Maternal Sleep and Sleep Disturbance in Relation to the Developing Fetus

母亲睡眠和睡眠障碍与胎儿发育的关系

• 批准号: 9107889
• 负责人: Janet A. Di Pietro
• 金额: $ 55.18万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-07 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9107889
• 关键词: Acute; Affect; Attention; Brain; Cardiac; Case Study; Characteristics; Chronic; Clinical; Clinical Management; Coupling; Data; Data Set; Deceleration; Detection; Development; Disease; Documentation; Electrocardiogram; Environment; Fetal Development; Fetal Distress; Fetal Growth; Fetal Heart Rate; Fetus; Gestational Diabetes; Goals; Health; Human; Life; Link; Measurement; Measures; Metabolism; Methods; Monitor; Motor Activity; Nervous system structure; Neurologic; Obesity; Obstructive Sleep Apnea; Participant; Patient Self-Report; Pattern; Perception; Physiological; Physiology; Polysomnography; Positioning Attribute; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnant Women; Premature Birth; Process; Research; Residual state; Risk; Risk Factors; Role; Sampling; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Sleep disturbances; Staging; Technology; Time; Translating; Ursidae Family; Variant; Wakefulness; Woman; adverse pregnancy outcome; base; fetal; fetal programming; forging; heart rate variability; interest; neurobehavioral; neurodevelopment; obesogenic; offspring; postnatal; prenatal; programs; response

DESCRIPTION (provided by applicant): Sleep disorders are common in pregnancy and disturbances to maternal sleep adversely affect pregnancy outcomes. Maternal sleep comprises, on average, 87 days of a full term pregnancy yet little is known about the role of normal or disordered sleep on the developing fetus. Our objective is to bring measurement of the fetus, using leading edge technologies which include the recent advancement in procuring fetal electrocardiogram (ECG) data in the antepartum, to the field of pregnancy sleep research. We propose that the fetus reacts to the physiological changes that accompany normal and that disordered maternal sleep and chronic sleep disturbances have persistent effects on fetal neuromaturation. To evaluate this premise, we will a) record fetal ECG continuously during nocturnal maternal sleep at 28 weeks gestation while participants are undergoing polysomnography, and b) record fetal neuromaturation indicators during daytime maternal wakefulness at 28 and 36 weeks gestation to evaluate functioning in relation to polysomnography-detected sleep disordered breathing and self-report of habitual sleep characteristics in a sample of 130 obese pregnant women. Fetal neuromaturation measures include fetal heart rate and variation, motor activity, and somatic- cardiac coupling. We focus on obese women because, while sleep disordered breathing has been shown to exert additional independent risk to pregnancy outcomes above that conferred solely by obesity, obesity is the primary risk factor for obstructive sleep apnea and other sleep disturbances in pregnancy. We predict that: 1. obstructive sleep apnea as well as milder forms of sleep disordered breathing will be contemporaneously associated with decelerations in fetal heart rate and reduction in heart rate variability during the night; 2. fetal heart rate and its derivatives will vary by maternal slep stage; 3. sleep disordered breathing will have residual effects on fetal neuromaturation that will be evident in daytime recordings during maternal wakefulness; and 4. maternal perception of sleep quality and disruption will be reflected in alterations to fetal neuromaturation between 28 and 36 weeks gestation. This project will forge an interdisciplinary team of technical and clinical expertise with long-standing independent research programs on both sleep in pregnancy and fetal neurodevelopment. Results will provide new information on the interface between maternal sleep and fetal neurological development and will have implications for clinical management of pregnancy with respect to both sleep disorders and obesity. If successful, we hope these findings will generate a new and productive avenue of inquiry regarding the potential fetal programming effects of disordered maternal sleep as well as essential understanding of the interface between maternal sleep and fetal functioning.

描述（由申请人提供）：睡眠障碍在怀孕期间很常见，母亲睡眠障碍会对妊娠结局产生不利影响。足月妊娠期间，母亲的睡眠时间平均为 87 天，但对于正常或紊乱的睡眠对胎儿发育的影响知之甚少。我们的目标是利用前沿技术（包括产前获取胎儿心电图 (ECG) 数据的最新进展）将胎儿测量引入妊娠睡眠研究领域。我们认为，胎儿会对正常情况下的生理变化做出反应，而母亲睡眠紊乱和慢性睡眠障碍对胎儿神经成熟具有持续影响。为了评估这一前提，我们将 a) 在妊娠 28 周的夜间母亲睡眠期间连续记录胎儿心电图，同时参与者接受多导睡眠图，以及 b) 在妊娠 28 周和 36 周的白天母亲清醒期间记录胎儿神经成熟指标，以评估与妊娠相关的功能多导睡眠图检测到 130 名肥胖孕妇样本中的睡眠呼吸障碍和习惯性睡眠特征的自我报告。胎儿神经成熟度测量包括胎儿心率和变异、运动活动和体心耦合。我们关注肥胖女性，因为虽然睡眠呼吸障碍已被证明对妊娠结局产生额外的独立风险（高于仅由肥胖引起的风险），但肥胖是妊娠期阻塞性睡眠呼吸暂停和其他睡眠障碍的主要危险因素。我们预测： 1. 阻塞性睡眠呼吸暂停以及较轻微形式的睡眠呼吸障碍将 同时与胎儿心率减慢和夜间心率变异性减少有关； 2. 胎心率及其导数会因母亲的睡眠阶段而异； 3. 睡眠呼吸障碍将对胎儿神经成熟产生残余影响，这在母亲清醒时的白天记录中很明显； 4. 母亲对睡眠质量和干扰的看法将反映在妊娠 28 至 36 周期间胎儿神经成熟度的变化中。该项目将打造一支由技术和临床组成的跨学科团队 拥有关于妊娠期睡眠和胎儿神经发育的长期独立研究项目的专业知识。研究结果将提供有关母亲睡眠与胎儿神经发育之间关系的新信息，并将对睡眠障碍和肥胖方面的妊娠临床管理产生影响。如果成功，我们希望这些发现将产生一个新的、富有成效的途径，以探究母亲睡眠紊乱对胎儿编程的潜在影响，以及对母亲睡眠和胎儿功能之间的相互作用的基本理解。