Bourjeily Ghada, El Sabbagh Rana, Sawan Peter, Raker Christina, Wang Carren, Hott Beth, Louis Mariam
Department of Medicine, The Miriam Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA,
Sleep Breath. 2013 Dec;17(4):1179-86. doi: 10.1007/s11325-013-0820-9. Epub 2013 Feb 19.
Snoring is associated with adverse pregnancy outcomes including gestational hypertensive disorders, gestational diabetes, and Cesarean deliveries. The purpose of this study was to assess whether excessive daytime sleepiness (EDS) assessed by Epworth Sleepiness Scale (ESS) increases the risk of these complications further.
Following institutional review board approval and informed consent, English-speaking women in the immediate postpartum period were systematically selected and recruited. Women answered a survey that included questions regarding symptoms of sleep-disordered breathing (SDB) using the multivariable apnea prediction index and excessive daytime sleepiness using ESS. Pregnancy and fetal outcomes were collected by review of medical records. Standard statistical analysis with multivariable logistic regression was performed. ESS was evaluated both as a continuous variable and with various cutoffs given that pregnant women are likely more sleepy at baseline than the general population.
In patients who underwent planned Cesarean delivery, mean ESS was significantly higher than in those with uncomplicated vaginal delivery, even after adjusting for confounders (adjusted odds ratio (aOR), 1.08; 95 % CI, 1.01-1.15; p = 0.02). There was no significant association between EDS (defined as ESS of >10) and gestational diabetes or gestational hypertensive disorders in snorers or non snorers. However, a significant association with gestational diabetes was found in patients with an ESS of >16 compared to those with an ESS of ≤16, even after multiple adjustments (aOR, 6.82; 95 % CI, 1.19-39.27), but the number of subjects in an ESS of >16 category was small.
There is an increased association between women with higher ESS and planned Cesarean delivery. Severe EDS was associated with gestational diabetes in pregnant women in a small sample size. Future studies in larger samples need to confirm the association of severe EDS and gestational diabetes and elucidate potential mechanisms of the links with adverse outcomes.
打鼾与不良妊娠结局相关，包括妊娠期高血压疾病、妊娠期糖尿病和剖宫产。本研究的目的是评估通过爱泼沃斯思睡量表（ESS）评估的日间过度嗜睡（EDS）是否会进一步增加这些并发症的风险。
在获得机构审查委员会批准并取得知情同意后，系统选取并招募产后即刻的英语流利女性。女性回答了一项调查问卷，其中包括使用多变量呼吸暂停预测指数询问睡眠呼吸障碍（SDB）症状，以及使用ESS询问日间过度嗜睡情况。通过查阅病历收集妊娠和胎儿结局。进行了多变量逻辑回归的标准统计分析。鉴于孕妇在基线时可能比一般人群更容易困倦，因此将ESS作为连续变量并采用各种临界值进行评估。
在接受计划剖宫产的患者中，即使在调整混杂因素后，平均ESS仍显著高于无并发症阴道分娩的患者（调整优势比（aOR），1.08；95%置信区间，1.01 - 1.15；p = 0.02）。在打鼾者或非打鼾者中，EDS（定义为ESS > 10）与妊娠期糖尿病或妊娠期高血压疾病之间无显著关联。然而，与ESS≤16的患者相比，ESS > 16的患者与妊娠期糖尿病存在显著关联，即使经过多次调整（aOR，6.82；95%置信区间，1.19 - 39.27），但ESS > 16组的受试者数量较少。
ESS较高的女性与计划剖宫产之间的关联增加。在小样本中，严重EDS与孕妇妊娠期糖尿病相关。未来更大样本的研究需要证实严重EDS与妊娠期糖尿病的关联，并阐明与不良结局相关的潜在机制。
