Predictors of de novo development of obstructive sleep apnea in pregnancy

摘要 睡眠呼吸障碍与妊娠期高血压疾病以及 严重的孕产妇发病率是产妇死亡的两个主要原因。深发展也有关联 肥胖和糖尿病被认为是严重孕产妇发病率的主要因素， 产妇死亡率。这些结果也与不良的长期产妇有关。 心血管和代谢健康，对围产期的公共健康有巨大的影响 而且是长期的，而且是主要成本负担的来源。睡眠障碍的治疗 孕期呼吸道正压呼吸可改善血压 经过一晚的治疗和随机对照试验；然而，长期治疗已经 由于粘附率低而变得复杂。这项研究建议对以下人员进行深入访谈 患有睡眠呼吸暂停的年轻女性参与者，怀孕和非怀孕，了解 在这一人群中遵守PAP的障碍和促进者，并专注于特定于妊娠的 障碍。我们还建议按种族检查孕妇在障碍和促进剂方面的差异。 女人。被诊断为睡眠呼吸暂停并开始PAP的妇女(怀孕和非怀孕) 临床医生的治疗将被招募参加深入访谈，检查障碍 以及所有PAP用户共有的促进器--但这可能会受到怀孕生理的影响-- 以及怀孕的特定障碍。我们将进行有目的的抽样以登记PAP- 坚持和不坚持PAP的妇女以及不采用PAP治疗的人，以更好地 了解他们不同的观点。然后，我们将检查黑色和非黑色的回复 女性通过种族识别可能与交流、信息传递或文化有关的差异 不同之处。将通过从PAP设备下载数据来评估PAP遵守情况，以及 通过使用头带测量在睡眠和活动数据的背景下解释这些数据 睡眠和动态手腕监测器，以测量活动和睡眠周期。这项研究将 能够开发有效的、对文化敏感的咨询策略，以确保最佳 坚持PAP，这是一种干预措施，可以改善患有糖尿病的女性的血液动力学指标 妊娠期糖尿病患者的子痫前期和葡萄糖代谢。大体上 人群PAP疗法已被证明能加速中风的临床恢复，并改善 心力衰竭患者的心功能和功能结局 造成严重孕产妇发病率和死亡率的主要原因。

Summary Sleep disordered breathing is associated with hypertensive disorders of pregnancy as well as severe maternal morbidity, both major causes of maternal mortality. SDB is also associated with obesity and diabetes, considered as major contributors to severe maternal morbidity and maternal mortality. These outcomes have also been associated with poor long term maternal cardiovascular and metabolic health, have a tremendous public health impact both perinatally and long term, and are the source of a major cost burden. Treatment of sleep disordered breathing with positive airway pressure in pregnancy has been shown to improve blood pressure after one night of therapy and in randomized controlled trials; however, long term treatment has been complicated by low adherence. This study proposes to perform in depth interviews with young women participants with sleep apnea, pregnant and non-pregnant, to understand the barriers and facilitators to PAP adherence in this population, and focus on pregnancy specific barriers. We also propose to examine differences in barriers and facilitators by race in pregnant women. Women (pregnant and non-pregnant) diagnosed with sleep apnea and initiated on PAP therapy by a clinician will be enrolled to participate in in-depth interviews examining barriers and facilitators common to all PAP users -but that could be impacted by pregnancy physiology-, as well as pregnancy specific barriers. We will perform purposive sampling to enroll PAP- adherent and PAP-nonadherent women, as well as non-adopters of PAP therapy to better understand their various perspectives. We will then examine responses in Black and non-Black women to identify differences by race that may relate to communication, messaging, or cultural differences. PAP adherence will be assessed by downloading data from PAP devices, and interpreting such data in the context of sleep and activity data by using a headband to measure sleep and an actigraphy wrist monitor to measure activity and sleep cycles. This study will enable the development of effective, culturally sensitive counseling strategies to ensure optimal adherence to PAP, an intervention that improves hemodynamic measures in women with preeclampsia as well as glucose metabolism in women with gestational diabetes. In the general population PAP therapy has been shown to hasten clinical recovery in stroke, and improve cardiac function and functional outcomes in patients with heart failure, conditions that are major causes of severe maternal morbidity and mortality.