Sleep-disordered breathing in pregnancy and post-delivery metabolic syndrome 

Sleep-disordered breathing in pregnancy and post-delivery metabolic syndrome 
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New research indicates that sleep-disordered breathing during and after pregnancy is associated with an increased risk of metabolic syndrome.

A research team from UPMC Magee-Women’s Hospital, Pittsburgh, examined whether sleep-disordered breathing (primarily sleep obstructive sleep apnoea) during pregnancy and the years after delivery, could increase the risk of metabolic syndrome and hypertension.

The study was published online in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

Sleep-disordered breathing in pregnancy

In “Sleep Disordered Breathing in Pregnancy and Post-Delivery: Associations with Cardiometabolic Health,” Francesca L. Facco, MD, assistant professor, Department of Obstetrics, Gynecology & Reproductive Science, Division of Maternal-Fetal Medicine, UPMC Magee-Women’s Hospital, Pittsburgh, and colleagues conducted sleep apnoea tests.

The participants were a subgroup of 1,964 women who were part of the ‘Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be Heart Health Study’ (nuMoM2b-HHS) who were experiencing their first pregnancy, and 1,222 of the same study participants who were examined two-seven years after delivery. The researchers then determined whether participants were at increased risk for hypertension or metabolic syndrome.

“Whilst epidemiologic data from cohorts of middle-aged and older adults indicate that sleep-disordered breathing is associated with adverse cardiometabolic outcomes, less is known about how sleep-disordered breathing in pregnancy and the post-delivery period impacts maternal health,” stated the authors.

Sleep-disordered breathing during pregnancy has been associated with a two to three-fold increased risk of preeclampsia – persistent high blood pressure during pregnancy that can lead to serious health consequences – and/or gestational diabetes (diabetes that develops during pregnancy).  These and other adverse pregnancy outcomes are risk factors for later development of hypertension and metabolic disease in the mother.

Participants were tested both during pregnancy and two to seven years later, each using the same model home sleep apnoea test. Amongst other factors, sleep apnoea tests measure the number of times a person experiences breathing pauses and associated drops with oxygen levels. Study participants were considered to have sleep apnoea if they experienced five or more breathing pauses or drops in oxygen during their estimated sleep period.

“We found that the presence of sleep apnoea measured both during pregnancy and two to seven years after delivery was associated with the development of hypertension and metabolic syndrome,” explained Dr Facco.

Further findings

Furthermore, participants with sleep apnoea that persisted during pregnancy, and the two-to-seven-year follow-up visit, were at more than the three-fold increased risk for incident hypertension, and a more than the two-fold increased risk for metabolic syndrome compared to participants who never participated in an abnormal sleep study. Incident hypertension is defined as the first occurrence at any follow-up visit of systolic blood pressure 140mmHg or higher or diastolic blood pressure 90mmHg or higher.

“Our data also demonstrated a higher risk of developing metabolic syndrome and hypertension using a simple measurement of oxygen dips per hour of sleep,” said study co-author Susan Redline, MD, MPH, who directs the Sleep Medicine Epidemiology program at Brigham and Women’s Hospital and Harvard Medical School, Boston. “These results suggest that use of simple oxygen monitoring devices may be useful for identifying women in pregnancy and the post-delivery period at risk for adverse health outcomes and identifying women who may potentially benefit from treating sleep disturbed breathing.”

“These data underscore the need to rigorously evaluate the role of screening and treating sleep apnoea during pregnancy and in the post-delivery period as new strategies for early interventions aimed at improving long-term maternal health,” the authors concluded.


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