Skip to main content
Log in

Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Sleep disturbances such as insomnia, nocturnal awakenings, restless legs syndrome, habitual snoring, and excessive daytime sleepiness are frequent during pregnancy, and these have been linked to adverse maternal and fetal outcomes.

Methods

A prospective observational study was performed in high-risk Indian pregnant women. We used modified Berlin questionnaire (MBQ), Pittsburgh sleep quality index (PSQI), International Restless Legs Syndrome Study Group 2011 criteria, and Epworth sleepiness scale to diagnose various sleep disorders, such as symptomatic OSA, poor sleep quality and insomnia, RLS, and excessive daytime sleepiness, respectively, in successive trimesters of pregnancy. Outcome variables of interest were development of gestational hypertension (GH), gestational diabetes mellitus (GDM), and cesarean delivery (CS); the Apgar scores; and low birth weight (LBW). The relationship between sleep disorders and outcomes was explored using logistic regression analysis.

Results

Outcome data were obtained in 209 deliveries. As compared to nonsnorers, women who reported snoring once, twice, and thrice or more had odds ratios for developing GH—4.0 (95 % CI 1.3–11.9), 1.5 (95 % CI 0.5–4.5), and 2.9 (95 % CI 1.0–8.2) and for undergoing CS—5.3 (95 % CI 1.7–16.3), 4.9 (95 % CI 1.8–13.1), and 5.1 (95 % CI 1.9–14.9), respectively. Pregnant women who were persistently positive on MBQ had increased odds for GH and CS.

Conclusions

Snoring and high-risk MBQ in pregnant women are strong risk factors for GH and CS. In view of the significant morbidity and health care costs, simple screening of pregnant women with questionnaires such as MBQ may have clinical utility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fung AM, Wilson DL, Barnes M, Walker SP (2012) Obstructive sleep apnea and pregnancy: the effect on perinatal outcomes. J Perinatol 32(6):399–406

    Article  CAS  PubMed  Google Scholar 

  2. Louis J, Auckley D, Miladinovic B, Shepherd A, Mencin P, Kumar D et al (2012) Perinatal outcomes associated with obstructive sleep apnea in obese pregnant women. Obstet Gynecol 120(5):1085–1092

    PubMed  Google Scholar 

  3. Weinberger SE, Weiss ST, Cohen WR, Weiss JW, Johnson TS (1980) Pregnancy and the lung. Am Rev Respir Dis 121(3):559–581

    Article  CAS  PubMed  Google Scholar 

  4. Bende M, Gredmark T (1999) Nasal stuffiness during pregnancy. Laryngoscope 109(7 Pt 1):1108–1110

    Article  CAS  PubMed  Google Scholar 

  5. Contreras G, Gutiérrez M, Beroíza T, Fantín A, Oddó H, Villarroel L et al (1991) Ventilatory drive and respiratory muscle function in pregnancy. Am Rev Respir Dis 144(4):837–841

    Article  CAS  PubMed  Google Scholar 

  6. Ding X-X, Wu Y-L, Xu S-J, Zhang S-F, Jia X-M, Zhu R-P et al (2014) A systematic review and quantitative assessment of sleep-disordered breathing during pregnancy and perinatal outcomes. Sleep Breath 18(4):703–713

    Article  PubMed  Google Scholar 

  7. Domingo C, Latorre E, Mirapeix RM, Abad J (2006) Snoring, obstructive sleep apnea syndrome, and pregnancy. Int J Gynaecol Obstet 93(1):57–59

    Article  CAS  PubMed  Google Scholar 

  8. Maasilta P, Bachour A, Teramo K, Polo O, Laitinen LA (2001) Sleep-related disordered breathing during pregnancy in obese women. Chest 120(5):1448–1454

    Article  CAS  PubMed  Google Scholar 

  9. Chen Y-H, Kang J-H, Lin C-C, Wang I-T, Keller JJ, Lin H-C (2012) Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J Obstet Gynecol 206(2):136.e1–136.e5

    Article  Google Scholar 

  10. Leung PL, Hui DSC, Leung TN, Yuen PM, Lau TK (2005) Sleep disturbances in Chinese pregnant women. BJOG 112(11):1568–1571

    Article  PubMed  Google Scholar 

  11. Ko H, Shin J, Kim MY, Kim YH, Lee J, Kil KC et al (2012) Sleep disturbances in Korean pregnant and postpartum women. J Psychosom Obstet Gynaecol 33(2):85–90

    Article  PubMed  Google Scholar 

  12. Loube DI, Poceta JS, Morales MC, Peacock MD, Mitler MM (1996) Self-reported snoring in pregnancy. Association with fetal outcome. Chest 109(4):885–889

    Article  CAS  PubMed  Google Scholar 

  13. Dørheim SK, Bjorvatn B, Eberhard-Gran M (2012) Insomnia and depressive symptoms in late pregnancy: a population-based study. Behav Sleep Med 10(3):152–166

    Article  PubMed  Google Scholar 

  14. Kızılırmak A, Timur S, Kartal B (2012) Insomnia in pregnancy and factors related to insomnia. Sci World J 2012:197093

    Google Scholar 

  15. O’Keeffe M, St-Onge M-P (2013) Sleep duration and disorders in pregnancy: implications for glucose metabolism and pregnancy outcomes. Int J Obes 37(6):765–770

    Article  Google Scholar 

  16. Qiu C, Sanchez SE, Gelaye B, Enquobahrie DA, Ananth CV, Williams MA (2014) Maternal sleep duration and complaints of vital exhaustion during pregnancy is associated with placental abruption. J Matern Fetal Neonatal Med 22:1–6

    Google Scholar 

  17. Goodman JD, Brodie C, Ayida GA (1988) Restless leg syndrome in pregnancy. BMJ 297(6656):1101–1102

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Sharma SK, Vasudev C, Sinha S, Banga A, Pandey RM, Handa KK (2006) Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome. Indian J Med Res 124(3):281–290

    CAS  PubMed  Google Scholar 

  19. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213

    Article  CAS  PubMed  Google Scholar 

  20. Allen RE, Kirby KA (2012) Nocturnal leg cramps. Am Fam Physician 86(4):350–355

    PubMed  Google Scholar 

  21. Walters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP et al (2003) Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 4(2):121–132

    Article  PubMed  Google Scholar 

  22. Johns MW (1992) Reliability and factor analysis of the Epworth sleepiness scale. Sleep 15(4):376–381

    CAS  PubMed  Google Scholar 

  23. American College of Obstetricians and Gynecologists Committee on Practice Bulletins–Obstetrics (2001) ACOG practice bulletin. Clinical management guidelines for obstetrician–gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational Diab Obstet Gynecol 98(3):525–538

    Article  Google Scholar 

  24. Roberts JM, Pearson G, Cutler J, Lindheimer M, NHLBI Working Group on Research on Hypertension During Pregnancy (2003) Summary of the NHLBI working group on research on hypertension during pregnancy. Hypertension 41(3):437–445

    Article  CAS  PubMed  Google Scholar 

  25. American Diabetes Association (2013) Standards of medical care in diabetes—2013. Diabetes Care 36(Suppl 1):S11–S66

    Article  PubMed Central  Google Scholar 

  26. Davies RJ, Stradling JR (1990) The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome. Eur Respir J 3:509–514

    CAS  PubMed  Google Scholar 

  27. Ramirez JO, Cabrera SAS, Hidalgo H, Cabrera SG, Linnebank M, Bassetti CL et al (2013) Is preeclampsia associated with restless legs syndrome? Sleep Med 14(9):894–896

    Article  CAS  PubMed  Google Scholar 

  28. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384

    Article  CAS  PubMed  Google Scholar 

  29. Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP (2010) Pathophysiology of sleep apnea. Physiol Rev 90(1):47–112

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Jelic S, Le Jemtel TH (2008) Inflammation, oxidative stress, and the vascular endothelium in obstructive sleep apnea. Trends Cardiovasc Med 18:253–260

    Article  CAS  PubMed  Google Scholar 

  31. Miehle K, Stepan H, Fasshauer M (2012) Leptin, adiponectin and other adipokines in gestational diabetes mellitus and pre-eclampsia. Clin Endocrinol (Oxf) 76(1):2–11

    Article  CAS  Google Scholar 

  32. Bernardi F, Guolo F, Bortolin T, Petronilho F, Dal-Pizzol F (2008) Oxidative stress and inflammatory markers in normal pregnancy and preeclampsia. J Obstet Gynaecol Res 34:948–951

    CAS  PubMed  Google Scholar 

  33. Challis JR, Lockwood CJ, Myatt L, Norman JE, Strauss JF, Petraglia F (2009) Inflammation and pregnancy. Reprod Sci 16:206–215

    Article  CAS  PubMed  Google Scholar 

  34. Salazar-Pousada D, Chedraui P, Villao A, Pérez-Roncero GR, Hidalgo L (2014) [Maternal and perinatal outcomes in nulliparous gestations with late onset preeclampsia: comparative study with gestations without preeclampsia.] Enferm Clin 24:345–350

  35. Adu-Bonsaffoh K, Obed SA, Seffah JD (2014) Maternal outcomes of hypertensive disorders in pregnancy at Korle Bu Teaching Hospital, Ghana. Int J Gynaecol Obstet 127:238–242

  36. Collop NA, Adkins D, Phillips BA (2004) Gender differences in sleep and sleep-disordered breathing. Clin Chest Med 25(2):257–268

    Article  PubMed  Google Scholar 

  37. Lin CM, Davidson TM, Ancoli-Israel S (2008) Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev 12:481–496

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sharma SK, Kumpawat S, Banga A, Goel A (2006) Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest 130(1):149–156

    Article  PubMed  Google Scholar 

  39. Sagheer F, Venkata C, Venkateshiah SB (2008) A 26-year-old pregnant woman with fatigue and excessive daytime sleepiness. Moderate obstructive sleep apnea-hypopnea syndrome in pregnancy. Chest 134:637–639

    Article  PubMed  Google Scholar 

  40. Krell SB, Kapur VK (2005) Insomnia complaints in patients evaluated for obstructive sleep apnea. Sleep Breath 9(3):104–110

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

All authors declare that they have no conflict of interest.

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. K. Sharma.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, S.K., Nehra, A., Sinha, S. et al. Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study. Sleep Breath 20, 87–93 (2016). https://doi.org/10.1007/s11325-015-1188-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-015-1188-9

Keywords

Navigation