Sharma S K, Nehra A, Sinha S, Soneja M, Sunesh K, Sreenivas V, Vedita D
Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, 110029, India.
Sleep Breath. 2016 Mar;20(1):87-93. doi: 10.1007/s11325-015-1188-9. Epub 2015 May 10.
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.
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.
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.
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.
失眠、夜间觉醒、不宁腿综合征、习惯性打鼾和日间过度嗜睡等睡眠障碍在孕期很常见，且这些与不良的母婴结局相关。
对印度高危孕妇进行了一项前瞻性观察研究。我们使用改良柏林问卷（MBQ）、匹兹堡睡眠质量指数（PSQI）、国际不宁腿综合征研究组2011年标准和爱泼沃斯嗜睡量表，分别在妊娠各连续阶段诊断各种睡眠障碍，如症状性阻塞性睡眠呼吸暂停、睡眠质量差和失眠、不宁腿综合征以及日间过度嗜睡。感兴趣的结局变量包括妊娠期高血压（GH）、妊娠期糖尿病（GDM）和剖宫产（CS）的发生情况；阿氏评分；以及低出生体重（LBW）。使用逻辑回归分析探讨睡眠障碍与结局之间的关系。
获取了209例分娩的结局数据。与不打鼾者相比，报告打鼾一次、两次以及三次或更多次的女性发生GH的比值比分别为4.0（95%CI 1.3 - 11.9）、1.5（95%CI 0.5 - 4.5）和2.9（95%CI 1.0 - 8.2），进行CS的比值比分别为5.3（95%CI 1.7 - 16.3）、4.9（95%CI 1.8 - 13.1）和5.1（95%CI 1.9 - 14.9）。MBQ持续呈阳性的孕妇发生GH和CS的几率增加。
孕妇打鼾和MBQ高危是发生GH和CS的强危险因素。鉴于显著的发病率和医疗保健成本，使用MBQ等问卷对孕妇进行简单筛查可能具有临床实用性。
