Association Between Sleep-Disordered Breathing and Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus.
Association Between Sleep-Disordered Breathing and Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus.
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DOI：
10.1097/aog.0000000000001805
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发表时间：
2017-01
影响因子：
7.2
通讯作者：
Zee PC
中科院分区：
文献类型：
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作者：
Facco FL;Parker CB;Reddy UM;Silver RM;Koch MA;Louis JM;Basner RC;Chung JH;Nhan-Chang CL;Pien GW;Redline S;Grobman WA;Wing DA;Simhan HN;Haas DM;Mercer BM;Parry S;Mobley D;Hunter S;Saade GR;Schubert FP;Zee PC
这项前瞻性队列研究的目的是确定妊娠期睡眠呼吸障碍是否是妊娠期高血压疾病和妊娠期糖尿病发生的危险因素。未产妇在怀孕早期（6-15周）和中期（22-31周）接受家庭睡眠呼吸障碍评估。参与者和提供者对睡眠测试结果不知情。呼吸暂停低通气指数（AHI）≥5被用于定义睡眠呼吸障碍。将受试者分为4个AHI组：AHI=0，0<AHI<5，5≤AHI<15和AHI≥15。该研究旨在检验妊娠期睡眠呼吸障碍与先兆子痫发病率增加相关的主要假设。次要结局是妊娠期高血压疾病（定义为先兆子痫和产前妊娠高血压）和GDM的发生率。通过单变量和多变量logistic回归模型计算粗比值比和校正比值比以及95%置信区间。有3705名妇女参加。分别有3 132名（84.5%）和2 474名（66.8%）怀孕早期和中期妇女的AHI数据。相应的睡眠呼吸障碍患病率为3.6%和8.3%。子痫前期患病率为6.0%，妊娠期高血压疾病患病率为13.1%，GDM患病率为4.1%。在妊娠早期和中期，当存在睡眠呼吸障碍时，先兆子痫的校正比值比为1.94（95%CI 1.07-3.51）和1.95（95% CI 1.18-3.23）;妊娠期高血压疾病，1.46（95% CI 0.91-2.32）和1.73（95% CI 1.19-2.52）; GDM，3.47（95% CI 1.95-6.19）和2.79（95% CI 1.63-4.77）。AHI与高血压疾病和GDM之间的关系越来越密切。睡眠呼吸障碍与先兆子痫、妊娠期高血压疾病和GDM之间存在独立的相关性。
The objective of this prospective cohort study was to determine if sleep disordered breathing during pregnancy is a risk factor for the development of hypertensive disorders of pregnancy and gestational diabetes mellitus. Nulliparous women underwent in-home sleep disordered breathing assessments in early (6–15 weeks) and mid-pregnancy (22–31 weeks). Participants and providers were blinded to the sleep test results. An apnea-hypopnea index (AHI) of ≥5 was used to define sleep disordered breathing. Exposure-response relationships were examined grouping participants into four AHI groups: AHI=0, 0<AHI<5, 5≤AHI<15 and AHI≥15. The study was powered to test the primary hypothesis that sleep disordered breathing occurring in pregnancy is associated with an increased incidence of preeclampsia.. Secondary outcomes were rates of hypertensive disorders of pregnancy, defined as preeclampsia and antepartum gestational hypertension, and GDM. Crude and adjusted odds ratios and 95% confidence intervals were calculated from univariate and multivariate logistic regression models. Three thousand seven hundred and five women were enrolled. AHI data were available for 3,132 (84.5%) and 2,474 (66.8%) women in early and mid-pregnancy, respectively. The corresponding prevalence of sleep disordered breathing was 3.6% and 8.3%. The prevalence of preeclampsia was 6.0%, hypertensive disorders of pregnancy 13.1% and GDM 4.1%. In early and mid-pregnancy the adjusted odds ratios for preeclampsia when sleep disordered breathing was present were 1.94 (95% CI 1.07–3.51) and 1.95 (95% CI 1.18–3.23), respectively; hypertensive disorders of pregnancy, 1.46 (95% CI 0.91–2.32) and 1.73 (95% CI 1.19–2.52); and GDM, 3.47 (95% CI 1.95–6.19) and 2.79 (95% CI 1.63–4.77). Increasing exposure-response relationships were observed between AHI and both hypertensive disorders and GDM. There is an independent association between sleep disordered breathing and preeclampsia, hypertensive disorders of pregnancy, and GDM.