The Impact of Sleep-Disordered Breathing on Adverse Pregnancy Outcomes

描述（由申请人提供）：妊娠期高血压影响美国5-8%的妊娠，并导致胎儿和母亲的严重并发症。高血压可能导致先兆子痫，这可能会限制胎儿生长或引发早产。在过去的十年中，先兆子痫的发病率增加了近三分之一。一个公认的高血压独立风险是睡眠呼吸障碍（SDB）。这种常见的和可治疗的，但通常未确诊的睡眠障碍往往与超重的发展。现有的文献表明，在怀孕的短期内，体重的大量增加和其他生理变化可能与打鼾增加有关，打鼾是SDB风险的一个众所周知的标志。然而，妊娠期SDB的患病率并不为人所知，用作筛查其存在的最佳症状和体征在很大程度上尚未研究，其与母体和胎儿结局的关系从未在大样本中进行过探索。因此，本修订申请的主要目标是确定妊娠最后三个月妇女样本中SDB症状和体征的频率，并评估这些症状和体征是否可以预测两个关键的不良结局，即母亲的先兆子痫和婴儿的胎龄较小。此外，我们将证明“概念验证”，即习惯性打鼾与多导睡眠描记仪在孕妇样本中的呼吸事件的客观测量相关。目的1：比较1400名妊娠晚期妇女和200名非妊娠妇女打鼾和其他SDB症状的横截面频率。目的2将证明在1400名孕妇中，简单的物理气道和颈部测量与SDB症状的横截面关联。目标3将使用1400名受试者队列的产后医疗记录来评估SDB症状和体征预测不良妊娠结局的程度，特别是先兆子痫和低出生体重。作为探索性目标，目标4将测试自我报告的习惯性打鼾是否与呼吸事件数量增加相关，如从20名习惯性打鼾女性和20名无习惯性打鼾女性的多导睡眠图中测量的。这些呼吸事件可能是SDB症状和结局之间的假定中间变量。这项研究的结果可能对公共卫生产生重要影响。SDB将首次在一项大型前瞻性研究中被认为是不良母婴结局的风险因素。临床医生将获得新的，简单的，廉价的筛查工具，以确定这些结果的风险。这项初步研究中产生的数据将为筛查之后的下一步新研究提供关键依据，即妊娠期间的早期SDB诊断和治疗-作为减少先兆子痫和低出生体重的策略。 公共卫生相关性：这项研究的结果将对公共卫生产生重大影响。在一项大型前瞻性研究中，睡眠呼吸障碍将首次被认为是孕产妇和婴儿不良结局的风险因素，临床医生将被提醒注意可能识别问题的潜在症状和体征。这项研究将最终导致早期干预策略的发展，以治疗妊娠期间的睡眠呼吸障碍，最终可能降低不良妊娠结局的风险。

DESCRIPTION (provided by applicant): Hypertension during pregnancy affects 5-8% of pregnancies in the United States and contributes to serious complications for both the fetus and mother. Hypertension may lead to pre-eclampsia, which can restrict fetal growth or trigger premature birth. The rate of pre-eclampsia has increased by nearly one-third during the past decade. One well recognized independent risk for hypertension is sleep-disordered breathing (SDB). This common and treatable, but usually undiagnosed sleep disorder often develops with excess body weight. Available literature suggests that substantial weight gain and other physiological changes during the short period of pregnancy may be associated with increased snoring, a well known marker for SDB risk. However, the prevalence of SDB in pregnancy is not well known, the best symptoms and signs to use as screens for its presence remain largely unstudied, and its relationships to maternal and fetal outcomes have never been explored in a large sample. The main goals of this revised application, therefore, are to determine the frequency of SDB symptoms and signs in a sample of women in the last trimester of pregnancy, and to assess whether such symptoms and signs may predict two key adverse outcomes, pre-eclampsia in the mother and small size for gestational age in the infant. In addition, we will show "proof-of-concept" that habitual snoring is associated with objective measures of respiratory events from polysomnography in a sample of pregnant women. Aim 1 will compare the cross-sectional frequencies of snoring and other SDB symptoms among 1400 third-trimester pregnant women and 200 non-pregnant women. Aim 2 will demonstrate the cross-sectional association, among the 1400 pregnant women, of simple physical airway and neck measurements with SDB symptoms. Aim 3 will use postpartum medical records of the 1400-subject cohort to assess the extent to which SDB symptoms and signs predict adverse pregnancy outcomes, in particular pre-eclampsia and low birth weight. As an exploratory aim, Aim 4, will test whether self-reported habitual snoring is associated with an increased number of respiratory events, as measured from a polysomnogram in 20 women with habitual and 20 women without habitual snoring. Such respiratory events are likely the presumed intermediary variable between SDB symptoms and outcomes. Results of this study could have important impact on public health. SDB will be implicated, for the first time in a large prospective study, as a risk factor for adverse maternal and infant outcomes. Clinicians will be given new, simple, and inexpensive screening tools to identify risk for these outcomes. Data generated in this initial study will provide critical justification for new research on next steps beyond screening, namely early SDB diagnosis and treatment during pregnancy -- as strategies to reduce pre-eclampsia and low birth weight. PUBLIC HEALTH RELEVANCE: Results from this study will have a major influence on public health. Sleep-disordered breathing will be implicated, for the first time in a large prospective study, as a risk factor for adverse maternal and infant outcomes and clinicians will be alerted to potential symptoms and signs that may identify a problem. This study will ultimately lead to the development of early intervention strategies to treat sleep disordered breathing during pregnancy which may ultimately reduce risk of adverse pregnancy outcome.