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Sleep-Disordered Breathing and Pregnancy

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Sleep Disorders in Women

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

During pregnancy there are profound anatomical, hormonal, respiratory, and sleep changes that increase the risk for sleep-related breathing disorder (SRBD). Untreated SRBD can lead to preeclampsia and other hypertensive disorders. It can also lead to intrauterine growth retardation, premature labor, and gestational diabetes. The treatment of obstructive sleep apnea (OSA) and other SRBD in pregnancy can be challenging given the dynamic changes in weight, upper airway anatomy, and fluid distribution.

Despite all this, there is still poor awareness of the prevalence of SRBD in pregnancy and there should be more education about this important association. Early diagnosis and treatment can prevent significant maternal and fetal morbidity.

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References

  1. Branchey M, Branchey L, Nadler RD. Effects of estrogen and progesterone on sleep patterns of female rats. Physiol Behav. 1971;6(6):743–6.

    Article  PubMed  CAS  Google Scholar 

  2. Colvin GB, Whitmoyer DI, Lisk RD, Walter DO, Sawyer CH. Changes in sleep-wakefulness in female rats during circadian and estrous cycles. Brain Res. 1968;7(2):173–81.

    Article  PubMed  CAS  Google Scholar 

  3. Fang J, Fishbein W. Sex differences in paradoxical sleep: influences of estrus cycle and ovariectomy. Brain Res. 1996;734(1–2):275–85.

    Article  PubMed  CAS  Google Scholar 

  4. Merryman W, Boiman R, Barnes L, Rothchild I. Progesterone anesthesia in human subjects. J Clin Endocrinol Metab. 1954;14(12):1567–9.

    Article  PubMed  CAS  Google Scholar 

  5. Friess E, Tagaya H, Trachsel L, Holsboer F, Rupprecht R. Progesterone-induced changes in sleep in male subjects. Am J Physiol. 1997;272:E885–91.

    PubMed  CAS  Google Scholar 

  6. Schweiger MS. Sleep disturbance in pregnancy. A subjective survey. Am J Obstet Gynecol. 1972;114(7):879–82.

    PubMed  CAS  Google Scholar 

  7. Facco FL, Kramer J, Ho KH, Zee PC, Grobman WA. Sleep disturbances in pregnancy. Obstet Gynecol. 2010;115(1):77–83.

    Article  PubMed  Google Scholar 

  8. Wilson DL, Barnes M, Ellett L, Permezel M, Jackson M, Crowe SF. Decreased sleep efficiency, increased wake after sleep onset and increased cortical arousals in late pregnancy. Aust N Z J Obstet Gynaecol. 2010;51(1):38–46.

    Article  PubMed  Google Scholar 

  9. Fast A, Weiss L, Parikh S, Hertz G. Night backache in pregnancy. Hypothetical pathophysiological mechanisms. Am J Phys Med Rehabil. 1989;68(5):227–9.

    Article  PubMed  CAS  Google Scholar 

  10. Cugell DW, Frank NR, Gaensler EA, Badger TL. Pulmonary function in pregnancy. I. Serial observations in normal women. Am Rev Tuberc. 1953;67(5):568–97.

    PubMed  CAS  Google Scholar 

  11. Weinberger SE, Weiss ST, Cohen WR, Weiss JW, Johnson TS. Pregnancy and the lung. Am Rev Respir Dis. 1980;121(3):559–81.

    PubMed  CAS  Google Scholar 

  12. Knuttgen HG, Emerson Jr K. Physiological response to pregnancy at rest and during exercise. J Appl Physiol. 1974;36(5):549–53.

    PubMed  CAS  Google Scholar 

  13. Craig DB, Toole MA. Airway closure in pregnancy. Can Anaesth Soc J. 1975;22(6):665–72.

    Article  PubMed  CAS  Google Scholar 

  14. Holdcroft A, Bevan DR, O’Sullivan JC, Sykes MK. Airway closure and pregnancy. Anaesthesia. 1977;32(6):517–23.

    Article  PubMed  CAS  Google Scholar 

  15. Feinsilver SH, Hertz G. Respiration during sleep in pregnancy. Clin Chest Med. 1992;13(4):637–44.

    PubMed  CAS  Google Scholar 

  16. Trakada G, Tsapanos V, Spiropoulos K. Normal pregnancy and oxygenation during sleep. Eur J Obstet Gynecol Reprod Biol. 2003;109(2):128–32.

    Article  PubMed  CAS  Google Scholar 

  17. Hertz G, Fast A, Feinsilver SH, Albertario CL, Schulman H, Fein AM. Sleep in normal late pregnancy. Sleep. 1992;15(3):246–51.

    PubMed  CAS  Google Scholar 

  18. Bourne T, Ogilvy AJ, Vickers R, Williamson K. Nocturnal hypoxaemia in late pregnancy. Br J Anaesth. 1995;75(6):678–82.

    Article  PubMed  CAS  Google Scholar 

  19. Awe RJ, Nicotra MB, Newsom TD, Viles R. Arterial oxygenation and alveolar-arterial gradients in term pregnancy. Obstet Gynecol. 1979;53(2):182–6.

    PubMed  CAS  Google Scholar 

  20. Mills GH, Chaffe AG. Sleeping positions adopted by pregnant women of more than 30 weeks gestation. Anaesthesia. 1994;49(3):249–50.

    Article  PubMed  CAS  Google Scholar 

  21. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–21.

    Article  PubMed  CAS  Google Scholar 

  22. Pien GW, Schwab RJ. Sleep disorders during pregnancy. Sleep. 2004;27(7):1405–17.

    PubMed  Google Scholar 

  23. Elkus R, Popovich Jr J. Respiratory physiology in pregnancy. Clin Chest Med. 1992;13(4):555–65.

    PubMed  CAS  Google Scholar 

  24. Bende M, Gredmark T. Nasal stuffiness during pregnancy. Laryngoscope. 1999;109(7 Pt 1):1108–10.

    Article  PubMed  CAS  Google Scholar 

  25. Pilkington S, Carli F, Dakin MJ, Romney M, De Witt KA, Dore CJ, et al. Increase in Mallampati score during pregnancy. Br J Anaesth. 1995;74(6):638–42.

    Article  PubMed  CAS  Google Scholar 

  26. Izci B, Vennelle M, Liston WA, Dundas KC, Calder AA, Douglas NJ. Sleep-disordered breathing and upper airway size in pregnancy and post-partum. Eur Respir J. 2006;27(2):321–7.

    Article  PubMed  CAS  Google Scholar 

  27. Prowse CM, Gaensler EA. Respiratory and acid–base changes during pregnancy. Anesthesiology. 1965;26:381–92.

    Article  PubMed  CAS  Google Scholar 

  28. Contreras G, Gutierrez M, Beroiza T, Fantin A, Oddo H, Villarroel L, et al. Ventilatory drive and respiratory muscle function in pregnancy. Am Rev Respir Dis. 1991;144(4):837–41.

    Article  PubMed  CAS  Google Scholar 

  29. Parisi RA, Santiago TV, Edelman NH. Genioglossal and diaphragmatic EMG responses to hypoxia during sleep. Am Rev Respir Dis. 1988;138(3):610–6.

    PubMed  CAS  Google Scholar 

  30. Wheatley JR, White DP. The influence of sleep on pharyngeal reflexes. Sleep. 1993;16(8 Suppl):S87–9.

    PubMed  CAS  Google Scholar 

  31. Loube DI, Poceta JS, Morales MC, Peacock MD, Mitler MM. Self-reported snoring in pregnancy. Association with fetal outcome. Chest. 1996;109(4):885–9.

    Article  PubMed  CAS  Google Scholar 

  32. Guilleminault C, Querra-Salva M, Chowdhuri S, Poyares D. Normal pregnancy, daytime sleeping, snoring and blood pressure. Sleep Med. 2000;4:289–97.

    Article  Google Scholar 

  33. Franklin KA, Holmgren PA, Jonsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancy-­induced hypertension, and growth retardation of the fetus. Chest. 2000;117(1):137–41.

    Article  PubMed  CAS  Google Scholar 

  34. Leung PL, Hui DSC, Leung TN, Yuen PM, Lau TK. Sleep disturbances in Chinese pregnant women. BJOG. 2005;112(11):1568–71.

    Article  PubMed  Google Scholar 

  35. Tauman R, Many A, Deutsch V, Arvas S, Ascher-Landsberg J, Greenfield M, et al. Maternal snoring during pregnancy is associated with enhanced fetal erythropoiesis—a preliminary study. Sleep Med. 2011;12(15):518–22.

    Article  PubMed  Google Scholar 

  36. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.

    Article  PubMed  CAS  Google Scholar 

  37. Maasilta P, Bachour A, Teramo K, Polo O, Laitinen LA. Sleep-related disordered breathing during pregnancy in obese women. Chest. 2001;120(5):1448–54.

    Article  PubMed  CAS  Google Scholar 

  38. Nikkola E, Ekblad U, Ekholm E, Mikola H, Polo O. Sleep in multiple pregnancy: breathing patterns, oxygenation, and periodic leg movements. Am J Obstet Gynecol. 1996;174(5):1622–5.

    Article  PubMed  CAS  Google Scholar 

  39. Conti M, Izzo V, Muggiasca ML, Tiengo M. Sleep apnoea syndrome in pregnancy: a case report. Eur J Anaesthesiol. 1988;5(2):151–4.

    PubMed  CAS  Google Scholar 

  40. Hastie SJ, Prowse K, Perks WH, Atkins J, Blunt VA. Obstructive sleep apnoea during pregnancy requiring tracheostomy. Aust N Z J Obstet Gynaecol. 1989;29(3 Pt 2):365–7.

    Article  PubMed  CAS  Google Scholar 

  41. Kowall J, Clark G, Nino-Murcia G, Powell N. Precipitation of obstructive sleep apnea during pregnancy. Obstet Gynecol. 1989;74(3 Pt 2):453–5.

    PubMed  CAS  Google Scholar 

  42. Sherer DM, Caverly CB, Abramowicz JS. Severe obstructive sleep apnea and associated snoring documented during external tocography. Am J Obstet Gynecol. 1991;165(5 Pt 1):1300–1.

    PubMed  CAS  Google Scholar 

  43. Charbonneau M, Falcone T, Cosio MG, Levy RD. Obstructive sleep apnea during pregnancy. Therapy and implications for fetal health. Am Rev Respir Dis. 1991;144(2):461–3.

    Article  PubMed  CAS  Google Scholar 

  44. Lefcourt LA, Rodis JF. Obstructive sleep apnea in pregnancy. Obstet Gynecol Surv. 1996;51(8):503–6.

    Article  PubMed  CAS  Google Scholar 

  45. Lewis DF, Chesson AL, Edwards MS, Weeks JW, Adair CD. Obstructive sleep apnea during pregnancy resulting in pulmonary hypertension. South Med J. 1998;91(8):761–2.

    Article  PubMed  CAS  Google Scholar 

  46. Brain KA, Thornton JG, Sarkar A, Johnson AO. Obstructive sleep apnoea and fetal death: successful treatment with continuous positive airway pressure. BJOG. 2001;108(5):543–4.

    PubMed  CAS  Google Scholar 

  47. Roush SF, Bell L. Obstructive sleep apnea in pregnancy. J Am Board Fam Pract. 2004;17(4):292–4.

    Article  PubMed  Google Scholar 

  48. Joel-Cohen SJ, Schoenfeld A. Fetal response to periodic sleep apnea: a new syndrome in obstetrics. Eur J Obstet Gynecol Reprod Biol. 1978;8(2):77–81.

    Article  PubMed  CAS  Google Scholar 

  49. Schoenfeld A, Ovadia Y, Neri A, Freedman S. Obstructive sleep apnea (OSA)-implications in maternal-fetal medicine. A hypothesis. Med Hypotheses. 1989;30(1):51–4.

    Article  PubMed  CAS  Google Scholar 

  50. Guilleminault C, Kreutzer M, Chang JL. Pregnancy, sleep disordered breathing and treatment with nasal continuous positive airway pressure. Sleep Med. 2004;5(1):43–51.

    Article  PubMed  Google Scholar 

  51. Olivarez SA, Maheshwari B, McCarthy M, Zacharias N, van den Veyver I, Casturi L, et al. Prospective trial on obstructive sleep apnea in pregnancy and fetal heart rate monitoring. Am J Obstet Gynecol. 2010;202(6):552.e1–7.

    Article  Google Scholar 

  52. Pien GW, Fife D, Pack AI, Nkwuo JE, Schwab RJ. Changes in symptoms of sleep-disordered breathing during pregnancy. Sleep. 2005;28(10):1299–305.

    PubMed  Google Scholar 

  53. Zhang J, Zeisler J, Hatch MC, Berkowitz G. Epidemiology of pregnancy-induced hypertension. Epidemiol Rev. 1997;19(2):218–32.

    Article  PubMed  CAS  Google Scholar 

  54. Kyle PM, Buckley D, Kissane J, de Swiet M, Redman CW. The angiotensin sensitivity test and low-dose aspirin are ineffective methods to predict and prevent hypertensive disorders in nulliparous pregnancy. Am J Obstet Gynecol. 1995;173(3 Pt 1):865–72.

    Article  PubMed  CAS  Google Scholar 

  55. Sibai BM, Caritis SN, Thom E, Klebanoff M, McNellis D, Rocco L, et al. Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous pregnant women. N Engl J Med. 1993;329(17):1213–8.

    Article  PubMed  CAS  Google Scholar 

  56. Carroli G, Duley L, Belizan JM, Villar J. Calcium supplementation during pregnancy: a systematic review of randomised controlled trials. Br J Obstet Gynaecol. 1994;101(9):753–8.

    Article  PubMed  CAS  Google Scholar 

  57. Hauth JC, Goldenberg RL, Parker Jr CR, Philips III JB, Copper RL, DuBard MB, et al. Low-­dose aspirin therapy to prevent preeclampsia. Am J Obstet Gynecol. 1993;168(4):1083–91.

    PubMed  CAS  Google Scholar 

  58. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-­disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.

    Article  PubMed  CAS  Google Scholar 

  59. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-­disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829–36.

    Article  PubMed  CAS  Google Scholar 

  60. Izci B, Riha RL, Martin SE, Vennelle M, Liston WA, Dundas KC, et al. The upper airway in pregnancy and pre-eclampsia. Am J Respir Crit Care Med. 2003;167(2):137–40.

    Article  PubMed  Google Scholar 

  61. Connolly G, Razak AR, Hayanga A, Russell A, McKenna P, McNicholas WT. Inspiratory flow limitation during sleep in pre-eclampsia: comparison with normal pregnant and nonpregnant women. Eur Respir J. 2001;18(4):672–6.

    Article  PubMed  CAS  Google Scholar 

  62. Champagne K, Schwartzman K, Opatrny L, Barriga P, Morin L, Mallozzi A, et al. Obstructive sleep apnoea and its association with gestational hypertension. Eur Respir J. 2009;33(3):559–65.

    Article  PubMed  CAS  Google Scholar 

  63. Poyares D, Guilleminault C, Hachul H, Fujita L, Takaoka S, Tufik S, et al. Pre-eclampsia and nasal CPAP: part 2. Hypertension during pregnancy, chronic snoring, and early nasal CPAP intervention. Sleep Med. 2007;9(1):15–21.

    Article  PubMed  Google Scholar 

  64. Seicean S, Kirchner HL, Gottlieb DJ, Punjabi NM, Resnick H, Sanders M, et al. Sleep-­disordered breathing and impaired glucose metabolism in normal-weight and overweight/obese individuals: the Sleep Heart Health Study. Diabetes Care. 2008;31(5):1001–6.

    Article  PubMed  Google Scholar 

  65. Reutrakul S, Zaidi N, Wroblewski K, Kay HH, Ismail M, Ehrmann DA, et al. Sleep disturbances and their relationship to glucose tolerance in pregnancy. Diabetes Care. 2011;34(11):2454–7.

    Article  PubMed  Google Scholar 

  66. Facco FL, Grobman WA, Kramer J, Ho KH, Zee PC. Self-reported short sleep duration and frequent snoring in pregnancy: impact on glucose metabolism. Am J Obstet Gynecol. 2010;203(2):142.e1–5.

    Article  Google Scholar 

  67. Bourjeily G, Raker CA, Chalhoub M, Miller MA. Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing. Eur Respir J. 2010;36(4):849–55.

    Article  PubMed  CAS  Google Scholar 

  68. Qiu C, Enquobahrie D, Frederick IO, Abetew D, Williams MA. Glucose intolerance and gestational diabetes risk in relation to sleep duration and snoring during pregnancy: a pilot study. BMC Womens Health. 2010;10:17.

    Article  PubMed  Google Scholar 

  69. Gozal D, Reeves SR, Row BW, Neville JJ, Guo SZ, Lipton AJ. Respiratory effects of gestational intermittent hypoxia in the developing rat. Am J Respir Crit Care Med. 2003;167(11):1540–7.

    Article  PubMed  Google Scholar 

  70. Gozal D, Gozal E, Reeves SR, Lipton AJ. Gasping and autoresuscitation in the developing rat: effect of antecedent intermittent hypoxia. J Appl Physiol. 2002;92(3):1141–4.

    PubMed  Google Scholar 

  71. Schwartz JE, Kovach A, Meyer J, McConnell C, Iwamoto HS. Brief, intermittent hypoxia restricts fetal growth in Sprague–Dawley rats. Biol Neonate. 1998;73(5):313–9.

    Article  PubMed  CAS  Google Scholar 

  72. Bernstein I, Gabbe SG. Intrauterine growth restriction. In: Gabbe SG, Niebyl JR, Simpson JL, editors. Obstetrics: normal and problem pregnancies. 3rd ed. New York: Churchill Livingstone; 1996. p. 863–86.

    Google Scholar 

  73. Tauman R, Sivan Y, Katsav S, Greenfeld M, Many A. Maternal snoring during pregnancy is not associated with fetal growth restriction. J Matern Fetal Neonatal Med. 2012;25(8):1283–6.

    Article  PubMed  Google Scholar 

  74. Sahin FK, Koken G, Cosar E, Saylan F, Fidan F, Yilmazer M, et al. Obstructive sleep apnea in pregnancy and fetal outcome. Int J Gynaecol Obstet. 2008;100(2):141–6.

    Article  PubMed  Google Scholar 

  75. Edwards N, Blyton DM, Hennessey A, Sullivan CE. Severity of Sleep disordered breathing improves following parturition. Sleep. 2005;28(6):737–41.

    PubMed  Google Scholar 

  76. Higgins N, Leong E, Park CS, Facco FL, McCarthy RJ, Wong CA. The Berlin Questionnaire for assessment of sleep disordered breathing risk in parturients and non-pregnant women. Int J Obstet Anesth. 2011;20(1):22–5.

    Article  PubMed  CAS  Google Scholar 

  77. Ayrım A, Keskin EA, Ozol D, Onaran Y, Yıidirim Z, Kafali H. Influence of self-reported snoring and witnessed sleep apnea on gestational hypertension and fetal outcome in pregnancy. Arch Gynecol Obstet. 2011;283(2):195–9.

    Article  PubMed  Google Scholar 

  78. Ursavas A, Karadag M, Nalci N, Ercan I, Gozu RO. Self-reported snoring, maternal obesity and neck circumference as risk factors for pregnancy-induced hypertension and preeclampsia. Respiration. 2008;76(1):33–9.

    Article  PubMed  Google Scholar 

  79. Pérez-Chada D, Videla AJ, O’Flaherty ME, Majul C, Catalini AM, Caballer CA, et al. Snoring, witnessed sleep apnoeas and pregnancy-induced hypertension. Acta Obstet Gynecol Scand. 2007;86(7):788–92.

    Article  PubMed  Google Scholar 

  80. Izci B, Martin SE, Dundas KC, Liston WA, Calder AA, Douglas NJ. Sleep complaints: snoring and daytime sleepiness in pregnant and pre-eclamptic women. Sleep Med. 2005;6(2):163–9.

    Article  PubMed  Google Scholar 

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Kumar, S., Schotland, H. (2013). Sleep-Disordered Breathing and Pregnancy. In: Attarian, H., Viola-Saltzman, M. (eds) Sleep Disorders in Women. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-324-4_16

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