Women's Medicine Collaborative, The Miriam Hospital, Providence, RI, USA; Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Sleep Medicine Unit, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland.
Sleep Med Rev. 2024 Feb;73:101868. doi: 10.1016/j.smrv.2023.101868. Epub 2023 Nov 1.
Sleep disordered breathing is extremely common in pregnancy and is a risk factor for maternal complications. Animal models demonstrate that intermittent hypoxia causes abnormal fetal growth. However, there are conflicting data on the association between maternal sleep disordered breathing and offspring growth in humans. We investigated this association by conducting a systematic review and meta-analysis. Sixty-three manuscripts, and total study population of 67, 671, 110 pregnant women were included. Thirty-one studies used subjective methods to define sleep disordered breathing, 24 applied objective methods and eight used international codes. Using a random effects model, habitual snoring, defined by subjective methods, and obstructive sleep apnea, diagnosed by objective methods, were associated with an increased risk for large for gestational age (OR 1.46; 95%CI 1.02-2.09 and OR 2.19; 95%CI 1.63-2.95, respectively), while obstructive sleep apnea, identified by international codes, was associated with an increased risk for small for gestational age newborns (OR 1.28; 95%CI 1.02-1.60). Our results support that maternal sleep disordered breathing is associated with offspring growth, with differences related to the type of disorder and diagnostic methods used. Future studies should investigate underlying mechanisms and whether treatment of sleep disordered breathing ameliorates the neonatal growth.
睡眠呼吸障碍在妊娠中极为常见，是产妇并发症的一个危险因素。动物模型表明，间歇性低氧会导致胎儿生长异常。然而，关于母体睡眠呼吸障碍与人类后代生长之间的关联，存在相互矛盾的数据。我们通过系统回顾和荟萃分析来研究这种关联。纳入了 63 篇文献，总研究人群为 67110 名孕妇。31 项研究采用主观方法来定义睡眠呼吸障碍，24 项研究采用客观方法，8 项研究采用国际标准。采用随机效应模型，习惯性打鼾（通过主观方法定义）和阻塞性睡眠呼吸暂停（通过客观方法诊断）与巨大儿的风险增加相关（OR 1.46；95%CI 1.02-2.09 和 OR 2.19；95%CI 1.63-2.95），而通过国际标准诊断的阻塞性睡眠呼吸暂停与小于胎龄儿的风险增加相关（OR 1.28；95%CI 1.02-1.60）。我们的研究结果表明，母体睡眠呼吸障碍与后代生长有关，其差异与障碍类型和诊断方法有关。未来的研究应该探讨潜在的机制，以及治疗睡眠呼吸障碍是否能改善新生儿的生长。
