Maternal Sleep and Sleep Disturbance in Relation to the Developing Fetus

描述（由申请人提供）：睡眠障碍在妊娠期很常见，对产妇睡眠的干扰会对妊娠结局产生不利影响。母亲的睡眠平均包括87天的足月妊娠，但人们对正常或紊乱的睡眠对发育中的胎儿的作用知之甚少。我们的目标是使用前沿技术，包括在产前获取胎儿心电图（ECG）数据的最新进展，将胎儿测量带入妊娠睡眠研究领域。我们认为，胎儿的反应，伴随着正常的生理变化和母亲的睡眠障碍和慢性睡眠障碍对胎儿的神经成熟有持续的影响。为了评估这一前提，我们将a）在妊娠28周的夜间母亲睡眠期间连续记录胎儿ECG，同时参与者正在接受多导睡眠描记术，和B）在妊娠28周和36周的白天母亲清醒期间记录胎儿神经成熟指标，以评价与多导睡眠描记术检测的睡眠呼吸障碍和自我监测相关的功能。130例肥胖孕妇的睡眠习惯特征报告胎儿神经成熟的测量包括胎心率和变异、运动活动和体心耦合。我们关注肥胖女性是因为，虽然睡眠呼吸障碍已被证明会对妊娠结局产生额外的独立风险，而不仅仅是肥胖，肥胖是妊娠期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障碍将 与胎儿心率减慢和夜间心率变异性降低同时相关; 2.胎儿心率及其衍生物将随母亲睡眠阶段而变化; 3.睡眠呼吸障碍将对胎儿神经成熟具有残余影响，这在母亲清醒期间的白天记录中将是明显的;以及4.母亲对睡眠质量和中断的感知将反映在妊娠28至36周之间胎儿神经成熟的改变中。该项目将建立一个跨学科的技术和临床团队， 在妊娠期睡眠和胎儿神经发育方面拥有长期独立研究项目的专业知识。结果将提供新的信息之间的接口产妇睡眠和胎儿神经系统发育，并将有影响的临床管理怀孕方面的睡眠障碍和肥胖。如果成功的话，我们希望这些发现将产生一个新的和富有成效的调查途径，关于母亲睡眠障碍的潜在胎儿编程影响，以及母亲睡眠和胎儿功能之间的界面的基本理解。

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.