Ross Naima, Baer Rebecca J, Oltman Scott P, Gossett Dana R, Aurora R Nisha, Jelliffe-Pawlowski Laura, Brandt Justin S
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York.
NYU Langone Health, New York.
JAMA Netw Open. 2025 Sep 2;8(9):e2532189. doi: 10.1001/jamanetworkopen.2025.32189.
Insomnia and obstructive sleep apnea (OSA) are associated with pregnancy complications.
To evaluate the association of insomnia and OSA during pregnancy with the risk of ischemic placental disease (IPD) and severe morbidity (SM) and to compare these risks between the 2 sleep disorders.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included a statewide population-based sample of liveborn singleton births with linked birth certificates for birthing people and their infants in California from January 1, 2011, through December 31, 2020. The analysis was performed on July 22, 2024.
Insomnia and OSA.
The main outcomes were IPD, defined as preeclampsia, placental abruption, and birth of a neonate small for gestational age (SGA), and SM, defined according to the Centers for Disease Control and Prevention definition.
During the study period, there were 4 145 096 singleton live births among birthing people aged 13 to 55 years; 4783 (0.1%) had insomnia, 5642 (0.1%) had OSA, and 4 134 671 (99.7%) had neither condition. The prevalence of insomnia and OSA was 116 and 136 cases per 1000 live births, respectively. Compared with patients without insomnia or OSA (738 660 [17.9%]), the adjusted relative risk (ARR) of any IPD was 1.42 (95% CI, 1.35-1.50) for those with insomnia (1406 patients [29.4%]) and 1.57 (95% CI, 1.50-1.64) for those with OSA (1848 [32.8%]). Compared with patients with neither disorder, the ARR of birth of an SGA neonate was higher for those with insomnia (1.23; 95% CI, 1.13-1.35) than for those with OSA. The ARR of preterm birth was 1.81 (95% CI, 1.68-1.95) for insomnia (711 patients [14.9%]) and 1.73 (95% CI, 1.62-1.85) for OSA (870 [15.4%]) vs neither disorder (279 364 [6.8%]). The ARR of SM was 2.26 (95% CI, 2.03-2.50) for insomnia (366 patients [7.7%]) and 2.81 (95% CI, 2.58-3.06) for OSA (545 [9.7%]) vs neither disorder (93 857 [2.3%]).
In this cross-sectional study of singleton live births, pregnant individuals with insomnia or OSA were at increased risk for IPD, SM, and preterm birth compared with those without these sleep disorders. Further study is needed to determine the biological mechanisms for these risks and whether early identification and targeted preventive interventions may improve pregnancy outcomes.
失眠和阻塞性睡眠呼吸暂停（OSA）与妊娠并发症相关。
评估孕期失眠和OSA与缺血性胎盘疾病（IPD）及严重发病（SM）风险的关联，并比较这两种睡眠障碍之间的这些风险。
设计、设置和参与者：这项横断面研究纳入了2011年1月1日至2020年12月31日加利福尼亚州基于全州人口的单胎活产样本，这些样本与分娩者及其婴儿的出生证明相关联。分析于2024年7月22日进行。
失眠和OSA。
主要结局为IPD，定义为子痫前期、胎盘早剥和小于胎龄儿（SGA）出生，以及SM，根据疾病控制与预防中心的定义确定。
在研究期间，13至55岁的分娩者中有4145096例单胎活产；4783例（0.1%）有失眠，5642例（0.1%）有OSA，4134671例（99.7%）两者均无。失眠和OSA的患病率分别为每1000例活产116例和136例。与无失眠或OSA的患者（738660例[17.9%]）相比，失眠患者（1406例[29.4%]）发生任何IPD的调整后相对风险（ARR）为1.42（95%CI，1.35 - 1.50），OSA患者（1848例[32.8%]）为1.57（95%CI，1.50 - 1.64）。与两种疾病均无的患者相比，失眠患者SGA新生儿出生的ARR（1.23；95%CI，1.13 - 1.35）高于OSA患者。失眠患者（711例[14.9%]）早产的ARR为1.81（95%CI，1.68 - 1.95），OSA患者（870例[15.4%]）为1.73（95%CI，1.62 - 1.85），而两种疾病均无的患者（279364例[6.8%]）。失眠患者（366例[7.7%]）SM的ARR为2.26（95%CI，2.03 - 2.50），OSA患者（545例[9.7%]）为2.81（95%CI，2.58 - 3.06），而两种疾病均无的患者（93857例[2.3%]）。
在这项单胎活产的横断面研究中，与无这些睡眠障碍的孕妇相比，患有失眠或OSA的孕妇发生IPD、SM和早产的风险增加。需要进一步研究以确定这些风险的生物学机制，以及早期识别和针对性的预防干预措施是否可改善妊娠结局。
