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有的疾病，其特征是妊娠20周后观察到高血压和蛋白尿。它影响了美国5%-8%的孕妇，是潜在致命子痫的先兆，是母婴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，目前美国每年至少有7.6万人死于妊娠期高血压疾病。先兆子痫的病因及其发病率的上升仍不确定。然而，一些证据表明，睡眠障碍呼吸(SDB)可能起到一定作用。SDB很常见，最常见的是没有诊断出来--尤其是在女性--而且是可以治疗的。打鼾症是SDB的标志症状，在怀孕期间更频繁。体重增加会促进SDB，怀孕期间显著的体重增加或其他生理变化也可能加剧SDB。SDB与消除或逆转正常夜间血压下降(BP)有关，类似于观察到的先兆子痫的血压模式。值得注意的是，SDB是已知的非妊娠成年人高血压的独立危险因素，但尚不清楚怀孕妇女的SDB是否会导致先兆子痫。CPAP治疗SDB可以改善有SDB的高血压患者的夜间血压升高，但不能改善无SDB的高血压患者的夜间血压。还没有研究确定SDB是否真的会增加怀孕期间的夜间血压，以及SDB是否会促进先兆子痫，这一点仍未得到证实。因此，这项研究的主要目标是确定夜间多导睡眠图测量的SDB是否与先兆子痫有关，确认使用自动滴定正压(AUTO-PAP)可以改善夜间血压，并确定是否存在潜在的SDB。此外，我们将展示夜间血压的这种改善将与母亲白天血压的改善和胎儿结局的改善有关，通过更多的宫内天数和更少的新生儿重症监护病房的入院来衡量。相关性(见说明)：这项新的研究将表明，治疗先兆子痫妇女的睡眠呼吸障碍--妊娠的一个严重并发症--将降低母亲的血压，这反过来将改善母亲和婴儿的健康。(摘要结束)

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)