Pregnancy-Related Sleep Disturbances May Increase Pregnancy Complications

不良妊娠结局会增加妇女未来患疾病的风险，并将其婴儿置于危险之中 发展、神经和呼吸异常以及死亡率的增加。尽管 对各种行为和心理社会因素的调查在很大程度上导致了 怀孕过程仍未得到解释。越来越多的文献表明，睡眠障碍与 增加的医疗发病率。人们普遍认为，怀孕与睡眠中断有关(3- 5)。尽管有这些证据，但这种干扰的性质和程度仍有待确定。最近的关注 专注于全身炎症参与妊娠并发症发病机制的证据 (23)。因此，提出一个概念模型是合理的，在这个概念模型中，早期的病理性睡眠中断 怀孕会导致全身炎症，从而增加怀孕并发症的风险。同样，它也是 也有理由认为，全身炎症增加会导致睡眠障碍增加 在怀孕早期观察，从而增加妊娠并发症的风险。在 目前的建议，我们建议首先对这种病理生理和双向进行纵向检查 可能导致妊娠并发症风险的途径。将实现以下目标：目标1。 描述复杂和非复杂妊娠的睡眠障碍。目标2.检查 妊娠早期睡眠与循环炎症标志物的关系 与睡眠相关的促炎标记物增加与妊娠并发症之间的关系。按顺序 为了回答这些研究问题，将对400名怀孕10周左右的女性进行观察 在怀孕~14周和~18周时又增加了两倍。参与者将完成睡眠日记，并穿上 Actigraph手表，为期2周。在每两周结束时，参与者将完成一系列 问卷调查，然后收集血液和身体信息。目标1将使用描述性统计。 将使用嵌套病例对照设计来分析睡眠和睡眠的独立和动态影响 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).