OSA were more likely to experience severe maternal morbidity than women without OSA (ORadj 2.65, 95% CI [1.94–3.61]). Moreover, women with concomitant OSA had more severe cardiovascular morbidity than women without OSA (ORadj 5.05, 95% CI [2.28–11.17]). Accordingly, OSA was associated with increased healthcare utilization in women with preeclampsia (ORadj. 2.26, 95% CI [1.45–3.52]). In women with preeclampsia, OSA increases the risk for severe maternal morbidity, cardiovascular morbidity, and healthcare utilization.
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