Department of Psychiatry, the California Preterm Birth Initiative, the Center for Health and Community, the Department of Obstetrics, Gynecology and Reproductive Sciences, and the Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; and the Department of Pediatrics, University of California, San Diego, San Diego, California.
Obstet Gynecol. 2017 Sep;130(3):573-581. doi: 10.1097/AOG.0000000000002132.
To test the hypothesis that sleep disorder diagnosis would be associated with increased risk of preterm birth and to examine risk by gestational age, preterm birth type, and specific sleep disorder (insomnia, sleep apnea, movement disorder, and other).
In this observational study, participants were from a cohort of nearly 3 million women in California between 2007 and 2012. Inclusion criteria were women with singleton neonates liveborn between 20 and 44 weeks of gestation without chromosomal abnormalities or major structural birth defects linked to a hospital discharge database maintained by the California Office of Statewide Health Planning and Development and without mental illness during pregnancy. Sleep disorder was defined based on International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code (n=2,265). Propensity score matching was used to select a referent population at a one-to-one ratio. Odds of preterm birth were examined by gestational age (less than 34 weeks, 34-36 weeks, and less than 37 weeks of gestation) and type (spontaneous, indicated).
Prevalence of preterm birth (before 37 weeks of gestation) was 10.9% in the referent group compared with 14.6% among women with a recorded sleep disorder diagnosis. Compared with the referent group, odds (95% CI, P value, percentage) of preterm birth were 1.3 (1.0-1.7, P=.023, 14.1%) for insomnia and 1.5 (1.2-1.8, P<.001, 15.5%) for sleep apnea. Risk varied by gestational age and preterm birth type. Odds of preterm birth were not significantly increased for sleep-related movement disorders or other sleep disorders.
Insomnia and sleep apnea were associated with significantly increased risk of preterm birth. Considering the high prevalence of sleep disorders during pregnancy and availability of evidence-based nonpharmacologic interventions, current findings suggest that screening for severe presentations would be prudent.
检验睡眠障碍诊断与早产风险增加相关的假设，并通过妊娠年龄、早产类型和特定睡眠障碍（失眠、睡眠呼吸暂停、运动障碍和其他）来检查风险。
在这项观察性研究中，参与者来自加利福尼亚州 2007 年至 2012 年间近 300 万女性的队列。纳入标准为单胎活产新生儿，妊娠 20 至 44 周，无染色体异常或主要结构出生缺陷，与加利福尼亚州卫生规划和发展办公室维护的医院出院数据库有关，且妊娠期间无精神疾病。睡眠障碍是根据国际疾病分类，第 9 版，临床修正诊断代码（n=2,265）定义的。使用倾向评分匹配以 1:1 的比例选择参照人群。通过妊娠年龄（小于 34 周、34-36 周和小于 37 周）和类型（自发性、指示性）检查早产的几率。
参照组的早产（37 周前）发生率为 10.9%，而有记录的睡眠障碍诊断的女性为 14.6%。与参照组相比，失眠的早产几率（95%CI，P 值，百分比）为 1.3（1.0-1.7，P=.023，14.1%），睡眠呼吸暂停为 1.5（1.2-1.8，P<.001，15.5%）。风险因妊娠年龄和早产类型而异。睡眠相关运动障碍或其他睡眠障碍与早产风险增加无关。
失眠和睡眠呼吸暂停与早产风险显著增加相关。考虑到妊娠期间睡眠障碍的高患病率和基于证据的非药物干预措施的可用性，目前的研究结果表明，筛查严重表现可能是谨慎的。
