Sleep-disordered breathing during pregnancy: future implications for cardiovascular health.
Sleep-disordered breathing during pregnancy: future implications for cardiovascular health.
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DOI：
10.1097/ogx.0000000000000052
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发表时间：
2014-03
影响因子：
6.2
通讯作者：
O'Brien LM
中科院分区：
文献类型：
--
作者：
Dunietz GL;Chervin RD;O'Brien LM
心血管疾病（CVD）是生殖后女性的常见病。晚年心血管疾病的主要危险因素包括妊娠期高血压（GHTN）和先兆子痫（PE）。虽然妊娠期高血压的几个危险因素已得到充分认识，但最近出现的一个新的危险因素是睡眠呼吸障碍（SDB），其特征是睡眠时上呼吸道反复关闭，通气中断和睡眠碎片化。在非怀孕人群中，现在已知SDB在未来心血管疾病中起因果作用。提出妊娠期隐匿性SDB可能在妊娠期高血压病患者长期心血管疾病发生中起作用的假说。SDB与GHTN/PE和GHTN/PE与未来心血管疾病相关的经验证据综述与综合越来越多的证据支持SDB与妊娠期高血压疾病之间的关系，其机制包括炎症、氧化应激和内皮功能障碍。妊娠期高血压疾病通过类似的机制与心血管疾病的长期风险相关。然而，没有研究表明SDB在妊娠期GHTN/PE妇女的长期预后中的潜在作用。考虑到解释这些关联的机制，妊娠期SDB可能增加长期心血管发病率和死亡率是合理的。怀孕可能为识别和治疗SDB提供了一个机会窗口，这可能在未来的许多年里为健康带来实质性的好处。妇产科医生、家庭医生在完成这项CME活动后，医生应该能够更好地评估有关妊娠期睡眠呼吸障碍频率、其危险因素、后续结果和治疗的现有证据。
Cardiovascular disease (CVD) is a common condition in post-reproductive females. Key risk factors for later-life CVD include gestational hypertension (GHTN) and pre-eclampsia (PE). Although several risk factors for hypertension in pregnancy are well recognized, a novel risk factor that has emerged recently is sleep-disordered breathing (SDB), a condition characterized by repeated closure of the upper airway during sleep with disrupted ventilation and sleep fragmentation. In the non-pregnant population, SDB is now known to play a causal role in future cardiovascular disease. To propose the hypothesis that occult SDB during pregnancy may play a role in long-term cardiovascular disease in women who had hypertensive disorders of pregnancy. A review and synthesis of empirical evidence that links SDB to GHTN/PE and GHTN/PE to future cardiovascular disease. An increasing body of evidence supports the relationship between SDB and hypertensive disorders of pregnancy via mechanisms of inflammation, oxidative stress, and endothelial dysfunction. It is well established that hypertensive disorders of pregnancy are associated with long-term risk for cardiovascular disease via similar mechanisms. However, no studies have addressed the potential role for SDB in long-term outcomes of women with GHTN/PE during pregnancy. Given the suggested mechanisms that explain these associations, it is plausible that SDB during pregnancy may increase long-term cardiovascular morbidity and mortality. Pregnancy may offer a window of opportunity for identification and treatment of SDB which could provide substantial health benefit for many years to come. Obstetricians & Gynecologists, Family Physicians After completing this CME activity, physicians should be better able to evaluate the current evidence regarding the frequency of sleep-disordered breathing in pregnancy, its risk factors, subsequent outcomes, and treatment.