Use of PAP in women with pre-eclampsia

描述（由申请人提供）：先兆子痫是一种妊娠特异性疾病，其特征为妊娠20周后观察到的高血压和蛋白尿。它影响5-8%的美国怀孕，是潜在致命的子痫的前兆，并且是孕产妇和婴儿发病率的主要全球原因。在过去的十年中，先兆子痫的发病率增加了近三分之一，怀孕期间的高血压疾病现在每年造成至少76，000名美国人死亡。先兆子痫的原因及其发病率的上升仍然不确定。然而，一些证据表明，睡眠呼吸障碍（SDB）可能起作用。SDB很常见，通常未被诊断-特别是在女性中-并且可以治疗。打鼾是睡眠呼吸障碍的标志性症状，在怀孕期间更频繁。体重增加促进SDB，怀孕期间体重显著增加或其他生理变化也可能加剧SDB。SDB与消除或逆转血压（BP）的正常夜间下降有关，类似于在先兆子痫中观察到的BP模式。值得注意的是，SDB是非妊娠成人高血压的已知独立风险因素，但尚不清楚孕妇的SDB是否会导致先兆子痫。CPAP治疗SDB已被证明可以改善伴有SDB的高血压患者的夜间血压升高，但对不伴有SDB的高血压患者无效。没有研究确定SDB是否真的会增加怀孕期间的夜间血压，SDB是否会促进先兆子痫仍然没有得到证实。因此，本研究的主要目标是确定SDB -通过夜间多导睡眠图测量-是否与先兆子痫相关，以确认使用自动滴定气道正压通气（auto-PAP）可以改善夜间血压，并确定是否存在潜在的SDB。此外，我们将表明，这种夜间血压的改善将与改善母亲白天血压和改善胎儿的结果，如测量更多的天在子宫内和新生儿重症监护室的入院人数减少。相关性（参见说明）：这项新的研究将表明，治疗患有先兆子痫（一种严重的妊娠并发症）的妇女的睡眠呼吸障碍将降低产妇的血压，从而改善母亲和婴儿的健康状况。 (End摘要）

DESCRIPTION (provided by applicant): Pre-eclampsia is a pregnancy-specific disorder characterized by hypertension and proteinuria observed after the 20th week of gestation. It affects 5-8% of U.S. pregnancies, is a precursor for potentially fatal eclampsia, and is a leading global cause of maternal and infant morbidity. The incidence of pre-eclampsia has increased by nearly one-third over the past decade and hypertensive disorders during pregnancy are now responsible for at least 76,000 U.S. deaths each year. The cause of pre-eclampsia and its rising incidence remain uncertain. However, several lines of evidence suggest that sleep-disordered breathing (SDB) could play a role. SDB is common, most often undiagnosed - especially in women - and treatable. Snoring, the hallmark symptom of SDB, is more frequent during pregnancy. Increased weight promotes SDB, and significant weight gain or other physiological changes during pregnancy also may exacerbate SDB. SDB has been associated with elimination or reversal of normal nocturnal dips in blood pressure (BP), similar to BP patterns observed in pre-eclampsia. Of note, SDB is a known independent risk factor for hypertension in non-pregnant adults but it is unknown if SDB in pregnant women contributes to pre-eclampsia. Treatment of SDB with CPAP has been shown to ameliorate nocturnal BP increases in hypertensive patients with SDB, but not in hypertensive patients without SDB. No study has determined whether SDB does in fact increase nocturnal BP during pregnancy and whether SDB promotes pre-eclampsia remains unproven. Therefore, the main goals of this research are to identify whether SDB - as measured by overnight polysomnography - is associated with pre-eclampsia, to confirm that use of auto-titrating positive airway pressure (auto-PAP) can improve nocturnal BP, and to determine whether any such effect depends on the presence of underlying SDB. Moreover, we will show that such improvement in nocturnal BP will be associated with improved maternal daytime BP and improved fetal outcome, as measured by more days in utero and fewer admissions to the neonatal intensive care unit. RELEVANCE (See instructions): This novel research will show that treatment of sleep-disordered breathing in women with pre-eclampsia - a serious complication of pregnancy - will reduce maternal blood pressure which will, in turn, result in improved health for mothers and babies. (End of Abstract)