Use of PAP in women with pre-eclampsia

PAP 在先兆子痫女性中的应用

基本信息

批准号：
8214567
负责人：
LOUISE M O'BRIEN
金额：
$ 11.7万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-06-01 至 2014-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8214567
关键词：
Admission activity Adult Affect Apgar Score Blood Pressure Blood Pressure Monitors Cessation of life Chronic Consent Continuous Positive Airway Pressure Data Disease Eclampsia Enrollment Frequencies Goals Health High-Risk Pregnancy Hypertension Incidence Infant Instruction Measures Medical Records Monitor Morbidity - disease rate Mothers Neonatal Intensive Care Neonatal Intensive Care Units Newly Diagnosed Outcome Patient Care Patients Pattern Physiological Play Polysomnography Pre-Eclampsia Pregnancy Pregnancy Complications Pregnant Women Principal Investigator Proteinuria Randomized Controlled Clinical Trials Reporting Research Risk Factors Role Severities Sleep Sleep Apnea Syndromes Snoring Symptoms Time Weight Gain Woman Women&apos s Group abstracting comparison group fetal improved in utero infant outcome instrumentation novel pregnant pressure standard care

项目摘要

DESCRIPTION (provided by applicant): Pre-eclampsia is a pregnancy-specific disorder characterized by hypertension and proteinuria observed after the 20th week of gestation. It affects 5-8% of U.S. pregnancies, is a precursor for potentially fatal eclampsia, and is a leading global cause of maternal and infant morbidity. The incidence of pre-eclampsia has increased by nearly one-third over the past decade and hypertensive disorders during pregnancy are now responsible for at least 76,000 U.S. deaths each year. The cause of pre-eclampsia and its rising incidence remain uncertain. However, several lines of evidence suggest that sleep-disordered breathing (SDB) could play a role. SDB is common, most often undiagnosed - especially in women - and treatable. Snoring, the hallmark symptom of SDB, is more frequent during pregnancy. Increased weight promotes SDB, and significant weight gain or other physiological changes during pregnancy also may exacerbate SDB. SDB has been associated with elimination or reversal of normal nocturnal dips in blood pressure (BP), similar to BP patterns observed in pre-eclampsia. Of note, SDB is a known independent risk factor for hypertension in non-pregnant adults but it is unknown if SDB in pregnant women contributes to pre-eclampsia. Treatment of SDB with CPAP has been shown to ameliorate nocturnal BP increases in hypertensive patients with SDB, but not in hypertensive patients without SDB. No study has determined whether SDB does in fact increase nocturnal BP during pregnancy and whether SDB promotes pre-eclampsia remains unproven. Therefore, the main goals of this research are to identify whether SDB - as measured by overnight polysomnography - is associated with pre-eclampsia, to confirm that use of auto-titrating positive airway pressure (auto-PAP) can improve nocturnal BP, and to determine whether any such effect depends on the presence of underlying SDB. Moreover, we will show that such improvement in nocturnal BP will be associated with improved maternal daytime BP and improved fetal outcome, as measured by more days in utero and fewer admissions to the neonatal intensive care unit. RELEVANCE (See instructions): This novel research will show that treatment of sleep-disordered breathing in women with pre-eclampsia - a serious complication of pregnancy - will reduce maternal blood pressure which will, in turn, result in improved health for mothers and babies. (End of Abstract)

描述（由申请人提供）：先兆子痫是一种妊娠特异性疾病，其特征是妊娠第 20 周后观察到的高血压和蛋白尿。它影响美国 5-8% 的妊娠，是可能致命的子痫的先兆，也是全球孕产妇和婴儿发病的主要原因。在过去十年中，先兆子痫的发病率增加了近三分之一，目前每年至少有 76,000 人因妊娠期高血压疾病死亡。先兆子痫的病因及其发病率上升仍不确定。然而，多项证据表明睡眠呼吸障碍（SDB）可能发挥了作用。 SDB 很常见，大多数情况下未被诊断（尤其是女性），但可以治疗。打鼾是 SDB 的标志性症状，在怀孕期间更为常见。体重增加会促进 SDB，怀孕期间体重显着增加或其他生理变化也可能加剧 SDB。 SDB 与消除或逆转正常夜间血压 (BP) 下降有关，类似于先兆子痫中观察到的血压模式。值得注意的是，SDB 是非妊娠成人高血压的已知独立危险因素，但尚不清楚孕妇的 SDB 是否会导致先兆子痫。 CPAP 治疗 SDB 已被证明可以改善患有 SDB 的高血压患者的夜间血压升高，但对于不患有 SDB 的高血压患者则不然。目前还没有研究确定 SDB 是否确实会增加怀孕期间的夜间血压，并且 SDB 是否会促进先兆子痫尚未得到证实。因此，本研究的主要目标是确定 SDB（通过夜间多导睡眠图测量）是否与先兆子痫相关，确认使用自动滴定气道正压通气 (auto-PAP) 可以改善夜间血压，并确定任何此类影响是否取决于底层 SDB 的存在。此外，我们将证明，夜间血压的这种改善将与母亲白天血压的改善和胎儿结局的改善相关，这可以通过在子宫内的天数增加和新生儿重症监护病房的入院次数减少来衡量。相关性（参见说明）：这项新颖的研究将表明，对先兆子痫（一种严重的妊娠并发症）女性睡眠呼吸障碍的治疗将降低母亲的血压，从而改善母亲和婴儿的健康。（摘要完）