Maternal Sleep and Sleep Disturbance in Relation to the Developing Fetus

描述（由申请人提供）：睡眠障碍在怀孕期间很常见，孕妇睡眠障碍会对妊娠结果产生不利影响。在足月怀孕期间，孕妇平均有87天的睡眠时间，但我们对正常或紊乱的睡眠对胎儿发育的影响知之甚少。我们的目标是将胎儿的测量，使用尖端技术，包括在产前获取胎儿心电图（ECG）数据的最新进展，到怀孕睡眠研究领域。我们认为胎儿对伴随正常的生理变化有反应，而母亲睡眠紊乱和慢性睡眠障碍对胎儿神经成熟有持续的影响。为了验证这一假设，我们将a)在孕28周孕妇夜间睡眠期间连续记录胎儿心电图，同时参与者接受多导睡眠描记术；b)在孕28周和36周孕妇白天清醒期间记录胎儿神经成熟指标，以评估130名肥胖孕妇的多导睡眠描记术检测到的睡眠呼吸障碍和习惯性睡眠特征自我报告的功能。胎儿神经成熟措施包括胎儿心率和变异、运动活动和躯体-心脏偶联。我们之所以关注肥胖女性，是因为虽然睡眠呼吸障碍已被证明对怀孕结果施加了额外的独立风险，而不仅仅是肥胖，但肥胖是怀孕期间阻塞性睡眠呼吸暂停和其他睡眠障碍的主要风险因素。我们预测：1；阻塞性睡眠呼吸暂停以及较轻形式的睡眠呼吸紊乱都会

DESCRIPTION (provided by applicant): Sleep disorders are common in pregnancy and disturbances to maternal sleep adversely affect pregnancy outcomes. Maternal sleep comprises, on average, 87 days of a full term pregnancy yet little is known about the role of normal or disordered sleep on the developing fetus. Our objective is to bring measurement of the fetus, using leading edge technologies which include the recent advancement in procuring fetal electrocardiogram (ECG) data in the antepartum, to the field of pregnancy sleep research. We propose that the fetus reacts to the physiological changes that accompany normal and that disordered maternal sleep and chronic sleep disturbances have persistent effects on fetal neuromaturation. To evaluate this premise, we will a) record fetal ECG continuously during nocturnal maternal sleep at 28 weeks gestation while participants are undergoing polysomnography, and b) record fetal neuromaturation indicators during daytime maternal wakefulness at 28 and 36 weeks gestation to evaluate functioning in relation to polysomnography-detected sleep disordered breathing and self-report of habitual sleep characteristics in a sample of 130 obese pregnant women. Fetal neuromaturation measures include fetal heart rate and variation, motor activity, and somatic- cardiac coupling. We focus on obese women because, while sleep disordered breathing has been shown to exert additional independent risk to pregnancy outcomes above that conferred solely by obesity, obesity is the primary risk factor for obstructive sleep apnea and other sleep disturbances in pregnancy. We predict that: 1. obstructive sleep apnea as well as milder forms of sleep disordered breathing will be contemporaneously associated with decelerations in fetal heart rate and reduction in heart rate variability during the night; 2. fetal heart rate and its derivatives will vary by maternal slep stage; 3. sleep disordered breathing will have residual effects on fetal neuromaturation that will be evident in daytime recordings during maternal wakefulness; and 4. maternal perception of sleep quality and disruption will be reflected in alterations to fetal neuromaturation between 28 and 36 weeks gestation. This project will forge an interdisciplinary team of technical and clinical expertise with long-standing independent research programs on both sleep in pregnancy and fetal neurodevelopment. Results will provide new information on the interface between maternal sleep and fetal neurological development and will have implications for clinical management of pregnancy with respect to both sleep disorders and obesity. If successful, we hope these findings will generate a new and productive avenue of inquiry regarding the potential fetal programming effects of disordered maternal sleep as well as essential understanding of the interface between maternal sleep and fetal functioning.