Panyarath Pattaraporn, Goldscher Noa, Pamidi Sushmita, Daskalopoulou Stella S, Gagnon Robert, Dayan Natalie, Raiche Kathleen, Olha Allen, Benedetti Andrea, Kimoff R John
Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada.
Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Front Physiol. 2021 Oct 18;12:747106. doi: 10.3389/fphys.2021.747106. eCollection 2021.
Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). Attenuation of the normal nocturnal blood pressure (BP) decline (non-dipping) is associated with adverse pregnancy outcomes. OSAH is associated with nocturnal non-dipping in the general population, but this has not been studied in pregnancy. We therefore analyzed baseline data from an ongoing RCT (NCT03309826) assessing the impact of OSAH treatment on HDP outcomes, to evaluate the relationship of OSAH to 24-h BP profile, in particular nocturnal BP dipping, and measures of arterial stiffness. Women with a singleton pregnancy and HDP underwent level II polysomnography. Patients with OSAH (apnea-hypopnea index (AHI) ≥ 5 events/h) then underwent 24-h ambulatory BP monitoring and arterial stiffness measurements (applanation tonometry, SphygmoCor). Positive dipping was defined as nocturnal systolic blood pressure (SBP) dip ≥ 10%. The relationships between measures of OSAH severity, measures of BP and arterial stiffness were evaluated using linear regression analyses. We studied 51 HDP participants (36.5 ± 4.9 years, BMI 36.9 ± 8.6 kg/m) with OSAH with mean AHI 27.7 ± 26.4 events/h at 25.0 ± 4.9 weeks' gestation. We found no significant relationships between AHI or other OSA severity measures and mean 24-h BP values, although BP was generally well-controlled. Most women were SBP non-dippers (78.4%). AHI showed a significant inverse correlation with % SBP dipping following adjustment for age, BMI, parity, gestational age, and BP medications (β = -0.11, = 0.02). Significant inverse correlations were also observed between AHI and DBP (β = -0.16, = 0.01) and MAP (β = -0.13, = 0.02) % dipping. Oxygen desaturation index and sleep time below SaO 90% were also inversely correlated with % dipping. Moreover, a significant positive correlation was observed between carotid-femoral pulse wave velocity (cfPWV) and REM AHI (β = 0.02, = 0.04) in unadjusted but not adjusted analysis. Blood pressure non-dipping was observed in a majority of women with HDP and OSAH. There were significant inverse relationships between OSAH severity measures and nocturnal % dipping. Increased arterial stiffness was associated with increasing severity of OSAH during REM sleep in unadjusted although not adjusted analysis. These findings suggest that OSAH may represent a therapeutic target to improve BP profile and vascular risk in HDP.
孕妇阻塞性睡眠呼吸暂停低通气（OSAH）与妊娠期高血压疾病（HDP）相关。正常夜间血压（BP）下降减弱（非勺型）与不良妊娠结局相关。OSAH在普通人群中与夜间非勺型血压相关，但在孕期尚未对此进行研究。因此，我们分析了一项正在进行的随机对照试验（RCT，NCT03309826）的基线数据，该试验评估OSAH治疗对HDP结局的影响，以评估OSAH与24小时血压曲线的关系，特别是夜间血压勺型变化以及动脉僵硬度指标。单胎妊娠且患有HDP的女性接受了二级多导睡眠图检查。OSAH患者（呼吸暂停低通气指数（AHI）≥5次/小时）随后接受24小时动态血压监测和动脉僵硬度测量（压平式眼压测量法，SphygmoCor）。正向勺型变化定义为夜间收缩压（SBP）下降≥10%。使用线性回归分析评估OSAH严重程度指标、血压指标和动脉僵硬度之间的关系。我们研究了51名患有OSAH的HDP参与者（年龄36.5±4.9岁，体重指数36.9±8.6kg/m²），在妊娠25.0±4.9周时平均AHI为27.7±26.4次/小时。我们发现AHI或其他OSA严重程度指标与平均24小时血压值之间无显著关系，尽管血压总体控制良好。大多数女性为SBP非勺型者（78.4%）。在对年龄、体重指数（BMI）、产次、孕周和降压药物进行校正后，AHI与SBP下降百分比呈显著负相关（β=-0.11，P=0.02）。在AHI与舒张压（DBP）下降百分比（β=-0.16，P=0.01）和平均动脉压（MAP）下降百分比（β=-0.13，P=0.02）之间也观察到显著负相关。氧饱和度下降指数和低于SaO₂90%的睡眠时间也与下降百分比呈负相关。此外，在未校正但校正分析中未发现颈股脉搏波速度（cfPWV）与快速眼动（REM）期AHI之间存在显著正相关（β=0.02，P=0.04）。大多数患有HDP和OSAH 的女性存在血压非勺型变化。OSAH严重程度指标与夜间下降百分比之间存在显著负相关。在未校正但校正分析中，动脉僵硬度增加与REM睡眠期间OSAH严重程度增加相关。这些发现表明，OSAH可能是改善HDP患者血压曲线和血管风险的一个治疗靶点。
