IMPACT OF SLEEP DISORDER IN PREGNANT WOMEN WITH ARTERIAL HYPERTENSION ON FETAL STATUS

Objective. To study the quantitative characteristics of sleep and the pattern of breathing by polysomnographic monitoring in pregnant women with extragenital pathology; and to establish the role of sleep breathing disorders during complicated pregnancy and neonatal adaptive processes. Subjects and methods. The study enrolled 400 pregnant women in their third trimester, who were interviewed using the extended inventory of the Stanford Sleep Center. The questionnaire survey revealed 246 (78%) women who informed of having sleep disorders presented as three major abnormalities: insomnia (66.5%), restless legs syndrome (42%), and obstructive sleep breathing disorders (39.5%). Thirty-one pregnant women in their third trimester were selected for polysomnography (PSG). The study inclusion criteria were Stage I arterial hypertension (AH); first-degree obesity; clinical manifestations of sleep breathing disorders: snoring and sleep apnea; excessive daytime sleepiness; and frequent nocturnal awakenings due to sleep breathing disorders. Group 1 included 32 pregnant women with AH, obesity without obstructive sleep apnea (OSA). Group 2 consisted of 36 pregnant women with AH, obesity, and OSA. A control group comprised pregnant women without obesity, AH, or clinical manifestations of OSA. PSG was carried out using the conventional procedure in a specially equipped room that was maximally close to domestic conditions, by applying a GRASS-TELEFACTOR Twin PSG (Comet) system with an AS booster and a SPM-1 integrated sleep module (USA). Fetal hemodynamics (systolic-to-diastolic ratio of blood flow velocity curves in the middle cerebral artery, fetal descending aorta, and umbilical artery) was studied to assess the fetal status. All the newborn infants underwent blood gas composition examination and neurosonography. Results. The paper presents the quantitative characteristics of sleep and breathing pattern in pregnant women with AH, obesity, obtained by PSG studies. Monitoring along with PSG cardiotocography (CTG) in the fetus has established that the episodes of nocturnal sleep apnea/hypopnea in the pregnant women with lower blood saturation levels are accompanied by alterations in the fetus status, particularly by those in motor activity and cardiac function as increased heart rate, suggesting fetal hypoxia. Conclusion. PSG monitoring enables abnormal phenomena to be identified in pregnant women with sleep breathing disorders. The results of simultaneous fetal CTG suggest that the fetus responds to maternal hypoxia during nocturnal sleep. Continuous and long-term hypoxia eventually gives rise to deranged fetal adaptive capacities and progressive chronic intrauterine hypoxia, fetal growth retardation, which in turn increases the risk of perinatal morbidity and mortality. This fact makes it necessary to develop new pathogenetic methods for the early prevention and correction of both pregnancy complications and labor outcomes, which is the aim of our further studies.

sleep, pregnancy, polysomnography, sleep breathing disorders, hypoxia, fetal cardiotocography