Pregnancy-Related Sleep Disturbances May Increase Pregnancy Complications

不良妊娠结局增加了妇女未来发生医学疾病的风险，并使其婴儿处于危险之中 发育、神经和呼吸系统异常，以及死亡率增加。尽管 对各种行为和心理社会因素的调查显示， 怀孕过程仍然无法解释。越来越多的文献表明，睡眠中断与以下因素有关： 增加医疗发病率。人们普遍认为怀孕与睡眠中断有关（3- 5）。尽管有这一证据，但这种破坏的性质和程度仍有待确定。近期关注 集中于全身炎症与妊娠并发症发病机制有关的证据 （23）.因此，提出一个概念模型是合理的，在该模型中，在早期睡眠中的病理性中断是合理的。 怀孕会导致全身性炎症，增加怀孕并发症的风险。同样， 同样合理的是，全身性炎症的增加会导致睡眠中断的增加， 在怀孕早期观察到，从而导致怀孕并发症的风险增加。在 目前的建议，我们提出了第一个纵向检查这种病理生理和双向 可能导致妊娠并发症风险的途径。将致力于实现以下目标：目标1。 描述复杂和简单妊娠中的睡眠障碍。目标2.检查 妊娠早期睡眠与循环炎症标志物的关系。探索 睡眠相关的促炎标志物增加与妊娠并发症之间的关系。为了 为了回答这些研究问题，一组400名妇女将在怀孕10周左右被观察， 在妊娠约14周和约18周时再增加两次。参与者将完成一个睡眠日记， 活动记录仪观察2周。在每两周结束时，参与者将完成一组 调查问卷，然后收集血液和身体信息。描述性统计量将用于目标1。 将采用巢式病例对照设计分析睡眠和睡眠障碍的独立和动态效应， 炎症对妊娠并发症风险的影响（目标2和3）。

Adverse pregnancy outcomes increase a woman's risk of future medical morbidities and place her infant at risk of developmental, neurological and respiratory abnormalities, as well as increased mortality. Despite the investigation of the various behavioral and psychosocial contributors a large portion of the variance in the pregnancy course remains unexplained. A growing literature shows that sleep disruption is associated with increased medical morbidity. It is widely accepted that pregnancy is associated with the disruption of sleep (3- 5). Despite this evidence, the nature and extent of this disruption remains to be determined. Recent attention has focused on evidence that systemic inflammation is involved in the pathogenesis of pregnancy complications (23). Thus, it is reasonable to propose a conceptual model where pathological disruption of sleep during early pregnancy results in systemic inflammation that contributes to risk of pregnancy complications. Likewise, it is also reasonable to propose that increased systemic inflammation contributes to increased sleep disruption observed during early pregnancy thereby contributing to increased risk of pregnancy complications. In the current proposal, we propose the first longitudinal examination of this pathophysiologic and bi-directional pathway that may contribute to risk of pregnancy complications. The following aims will be addressed: Aim 1. Characterize sleep disturbances in both complicated and uncomplicated pregnancies. Aim 2. Examine the relationship between sleep and circulating inflammatory markers during early pregnancy .Aim 3. Explore the association between sleep-related increases in proinflammatory markers and pregnancy complications. In order to answer these research questions a cohort of 400 women will be seen around 10 weeks gestation and seen twice more at ~14 weeks and ~18 weeks gestation. Participants will complete a sleep diary and wear an actigraph watch for a 2-week period. At the end of each 2-week period, participants will complete a battery of questionnaires, then have blood and physical information collected. Descriptive statistics will be used for Aim 1. A nested case-control design will be used to analyze the independent and djmamic effects of sleep and inflammation on the risk of pregnancy complications (Aims 2 and 3).