Sleep-disordered breathing in hypertensive disorders of pregnancy: a BMI-matched study

Danielle L Wilson; Susan P Walker; Alison M Fung; Gabrielle Pell; Fergal J O'Donoghue; Maree Barnes; Mark E Howard

doi:10.1111/jsr.12656

Sleep-disordered breathing in hypertensive disorders of pregnancy: a BMI-matched study

J Sleep Res. 2018 Oct;27(5):e12656. doi: 10.1111/jsr.12656. Epub 2018 Jan 25.

Authors

Danielle L Wilson^{1

2

3}, Susan P Walker^{2

4}, Alison M Fung², Gabrielle Pell⁴, Fergal J O'Donoghue^{1

3}, Maree Barnes^{1

3}, Mark E Howard^{1

3}

Affiliations

¹ Institute for Breathing and Sleep, Austin Health, Heidelberg, Vic., Australia.
² Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Vic., Australia.
³ Department of Medicine, University of Melbourne, Parkville, Vic., Australia.
⁴ Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Vic., Australia.

PMID: 29368415
DOI: 10.1111/jsr.12656

Abstract

Sleep-disordered breathing is more common in hypertensive disorders during pregnancy; however, most studies have not adequately accounted for the potential confounding impact of obesity. This study evaluated the frequency of sleep-disordered breathing in women with gestational hypertension and pre-eclampsia compared with body mass index- and gestation-matched normotensive pregnant women. Women diagnosed with gestational hypertension or pre-eclampsia underwent polysomnography shortly after diagnosis. Normotensive controls body mass index-matched within ±4 kg m^-2 underwent polysomnography within ±4 weeks of gestational age of their matched case. The mean body mass index and gestational age at polysomnography were successfully matched for 40 women with gestational hypertension/pre-eclampsia and 40 controls. The frequency of sleep-disordered breathing in the cases was 52.5% compared with 37.5% in the control group (P = 0.18), and the respiratory disturbance index overall did not differ (P = 0.20). However, more severe sleep-disordered breathing was more than twice as common in women with gestational hypertension or pre-eclampsia (35% versus 15%, P = 0.039). While more than half of women with a hypertensive disorder of pregnancy meet the clinical criteria for sleep-disordered breathing, it is also very common in normotensive women of similar body mass index. This underscores the importance of adjusting for obesity when exploring the relationship between sleep-disordered breathing and hypertension in pregnancy. More severe degrees of sleep-disordered breathing are significantly associated with gestational hypertension and pre-eclampsia, and sleep-disordered breathing may plausibly play a role in the pathophysiology of pregnancy hypertension in these women. This suggests that more severe sleep-disordered breathing is a potential therapeutic target for reducing the prevalence or severity of hypertensive disorders in pregnancy.

Keywords: obese; obstructive sleep apnea; pregnant; sleep study.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Body Mass Index
Cross-Sectional Studies
Female
Humans
Hypertension, Pregnancy-Induced / physiopathology*
Pregnancy
Pregnancy Complications / diagnosis*
Sleep Apnea Syndromes / etiology*
Sleep Apnea Syndromes / physiopathology