肥胖孕妇中睡眠呼吸紊乱与母体内皮和代谢标志物的关系。
The association between sleep-disordered breathing and maternal endothelial and metabolic markers in pregnancies complicated by obesity.
机构信息
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Obstetrics and Gynecology, University Hospitals, Cleveland, Ohio.
出版信息
J Clin Sleep Med. 2023 Jan 1;19(1):97-109. doi: 10.5664/jcsm.10254.
STUDY OBJECTIVES
To evaluate the impact of sleep-disordered breathing (SDB) on vascular, angiogenic and metabolic analytes in pregnancy.
METHODS
Participants with a body mass index ≥30 kg/m underwent polysomnography at 14-20 weeks gestation (visit 1). Participants with SDB (defined as an apnea-hypopnea index ≥5 events/h) were then enrolled in a separate trial. SDB-negative participants returned for a polysomnogram at 28-31 weeks (visit 2) and were recategorized as persistent-negative SDB or new-onset SDB. Mean arterial blood pressure, mean uterine artery Doppler pulsatility index, endoglin, soluble Feline McDonough Sarcoma-like tyrosine kinase 1, placental growth factor, and the homeostatic model assessment for insulin resistance were measured after each visit. Our primary outcome was a composite of uterine artery Doppler pulsatility index, soluble FMS-like tyrosine kinase 1/placental growth factor ratio, and homeostatic model assessment for insulin resistance. For secondary analyses, each outcome variable was analyzed independently.
RESULTS
A total of 242 and 130 participants completed visit 1 and visit 2, respectively. Newly diagnosed SDB was present in 37% of individuals at visit 1 and 31% of individuals at visit 2. No significant differences in our composite outcome vector were observed in individuals with and without SDB at either visit. In our secondary analysis, mean arterial blood pressure (88.7 ± 7.3 mm Hg vs 85.4 ± 7.1 mm Hg, = .04) and fasting glucose (92.4 ± 15.2 mg/dL vs 86.6 ± 11.5 mg/dL, = .05) were higher in participants with early pregnancy SDB. These associations were not observed for new-onset SDB. No associations were observed between uterine artery Doppler pulsatility index and angiogenic markers and SDB in pregnancy.
CONCLUSIONS
SDB in early pregnancy was not associated with our composite primary outcome but was associated with higher mean arterial blood pressure and fasting glucose. The pathophysiologic changes that occur in pregnant individuals with SDB and how they lead to an increased risk of preeclampsia and gestational diabetes remain poorly understood.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Name: Sleep Disordered Breathing, Obesity and Pregnancy Study (SOAP); URL: https://clinicaltrials.gov/ct2/show/NCT02086448; Identifier: NCT02086448.
CITATION
Onslow ML, Wolsk J, Wisniewski S, et al. The association between sleep-disordered breathing and maternal endothelial and metabolic markers in pregnancies complicated by obesity. . 2023;19(1):97-109.
研究目的
评估睡眠呼吸障碍（SDB）对妊娠期间血管、血管生成和代谢分析物的影响。
方法
体重指数≥30 kg/m2 的参与者在 14-20 周妊娠时进行多导睡眠图检查（第 1 次就诊）。有 SDB（定义为每小时呼吸暂停低通气指数≥5 次）的参与者随后被纳入一项单独的试验。SDB 阴性的参与者在 28-31 周时再次进行多导睡眠图检查（第 2 次就诊），并重新分类为持续性 SDB 阴性或新发 SDB。每次就诊后测量平均动脉血压、子宫动脉多普勒搏动指数、内胚层、可溶性猫麦克唐纳肉瘤样酪氨酸激酶 1、胎盘生长因子和稳态模型评估的胰岛素抵抗。我们的主要结局是子宫动脉多普勒搏动指数、可溶性 FMS 样酪氨酸激酶 1/胎盘生长因子比值和稳态模型评估的胰岛素抵抗的复合指标。对于次要分析，分别分析每个结局变量。
结果
共有 242 名和 130 名参与者分别完成了第 1 次和第 2 次就诊。第 1 次就诊时，37%的参与者新诊断为 SDB，第 2 次就诊时，31%的参与者新诊断为 SDB。在第 1 次和第 2 次就诊时，无论是否存在 SDB，我们的复合结局向量均无显著差异。在我们的二次分析中，早期妊娠 SDB 参与者的平均动脉血压（88.7±7.3 mm Hg 比 85.4±7.1 mm Hg， =.04）和空腹血糖（92.4±15.2 mg/dL 比 86.6±11.5 mg/dL， =.05）较高。这些关联在新发 SDB 中并未观察到。妊娠期间 SDB 与子宫动脉多普勒搏动指数和血管生成标志物之间无关联。
结论
妊娠早期的 SDB 与我们的复合主要结局无关，但与较高的平均动脉血压和空腹血糖有关。SDB 孕妇发生的病理生理变化及其如何导致子痫前期和妊娠期糖尿病风险增加仍知之甚少。
临床试验注册
注册处：ClinicalTrials.gov；名称：睡眠呼吸障碍、肥胖与妊娠研究（SOAP）；网址：https://clinicaltrials.gov/ct2/show/NCT02086448；标识符：NCT02086448。
引文
Onslow ML，Wolsk J，Wisniewski S，等。睡眠呼吸障碍与肥胖合并妊娠期间母体内皮和代谢标志物的关系。 2023；19（1）：97-109。
Zotero 插件