Perinatal Outcomes Associated With Obstructive Sleep Apnea in Obese Pregnant Women
Perinatal Outcomes Associated With Obstructive Sleep Apnea in Obese Pregnant Women
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DOI：
10.1097/aog.0b013e31826eb9d8
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发表时间：
2012-11-01
影响因子：
7.2
通讯作者：
Redline, Susan
中科院分区：
文献类型：
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作者：
Louis, Judette;Auckley, Dennis;Redline, Susan
目的：探讨阻塞性睡眠呼吸暂停（OSA）与肥胖孕妇的母亲和新生儿发病率之间的关系。方法：参与者被纳入一项前瞻性观察性研究，旨在筛查OSA，并描述肥胖（体重指数[BMI，计算为体重（kg）/[身高（m）]（2）] ≥ 30）孕妇中OSA的可能危险因素和结局。妇女们使用便携式家庭监测器进行了一项通宵睡眠研究。研究由中央掩蔽睡眠阅读中心使用美国睡眠医学学会诊断标准手动评分。呼吸暂停低通气指数5或以上被认为是OSA的诊断。结果：175例妇女中，OSA患病率为15.4%（轻度13例，中度9例，重度5例）。与无OSA（呼吸暂停低通气指数小于5）相比，OSA组的BMI更高（46.8+/-12.2比38.1+/-7.5; P= 0.002），慢性高血压更多（55.6%比32.4%，P= 0.02）。产妇并发症包括产妇死亡（n=1，羊水栓塞[无OSA组]）和心脏骤停（n=1，剖宫产术中[OSA组]）。在无OSA组中发生了1例可预见分娩和2例死产。在活产婴儿中，OSA与更频繁的剖宫产（65.4%与32.8%; P= 0.003）、先兆子痫（42.3%与16.9%; P= 0.005）和新生儿重症监护病房入院（46.1%与17.8%; P= 0.002）相关。在控制了BMI、母亲年龄和糖尿病后，（比值比[OR] 3.55，95%置信区间[CI] 1.1-11.3），既往先兆子痫（OR 2.79，95% CI 1.09-7.19），高血压（OR 4.25，95%CI 1.67-10.77）与子痫前期的发生有关。肥胖孕妇中阻塞性睡眠呼吸暂停与更频繁的先兆子痫、新生儿重症监护病房入院和剖宫产相关。（Obstet Gynecol 2012; 120：1085-92）DOI：http：//10.1097/AOG.0b013e31826eb9d8
OBJECTIVE: To investigate the associations between obstructive sleep apnea (OSA) and maternal and neonatal morbidities in a cohort of obese gravid women.METHODS: Participants were enrolled in a prospective observational study designed to screen for OSA and describe the possible risk factors for and outcomes of OSA among obese (body mass index [BMI, calculated as weight (kg)/[height (m)](2)] 30 or higher) pregnant women. Women underwent an overnight sleep study using a portable home monitor. Studies were manually scored by a central masked sleep reading center using American Academy of Sleep Medicine diagnostic criteria. An apnea hypopnea index of 5 or more was considered diagnostic of OSA. Perinatal outcomes were compared between women with and without OSA.RESULTS: Among 175 women, OSA prevalence was 15.4% (13 mild, 9 moderate, 5 severe). Compared with no OSA (apnea hypopnea index less than 5), the OSA group had a higher BMI (46.8+/-12.2 compared with 38.1+/-7.5; P=.002) and more chronic hypertension (55.6% compared with 32.4%, P=.02). Maternal complications included maternal death (n=1, amniotic fluid embolus [no OSA group]) and cardiac arrest (n=1, intra-operative at cesarean delivery [OSA group]). One previable birth and two stillbirths occurred in the no OSA group. Among live births, OSA was associated with more frequent cesarean delivery (65.4% compared with 32.8%; P=.003), preeclampsia (42.3% compared with 16.9%; P=.005), and neonatal intensive care unit admission (46.1% compared with 17.8%; P=.002). After controlling for BMI, maternal age, and diabetes, OSA (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.1-11.3), previous preeclampsia (OR 2.79, 95% CI 1.09-7.19), and hypertension (OR 4.25, 95% CI 1.67-10.77) were associated with development of preeclampsia.CONCLUSION: Obstructive sleep apnea among obese pregnant women is associated with more frequent preeclampsia, neonatal intensive care unit admissions, and cesarean delivery. (Obstet Gynecol 2012; 120: 1085-92) DOI: http://10.1097/AOG.0b013e31826eb9d8