睡眠呼吸障碍与妊娠期高血压疾病及妊娠期糖尿病之间的关联。
Association Between Sleep-Disordered Breathing and Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus.
作者信息
Facco Francesca L, Parker Corette B, Reddy Uma M, Silver Robert M, Koch Matthew A, Louis Judette M, Basner Robert C, Chung Judith H, Nhan-Chang Chia-Ling, Pien Grace W, Redline Susan, Grobman William A, Wing Deborah A, Simhan Hyagriv N, Haas David M, Mercer Brian M, Parry Samuel, Mobley Daniel, Hunter Shannon, Saade George R, Schubert Frank P, Zee Phyllis C
机构信息
University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; RTI International, Washington, DC; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Utah, Salt Lake City, Utah; Case Western Reserve University, Cleveland, Ohio; Columbia University, New York, New York; the University of California-Irvine, Irvine, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; Northwestern University, Chicago, Illinois; Indiana University, Bloomington, Indiana; and the University of Texas Medical Branch, Galveston, Galveston, Texas.
出版信息
Obstet Gynecol. 2017 Jan;129(1):31-41. doi: 10.1097/AOG.0000000000001805.
OBJECTIVE
To estimate whether sleep-disordered breathing during pregnancy is a risk factor for the development of hypertensive disorders of pregnancy and gestational diabetes mellitus (GDM).
METHODS
In this prospective cohort study, nulliparous women underwent in-home sleep-disordered breathing assessments in early (6-15 weeks of gestation) and midpregnancy (22-31 weeks of gestation). Participants and health care providers were blinded to the sleep test results. An apnea-hypopnea index of 5 or greater was used to define sleep-disordered breathing. Exposure-response relationships were examined, grouping participants into four apnea-hypopnea index groups: 0, greater than 0 to less than 5, 5 to less than 15, and 15 or greater. The study was powered to test the primary hypothesis that sleep-disordered breathing occurring in pregnancy is associated with an increased incidence of preeclampsia. Secondary outcomes were rates of hypertensive disorders of pregnancy, defined as preeclampsia and antepartum gestational hypertension, and GDM. Crude and adjusted odds ratios and 95% confidence intervals (CIs) were calculated from univariate and multivariate logistic regression models.
RESULTS
Three thousand seven hundred five women were enrolled. Apnea-hypopnea index data were available for 3,132 (84.5%) and 2,474 (66.8%) women in early and midpregnancy, respectively. The corresponding prevalence of sleep-disordered breathing was 3.6% and 8.3%. The prevalence of preeclampsia was 6.0%, hypertensive disorders of pregnancy 13.1%, and GDM 4.1%. In early and midpregnancy the adjusted odds ratios for preeclampsia when sleep-disordered breathing was present were 1.94 (95% CI 1.07-3.51) and 1.95 (95% CI 1.18-3.23), respectively; hypertensive disorders of pregnancy 1.46 (95% CI 0.91-2.32) and 1.73 (95% CI 1.19-2.52); and GDM 3.47 (95% CI 1.95-6.19) and 2.79 (95% CI 1.63-4.77). Increasing exposure-response relationships were observed between apnea-hypopnea index and both hypertensive disorders and GDM.
CONCLUSION
There is an independent association between sleep-disordered breathing and preeclampsia, hypertensive disorders of pregnancy, and GDM.
目的
评估孕期睡眠呼吸紊乱是否为妊娠高血压疾病和妊娠期糖尿病（GDM）发生的危险因素。
方法
在这项前瞻性队列研究中，未生育女性在孕早期（妊娠6 - 15周）和孕中期（妊娠22 - 31周）接受家庭睡眠呼吸紊乱评估。参与者和医护人员对睡眠测试结果不知情。呼吸暂停低通气指数为5或更高被用于定义睡眠呼吸紊乱。研究了暴露 - 反应关系，将参与者分为四个呼吸暂停低通气指数组：0、大于0至小于5、5至小于15以及15或更高。该研究旨在检验主要假设，即孕期发生的睡眠呼吸紊乱与子痫前期发病率增加相关。次要结局是妊娠高血压疾病的发生率，定义为子痫前期和产前妊娠高血压，以及GDM。从单变量和多变量逻辑回归模型计算粗比值比和调整后的比值比以及95%置信区间（CI）。
结果
共纳入3705名女性。分别有3132名（84.5%）和2474名（66.8%）女性在孕早期和孕中期有呼吸暂停低通气指数数据。睡眠呼吸紊乱的相应患病率分别为3.6%和8.3%。子痫前期的患病率为6.0%，妊娠高血压疾病为13.1%，GDM为4.1%。在孕早期和孕中期，存在睡眠呼吸紊乱时子痫前期的调整后比值比分别为1.94（95%CI 1.07 - 3.51）和1.95（95%CI 1.18 - 3.23）；妊娠高血压疾病为1.46（95%CI 0.91 - 2.32）和1.73（95%CI 1.19 - 2.52）；GDM为3.47（95%CI 1.95 - 6.19）和2.79（95%CI 1.63 - 4.77）。在呼吸暂停低通气指数与高血压疾病和GDM之间均观察到暴露 - 反应关系增强。
结论
睡眠呼吸紊乱与子痫前期、妊娠高血压疾病和GDM之间存在独立关联。
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