Mater Research Institute-University of Queensland, Mater Mothers' Hospital, and the Faculty of Medicine, The University of Queensland, Australia, South Brisbane, Queensland, Australia.
Mater Research Institute-University of Queensland, Mater Mothers' Hospital, and the Faculty of Medicine, The University of Queensland, Australia, South Brisbane, Queensland, Australia.
Am J Obstet Gynecol. 2018 Aug;219(2):147-161.e1. doi: 10.1016/j.ajog.2018.02.004. Epub 2018 Feb 15.
Sleep-disordered breathing is an increasingly common condition in nonobstetric populations and is associated with significant morbidity. The incidence of sleep-disordered breathing in pregnancy is unknown, and it is likely that many cases go undiagnosed.
A systematic review and metaanalysis was undertaken to determine whether pregnant women who receive a diagnosis of sleep-disordered breathing are more likely to have adverse intrapartum and perinatal outcomes compared with control subjects.
PubMed, Embase, and Cinahl databases were searched for full-text publications in English of sleep-disordered breathing and human pregnancy up to June 2017. Only studies that reported on sleep-disordered breathing in relation to gestational age or birthweight at delivery, preterm birth, mode of delivery, cord pH, Apgar score, nursery admission, stillbirth or perinatal death, meconium at delivery, or wound complications were included.
A total of 1576 results were identified; 33 studies met inclusion criteria. Women with sleep-disordered breathing were older (mean difference, 1.66; 95% confidence interval, 1.04-2.28) and had a higher body mass index (mean difference, 3.31; 95% confidence interval, 2.30-4.32) than those who did not. Maternal sleep-disordered breathing was associated significantly with preterm birth (<37 weeks gestation; odds ratio, 1.86; 95% confidence interval, 1.50-2.31) and low birthweight (<2500 g; odds ratio, 1.67; 95% confidence interval, 1.00-2.78). These women were also less likely to have a vaginal delivery (odds ratio, 0.61; 95% confidence interval, 0.48-0.78) and to be at a higher risk of having an assisted vaginal delivery (odds ratio, 1.88; 95% confidence interval, 1.10-3.21) or a cesarean delivery (odds ratio, 1.81; 95% confidence interval, 1.55-2.11). The risk of both elective (odds ratio, 1.38; 95% confidence interval, 1.09 - 1.76) and emergency cesarean (odds ratio, 2.52; 95% confidence interval, 1.20-5.29) was increased. In addition, women with sleep-disordered breathing were at a higher risk of having an infant with a 5-minute Apgar score <7 (odds ratio, 2.14; 95% confidence interval, 1.24-3.71), stillbirth or perinatal death (odds ratio, 2.02; 95% confidence interval, 1.25-3.28), and neonatal nursery admission (odds ratio, 1.90; 95% confidence interval, 1.38-2.61).
Maternal sleep-disordered breathing is associated with increased risks of adverse intrapartum and perinatal outcomes.
睡眠呼吸障碍在非产科人群中越来越常见，与显著的发病率相关。妊娠睡眠呼吸障碍的发生率尚不清楚，但很可能有许多病例未被诊断出来。
进行了系统评价和荟萃分析，以确定与对照组相比，被诊断为睡眠呼吸障碍的孕妇是否更有可能出现不良的分娩期和围产期结局。
检索了 PubMed、Embase 和 Cinahl 数据库中截至 2017 年 6 月的关于睡眠呼吸障碍和人类妊娠的全文出版物。仅包括报告与妊娠年龄或分娩时体重、早产、分娩方式、脐带 pH 值、阿普加评分、新生儿病房入院、死产或围产儿死亡、分娩时胎粪或伤口并发症有关的睡眠呼吸障碍的研究。
共确定了 1576 项结果；33 项研究符合纳入标准。患有睡眠呼吸障碍的女性年龄较大（平均差异，1.66；95%置信区间，1.04-2.28），体重指数较高（平均差异，3.31；95%置信区间，2.30-4.32）。与未患睡眠呼吸障碍的女性相比。母亲睡眠呼吸障碍与早产（<37 周妊娠；优势比，1.86；95%置信区间，1.50-2.31）和低出生体重（<2500 克；优势比，1.67；95%置信区间，1.00-2.78）显著相关。这些女性阴道分娩的可能性也较小（优势比，0.61；95%置信区间，0.48-0.78），经阴道辅助分娩（优势比，1.88；95%置信区间，1.10-3.21）或剖宫产（优势比，1.81；95%置信区间，1.55-2.11）的风险较高。选择性（优势比，1.38；95%置信区间，1.09-1.76）和紧急剖宫产（优势比，2.52；95%置信区间，1.20-5.29）的风险也增加了。此外，患有睡眠呼吸障碍的女性其婴儿在 5 分钟阿普加评分<7 的风险较高（优势比，2.14；95%置信区间，1.24-3.71）、死产或围产儿死亡（优势比，2.02；95%置信区间，1.25-3.28）以及新生儿病房入院（优势比，1.90；95%置信区间，1.38-2.61）的风险较高。
母亲睡眠呼吸障碍与不良分娩期和围产期结局的风险增加有关。
