Duke Department of Anesthesiology, Durham, NC, 27710, USA.
Duke Department of Anesthesiology, Durham, NC, 27710, USA.
Sleep Med Rev. 2018 Dec;42:37-46. doi: 10.1016/j.smrv.2018.05.004. Epub 2018 May 28.
Obesity is prevalent among pregnant women in the United States; 15-20% of obese pregnant women have obstructive sleep apnea. The prevalence of obstructive sleep apnea increases along with body mass index, age and in the presence of other co-morbidities. Untreated obstructive sleep apnea in women is associated with a range of cardiovascular, pulmonary and metabolic co-morbidities; recent studies suggest that women with obstructive sleep apnea in pregnancy may be at significantly greater risk of entering pregnancy with chronic hypertension and/or of developing hypertensive disorders of pregnancy: gestational hypertension; preeclampsia; or eclampsia. This has serious public health implications; hypertensive disorders of pregnancy are a major cause of maternal and neonatal morbidity and mortality and are associated with a greater lifetime risk for cardiovascular disease. The mechanisms that associated obstructive sleep apnea with hypertensive disorders of pregnancy have not been defined, but several pathways are scientifically plausible. In this review, we will present a comprehensive literature review of the following: the associations between obstructive sleep apnea and hypertensive disorders of pregnancy; the proposed mechanisms that may connect obstructive sleep apnea and hypertensive disorders of pregnancy; and the effectiveness of treatment at mitigating these adverse outcomes.
肥胖在美国孕妇中很常见；15-20%的肥胖孕妇患有阻塞性睡眠呼吸暂停。阻塞性睡眠呼吸暂停的患病率随着体重指数、年龄以及其他合并症的存在而增加。未经治疗的女性阻塞性睡眠呼吸暂停与一系列心血管、肺部和代谢合并症有关；最近的研究表明，患有阻塞性睡眠呼吸暂停的孕妇在怀孕期间患慢性高血压和/或发展为妊娠高血压疾病的风险显著增加：妊娠期高血压；先兆子痫；或子痫。这具有严重的公共卫生意义；妊娠高血压疾病是孕产妇和新生儿发病率和死亡率的主要原因，并且与心血管疾病的终生风险增加有关。与妊娠高血压疾病相关的阻塞性睡眠呼吸暂停的机制尚未确定，但有几个途径在科学上是合理的。在这篇综述中，我们将对以下内容进行全面的文献回顾：阻塞性睡眠呼吸暂停与妊娠高血压疾病之间的关联；可能连接阻塞性睡眠呼吸暂停和妊娠高血压疾病的机制；以及治疗减轻这些不良后果的有效性。
