Kim Minjee, Wiener Laura Elizabeth, Gilbert Jace, McNeil Rebecca B, Reid Kathryn J, Grobman William A, Facco Francesca, Haas David M, Silver Robert M, Greenland Philip, Yee Lynn M, Zee Phyllis C
Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
JAMA Netw Open. 2024 Dec 2;7(12):e2452204. doi: 10.1001/jamanetworkopen.2024.52204.
Short sleep duration during pregnancy and the perimenopausal period has been associated with adverse cardiometabolic outcomes. However, it remains unclear how sleep duration changes after delivery and whether such changes are associated with the cardiometabolic health of birthing people.
To investigate whether persistently short sleep during pregnancy and after delivery is associated with incident hypertension and metabolic syndrome.
DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study (NuMoM2b-HHS), an ongoing prospective cohort study, was conducted between September 5, 2023, and March 1, 2024, in 8 US academic medical centers. Participants were aged 18 years or older at NuMoM2b enrollment; recruited during their first pregnancy between October 1, 2010, and September 30, 2013; and followed up for a mean (SD) of 3.1 (0.9) years after delivery.
Self-reported short sleep duration (<7 hours) during pregnancy and 2 to 7 years after delivery was defined as persistent short sleep.
Incident hypertension and metabolic syndrome (MetS) at follow-up. Regression models were used to estimate relative risks of incident hypertension and MetS by sleep duration pattern. Hypertension analyses excluded participants with hypertension at baseline, and MetS analyses excluded participants with MetS at baseline. Multivariable models included a priori covariates of baseline age and time from delivery to follow-up. Incident hypertension analyses included an additional covariate of body mass index at baseline.
Among 3922 participants (mean [SD] age, 27.3 [5.4] years; 598 Hispanic [15.2%], 485 non-Hispanic Black [12.4%], and 2542 non-Hispanic White [64.8%]), 565 individuals (14.4%) experienced persistent short sleep. Non-Hispanic Black (adjusted odds ratio [aOR], 2.17; 95% CI, 1.59-2.97) and unmarried (aOR, 1.68, 95% CI, 1.29-2.19) participants were significantly more likely to experience persistent short sleep compared with non-Hispanic White and married participants, respectively. Persistent short sleep was associated with higher odds of incident MetS (aOR, 1.60; 95% CI, 1.21-2.11) but not incident hypertension (aOR, 0.91; 95% CI, 0.69-1.19).
In this study, short sleep duration that persisted from pregnancy to 2 to 7 years after delivery was associated with a greater risk for adverse cardiometabolic outcomes. Future studies should explore whether sleep-targeted interventions during and after pregnancy are associated with improved cardiometabolic health outcomes, particularly among populations at increased risk.
孕期和围绝经期睡眠时长较短与不良心脏代谢结局相关。然而，产后睡眠时长如何变化以及这种变化是否与产妇的心脏代谢健康相关仍不清楚。
调查孕期和产后持续短睡眠是否与新发高血压和代谢综合征相关。
设计、地点和参与者：本研究是对未生育孕妇结局研究：监测准妈妈心脏健康研究（NuMoM2b - HHS）的二次分析，这是一项正在进行的前瞻性队列研究，于2023年9月5日至2024年3月1日在美国8家学术医疗中心开展。参与者在NuMoM2b入组时年龄为18岁及以上；于2010年10月1日至2013年9月30日首次怀孕时被招募；产后平均（标准差）随访3.1（0.9）年。
孕期及产后2至7年自我报告的短睡眠时长（<7小时）被定义为持续短睡眠。
随访时的新发高血压和代谢综合征（MetS）。采用回归模型按睡眠时长模式估计新发高血压和MetS的相对风险。高血压分析排除了基线时患有高血压的参与者，MetS分析排除了基线时患有MetS的参与者。多变量模型纳入了基线年龄和从分娩到随访时间的先验协变量。新发高血压分析还纳入了基线体重指数这一协变量。
在3922名参与者中（平均[标准差]年龄为27.3[5.4]岁；598名西班牙裔[15.2%]，485名非西班牙裔黑人[12.4%]，2542名非西班牙裔白人[64.8%]），565人（14.4%）经历了持续短睡眠。与非西班牙裔白人和已婚参与者相比，非西班牙裔黑人（调整后的优势比[aOR]为2.17；95%置信区间[CI]为1.59 - 2.97）和未婚参与者（aOR为1.68，95% CI为1.29 - 2.19）经历持续短睡眠的可能性显著更高。持续短睡眠与新发MetS的较高几率相关（aOR为1.60；95% CI为1.21 - 2.11），但与新发高血压无关（aOR为0.91；95% CI为0.69 - 1.19）。
在本研究中，从孕期持续至产后至2至7年的短睡眠时长与不良心脏代谢结局的更大风险相关。未来研究应探索孕期及产后针对睡眠的干预措施是否与改善心脏代谢健康结局相关，尤其是在风险增加的人群中。
