Top

Published in:

01-06-2019 | Epidemiology • Original Article

Obstructive sleep apnea as a risk factor for preeclampsia–eclampsia

Authors: Nattapong Jaimchariyatam, Kunyalak Na-rungsri, Somkanya Tungsanga, Somrat Lertmaharit, Vitool Lohsoonthorn, Surachart Totienchai

Published in: Sleep and Breathing | Issue 2/2019

Abstract

Purpose

Preeclampsia–eclampsia remains one of the leading causes of maternal and perinatal morbidity and mortality. Emerging evidence suggests that obstructive sleep apnea (OSA), which has been linked to hypertension in the general population, may play role in hypertensive disorders in pregnancy, including preeclampsia–eclampsia. However, little research has been conducted in Asia (no data in Thailand) on the effects of OSA on preeclampsia–eclampsia. We aimed to examine the association between OSA and preeclampsia–eclampsia among Thai pregnant women.

Methods

We conducted a large prospective cohort study among Thai pregnant women who were in the second trimester of singleton pregnancy. The Berlin Questionnaire was administered to evaluate the risk for OSA. Preeclampsia–eclampsia was diagnosed by standard clinical assessment. Multivariate models were applied in adjustment for confounding factors.

Results

Enrolled were 1345 pregnant women. The overall prevalence of high risk for OSA was 10.1% (95% confidence intervals [CIs] 8.5–11.7), and it was significantly associated with pre-pregnancy body mass index and score on the Perceived Stress Scale. An adjusted odds ratio (OR) for preeclampsia–eclampsia in women with high risk for OSA was 2.72 (95% CI 1.33–5.57).

Conclusions

Pregnant women with high risk for OSA are at increased risks for preeclampsia–eclampsia compared to those with low risk for OSA. Our results support a role for screening for OSA by BQ during antenatal care.

Wallis AB, Saftlas AF, Hsia J, Atrash HK (2008) Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, United States, 1987–2004. Am J Hypertens 21(5):521–526. https://doi.org/10.1038/ajh.2008.20 CrossRefPubMed

Duley L (2009) The global impact of pre-eclampsia and eclampsia. Semin Perinatol 33(3):130–137. https://doi.org/10.1053/j.semperi.2009.02.010 CrossRefPubMed

Khan KS, Wojdyla D, Say L, Gulmezoglu AM, VanLook PF (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367:1066–1074. https://doi.org/10.1016/S0140-6736(06)68397-9 CrossRefPubMed

Nadeem R, Molnar J, Madbouly EM, Nida M, Aggarwal S, Sajid H, Naseem J, Loomba R (2013) Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med 9(10):1003–1012. https://doi.org/10.5664/jcsm.3070 CrossRefPubMedPubMedCentral

Narkiewicz K, Wolf J, Lopez-Jimenez F, Somers VK (2005) Obstructive sleep apnea and hypertension. Curr Cardiol Rep 7(6):435–440CrossRefPubMed

Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D’Agostino RB, Newman AB, Lebowitz MD, Pickering TG (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 283(14):1829–1836CrossRefPubMed

Gargano JW, Holzman C, Senagore P, Thorsen P, Skogstrand K, Hougaard DM, Rahbar MH, Chung H (2008) Mid-pregnancy circulating cytokine levels, histologic chorioamnionitis and spontaneous preterm birth. J Reprod Immunol 79(1):100–110. https://doi.org/10.1016/j.jri.2008.08.006 CrossRefPubMedPubMedCentral

Pien GW, Fife D, Pack AI, Nkwuo JE, Schwab RJ (2005) Changes in symptoms of sleep-disordered breathing during pregnancy. Sleep 28(10):1299–1305CrossRefPubMed

O'Brien LM, Bullough AS, Owusu JT, Tremblay KA, Brincat CA, Chames MC, Kalbfleisch JD, Chervin RD (2012) Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study. Am J Obstet Gynecol 207(6):487e1–487e9. https://doi.org/10.1016/j.ajog.2012.08.034 CrossRef

10.

Bourjeily G, Raker CA, Chalhoub M, Miller MA (2010) Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing. Eur Respir J 36(4):849–855. https://doi.org/10.1183/09031936.00021810 CrossRefPubMed

11.

Punjabi NM (2008) The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5(2):136–143. https://doi.org/10.1513/pats.200709-155MG CrossRefPubMedPubMedCentral

12.

Li L, Zhao K, Hua J, Li S (2018) Association between sleep-disordered breathing during pregnancy and maternal and fetal outcomes: an updated systematic review and meta-analysis. Front Neurol 9:91. https://doi.org/10.3389/fneur.2018.00091 CrossRefPubMedPubMedCentral

13.

Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491CrossRefPubMed

14.

Tantrakul V, Sirijanchune P, Panburana P, Pengjam J, Suwansathit W, Boonsarngsuk V, Guilleminault C (2015) Screening of obstructive sleep apnea during pregnancy: differences in predictive values of questionnaires across trimesters. J Clin Sleep Med 11(2):157–163. https://doi.org/10.5664/jcsm.4464 CrossRefPubMedPubMedCentral

15.

Parry BL, Martinez LF, Maurer EL, Lopez AM, Sorenson D, Meliska CJ (2006) Sleep, rhythms and women’s mood. Part I. Menstrual cycle, pregnancy and postpartum. Sleep Med Rev 10(2):129–144. https://doi.org/10.1016/j.smrv.2005.09.003 CrossRefPubMed

16.

Facco FL, Kramer J, Ho KH, Zee PC, Grobman WA (2010) Sleep disturbances in pregnancy. Obstet Gynecol 115(1):77–83. https://doi.org/10.1097/AOG.0b013e3181c4f8ec CrossRefPubMed

17.

Wilson DL, Barnes M, Ellett L, Permezel M, Jackson M, Crowe SF (2011) Decreased sleep efficiency, increased wake after sleep onset and increased cortical arousals in late pregnancy. Aust N Z J Obstet Gynaecol 51(1):38–46. https://doi.org/10.1111/j.1479-828X.2010.01252.x CrossRefPubMed

18.

Lee KA, Zaffke ME, McEnany G (2000) Parity and sleep patterns during and after pregnancy. Obstet Gynecol 95(1):14–18PubMed

19.

Hedman C, Pohjasvaara T, Tolonen U, Suhonen-Malm AS, Myllyla VV (2002) Effects of pregnancy on mothers’ sleep. Sleep Med 3(1):37–42CrossRefPubMed

20.

Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396CrossRefPubMed

21.

Wongpakaran N, Wongpakaran T (2010) The Thai version of the PSS-10: an investigation of its psychometric properties. Biopsychosoc Med 4:6. https://doi.org/10.1186/1751-0759-4-6 CrossRefPubMedPubMedCentral

22.

American College of Obstetricians and Gynecologists (2013) Task Force on Hypertension in Pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on hypertension in pregnancy executive summary. Obstet Gynecol 122:1122–1131. https://doi.org/10.1097/01.AOG.0000437382.03963.88 CrossRef

23.

Antony KM, Agrawal A, Arndt ME, Murphy AM, Alapat PM, Guntupalli KK, Aagaard KM (2014) Association of adverse perinatal outcomes with screening measures of obstructive sleep apnea. J Perinatol 34(6):441–448. https://doi.org/10.1038/jp.2014.25 CrossRefPubMed

24.

Olivarez SA, Ferres M, Antony K, Mattewal A, Maheshwari B, Sangi-Haghpeykar H, Aagaard-Tillery K (2011) Obstructive sleep apnea screening in pregnancy, perinatal outcomes, and impact of maternal obesity. Am J Perinatol 28(8):651–658. https://doi.org/10.1055/s-0031-1276740 CrossRefPubMed

25.

Louis J, Auckley D, Miladinovic B, Shepherd A, Mencin P, Kumar D, Mercer B, Redline S (2012) Perinatal outcomes associated with obstructive sleep apnea in obese pregnant women. Obstet Gynecol 120(5):1085–1092. https://doi.org/10.1097/AOG.0b013e31826eb9d8 CrossRefPubMed

26.

Facco FL, Parker CB, Reddy UM et al (2017) Association between sleep-disordered breathing and hypertensive disorders of pregnancy and gestational diabetes mellitus. Obstet Gynecol 129(1):31–41. https://doi.org/10.1097/AOG.0000000000001805 CrossRefPubMedPubMedCentral

27.

Romero R, Badr MS (2014) A role for sleep disorders in pregnancy complications: challenges and opportunities. Am J Obstet Gynecol 210(1):3–11. https://doi.org/10.1016/j.ajog.2013.11.020 CrossRefPubMedPubMedCentral

28.

Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP (2010) Pathophysiology of sleep apnea. Physiol Rev 90(1):47–112. https://doi.org/10.1152/physrev.00043.2008 CrossRefPubMedPubMedCentral

29.

Challis JR, Lockwood CJ, Myatt L, Norman JE, Strauss JF 3rd, Petraglia F (2009) Inflammation and pregnancy. Reprod Sci 16(2):206–215. https://doi.org/10.1177/1933719108329095 CrossRefPubMed

30.

Hubel CA (1999) Oxidative stress in the pathogenesis of preeclampsia. Proc Soc Exp Biol Med 222(3):222–235CrossRefPubMed

31.

Sibai BM, Koch MA, Freire S, Pinto e Silva JL, Rudge MV, Martins-Costa S, Moore J, Santos Cde B, Cecatti JG, Costa R, Ramos JG, Moss N, Spinnato JA (2011) The impact of prior preeclampsia on the risk of superimposed preeclampsia and other adverse pregnancy outcomes in patients with chronic hypertension. Am J Obstet Gynecol 204(4):345e1–345e6. https://doi.org/10.1016/j.ajog.2010.11.027 CrossRef

32.

Chappell LC, Enye S, Seed P, Briley AL, Poston L, Shennan AH (2008) Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: a prospective study. Hypertension 51(4):1002–1009. https://doi.org/10.1161/HYPERTENSIONAHA.107.107565 CrossRefPubMed

33.

Wilson DL, Walker SP, Fung AM, O'Donoghue F, Barnes M, Howard M (2013) Can we predict sleep-disordered breathing in pregnancy? The clinical utility of symptoms. J Sleep Res 22(6):670–678. https://doi.org/10.1111/jsr.12063 CrossRefPubMed

34.

Mindell JA, Cook RA, Nikolovski J (2015) Sleep patterns and sleep disturbances across pregnancy. Sleep Med 16(4):483–488. https://doi.org/10.1016/j.sleep.2014.12.006 CrossRefPubMed

Title: Obstructive sleep apnea as a risk factor for preeclampsia–eclampsia
Authors: Nattapong Jaimchariyatam
Kunyalak Na-rungsri
Somkanya Tungsanga
Somrat Lertmaharit
Vitool Lohsoonthorn
Surachart Totienchai
Publication date: 01-06-2019
Publisher: Springer International Publishing
Published in: Sleep and Breathing / Issue 2/2019
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-018-1758-8

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Obstructive sleep apnea as a risk factor for preeclampsia–eclampsia

Abstract

Purpose

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2019

Weight gain may affect mandibular advancement device therapy in patients with obstructive sleep apnea: a retrospective study

Laryngopharyngeal motor dysfunction and obstructive sleep apnea in Parkinson’s disease

Postural and vestibular changes related to CPAP treatment in moderate-to-severe OSA patients: a 12-month longitudinal study

Predictors of cognitive behavioral therapy outcomes for insomnia in veterans with post-traumatic stress disorder

Pollen levels on the day of polysomnography influence sleep disordered breathing severity in children with allergic rhinitis

Physical activity and sleep quality in relation to mental health among college students

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page