Use of PAP in women with pre-eclampsia

描述（由申请人提供）：先兆子痫是妊娠20周后观察到的以高血压和蛋白尿为特征的妊娠特异性疾病。它影响了美国5-8%的孕妇，是潜在致命的子痫的前兆，是全球孕产妇和婴儿发病率的主要原因。在过去的十年中，先兆子痫的发病率增加了近三分之一，怀孕期间的高血压疾病现在导致美国每年至少76,000人死亡。先兆子痫的病因及其发病率的上升仍不确定。然而，一些证据表明睡眠呼吸障碍（SDB）可能起了一定作用。SDB很常见，大多数情况下无法确诊——尤其是女性——而且是可以治疗的。打鼾是SDB的标志性症状，在怀孕期间更为频繁。体重增加可促进SDB，孕期体重明显增加或其他生理变化也可加重SDB。SDB与消除或逆转正常夜间血压（BP）下降有关，类似于在子痫前期观察到的BP模式。值得注意的是，SDB是已知的非怀孕成人高血压的独立危险因素，但尚不清楚孕妇的SDB是否会导致先兆子痫。用CPAP治疗SDB已被证明可以改善患有SDB的高血压患者的夜间血压升高，但对没有SDB的高血压患者则没有效果。没有研究确定SDB是否确实会增加妊娠期夜间血压，也没有研究证实SDB是否会促进先兆子痫。因此，本研究的主要目的是确定SDB（通过夜间多导睡眠图测量）是否与先兆子痫相关，确认使用自动滴定气道正压通气（auto-PAP）可以改善夜间血压，并确定这种效果是否取决于潜在SDB的存在。此外，我们将表明，这种夜间血压的改善将与母亲白天血压的改善和胎儿结局的改善有关，通过子宫内天数的增加和新生儿重症监护病房的入院次数的减少来衡量。相关性（见说明）：这项新研究将表明，对患有先兆子痫（一种严重的妊娠并发症）的妇女进行睡眠呼吸障碍的治疗，将降低母亲的血压，从而改善母亲和婴儿的健康状况。（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)