The Impact of Sleep-Disordered Breathing on Adverse Pregnancy Outcomes

睡眠呼吸障碍对不良妊娠结局的影响

• 批准号: 7860589
• 负责人: LOUISE M O'BRIEN
• 金额: $ 23.17万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7860589
• 关键词: Admission activity; Affect; Body Weight; Cardiovascular system; Characteristics; Chronic; Clinic; Communities; Cross-Sectional Studies; Data; Development; Diagnosis; Discipline of obstetrics; Early treatment; Event; Fetal Growth; Fetus; Frequencies; Gestational Age; Goals; Gynecology; Health; Hypertension; Infant; Intervention; Lead; Link; Literature; Low Birth Weight Infant; Measurement; Measures; Medical; Medical Records; Mothers; Neck; Newborn Infant; Outcome; Participant; Patient Self-Report; Physical assessment; Physicians; Physiological; Polysomnography; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Prevalence; Prospective Studies; Public Health; Recruitment Activity; Reporting; Research; Research Personnel; Risk; Risk Factors; Sampling; Schedule; Screening procedure; Signs and Symptoms; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Snoring; Soft Palate; Symptoms; System; Testing; Third Pregnancy Trimester; Time; United States; Universities; Validation; Weight Gain; Woman; adverse outcome; base; clinically significant; cohort; fetal; improved; infant outcome; instrument; pregnant; programs; prospective; public health relevance; respiratory; tool

DESCRIPTION (provided by applicant): Hypertension during pregnancy affects 5-8% of pregnancies in the United States and contributes to serious complications for both the fetus and mother. Hypertension may lead to pre-eclampsia, which can restrict fetal growth or trigger premature birth. The rate of pre-eclampsia has increased by nearly one-third during the past decade. One well recognized independent risk for hypertension is sleep-disordered breathing (SDB). This common and treatable, but usually undiagnosed sleep disorder often develops with excess body weight. Available literature suggests that substantial weight gain and other physiological changes during the short period of pregnancy may be associated with increased snoring, a well known marker for SDB risk. However, the prevalence of SDB in pregnancy is not well known, the best symptoms and signs to use as screens for its presence remain largely unstudied, and its relationships to maternal and fetal outcomes have never been explored in a large sample. The main goals of this revised application, therefore, are to determine the frequency of SDB symptoms and signs in a sample of women in the last trimester of pregnancy, and to assess whether such symptoms and signs may predict two key adverse outcomes, pre-eclampsia in the mother and small size for gestational age in the infant. In addition, we will show "proof-of-concept" that habitual snoring is associated with objective measures of respiratory events from polysomnography in a sample of pregnant women. Aim 1 will compare the cross-sectional frequencies of snoring and other SDB symptoms among 1400 third-trimester pregnant women and 200 non-pregnant women. Aim 2 will demonstrate the cross-sectional association, among the 1400 pregnant women, of simple physical airway and neck measurements with SDB symptoms. Aim 3 will use postpartum medical records of the 1400-subject cohort to assess the extent to which SDB symptoms and signs predict adverse pregnancy outcomes, in particular pre-eclampsia and low birth weight. As an exploratory aim, Aim 4, will test whether self-reported habitual snoring is associated with an increased number of respiratory events, as measured from a polysomnogram in 20 women with habitual and 20 women without habitual snoring. Such respiratory events are likely the presumed intermediary variable between SDB symptoms and outcomes. Results of this study could have important impact on public health. SDB will be implicated, for the first time in a large prospective study, as a risk factor for adverse maternal and infant outcomes. Clinicians will be given new, simple, and inexpensive screening tools to identify risk for these outcomes. Data generated in this initial study will provide critical justification for new research on next steps beyond screening, namely early SDB diagnosis and treatment during pregnancy -- as strategies to reduce pre-eclampsia and low birth weight. PUBLIC HEALTH RELEVANCE: Results from this study will have a major influence on public health. Sleep-disordered breathing will be implicated, for the first time in a large prospective study, as a risk factor for adverse maternal and infant outcomes and clinicians will be alerted to potential symptoms and signs that may identify a problem. This study will ultimately lead to the development of early intervention strategies to treat sleep disordered breathing during pregnancy which may ultimately reduce risk of adverse pregnancy outcome.

描述（由申请人提供）：怀孕期间的高血压会影响美国5-8％的怀孕，并导致胎儿和母亲的严重并发症。高血压可能会导致子痫前期，这可能会限制胎儿生长或触发早产。在过去的十年中，子痫前期的率提高了近三分之一。高血压的一个公认的独立风险是睡眠呼吸呼吸（SDB）。这种常见且可以治疗但通常无法诊断的睡眠障碍通常会出现过多的体重。现有文献表明，在短期怀孕期间，体重增加和其他生理变化可能与打s的增加有关，这是SDB风险的众所周知的标记。然而，怀孕中SDB的患病率尚不清楚，用作其存在的屏幕的最佳症状和迹象在很大程度上仍未被研究，并且它与孕产妇和胎儿结果的关系从未在大型样本中探索过。因此，该修订后的应用的主要目标是确定怀孕最后三个月中女性样本中的SDB症状和迹象的频率，并评估这种症状和迹象是否可以预测母亲的两个关键不利结果，即母亲的前子症状和婴儿的小体大小。此外，我们将显示“概念证明”表明，习惯打nor与孕妇样本中的多个呼吸事件的客观度量有关。 AIM 1将比较1400名三年孕妇和200名非怀孕妇女的打nor和其他SDB症状的横截面频率。 AIM 2将证明1400名孕妇中的横截面关联具有简单的物理气道和SDB症状的颈部测量。 AIM 3将使用1400个受试者队列的产后医疗记录来评估SDB症状和体征可以预测不良妊娠结局的程度，尤其是前体前期和低出生体重。作为探索性目的，AIM 4将测试自我报告的习惯打ing是否与呼吸事件的数量增加有关，这是根据20名习惯性和20名没有习惯打ing的女性的多种习惯效果来衡量的。这种呼吸事件可能是SDB症状和结果之间假定的中间变量。这项研究的结果可能会对公共卫生产生重要影响。 SDB将首次参与一项大型前瞻性研究，是不良母亲和婴儿结果的危险因素。将为临床医生提供新的，简单且廉价的筛查工具，以识别这些结果的风险。在这项初步研究中产生的数据将为筛查以外的下一步，即SDB早期诊断和怀孕期间的新步骤提供关键的理由，这是减少先兆子痫前期和低出生体重的策略。 公共卫生相关性：这项研究的结果将对公共卫生产生重大影响。在大型的前瞻性研究中，将首次涉及睡眠呼吸的呼吸，这是不良产妇和婴儿结果的危险因素，临床医生将被告知可能会出现可能发现问题的潜在症状和迹象。这项研究最终将导致制定早期干预策略，以治疗怀孕期间睡眠不足的呼吸，这最终可能降低了不良怀孕结局的风险。