The Impact of Sleep-Disordered Breathing on Adverse Pregnancy Outcomes

描述(申请人提供)：在美国，妊娠期高血压影响5-8%的怀孕，对胎儿和母亲都会造成严重的并发症。高血压可能会导致先兆子痫，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。公认的高血压的一个独立风险是睡眠呼吸紊乱(SDB)。这种常见的、可治疗的、但通常未确诊的睡眠障碍通常会随着体重超标而发展。现有文献表明，怀孕期间体重大幅增加和其他生理变化可能与鼾声增加有关，鼾声是SDB风险的一个众所周知的标志。然而，SDB在妊娠中的患病率并不是很清楚，作为筛查其存在的最佳症状和体征在很大程度上仍然没有研究，而且它与母婴结局的关系从未在大样本中进行过探索。因此，这项修订后的应用程序的主要目标是确定妊娠最后三个月的妇女样本中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后果，即母亲的先兆子痫和婴儿的胎龄偏小。此外，我们还将展示“概念证明”，即习惯性打鼾症与多导睡眠图在孕妇样本中对呼吸事件的客观测量有关。目的1比较1400例晚期妊娠妇女和200例非妊娠妇女鼾症和其他SDB症状的横断面频率。目的2将在1400名孕妇中证明简单的体格测量和颈部测量与SDB症状之间的横断面关联。AIM 3将使用1400名受试者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。作为一个探索性目标，目标4将测试自我报告的习惯性鼾声是否与呼吸事件的增加有关，这是通过对20名习惯性鼾症妇女和20名非习惯性鼾症妇女的多导睡眠图测量得出的。这种呼吸事件很可能是SDB症状和结果之间的假定中介变量。这项研究的结果可能会对公众健康产生重要影响。在一项大型前瞻性研究中，首次将SDB作为不良母婴结局的危险因素。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关于筛查以外的下一步行动的新研究提供关键证据，即怀孕期间的早期SDB诊断和治疗--作为减少先兆子痫和低出生体重的战略。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。睡眠障碍呼吸将首次在一项大型前瞻性研究中被牵连，作为不良母婴结局的风险因素，临床医生将被提醒可能识别问题的潜在症状和体征。这项研究最终将导致开发早期干预策略来治疗妊娠期睡眠呼吸障碍，这可能最终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.