OBSTRUCTIVE SLEEP APNEA SYNDROME DURING PREGNANCY


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Abstract

The review presents up-to-date data on the current state of the problem of sleep-related breathing disorders in pregnant women. Obstructive sleep apnea syndrome (OSAS) is a common, but often unrecognized condition that has serious negative health outcomes for a pregnant woman and her future baby. Recently, this problem has been actively studied in our and foreign countries. Over the past decade, there has been a lot of accumulated clinical data on the predisposition of women during pregnancy to the development of OSAS due to physiological, hormonal, and endocrine changes during this period. In the article, the authors have attempted to reveal the mechanisms and consequences of this disease not only for the pregnant woman, but also for her fetus. To develop appropriate prevention and treatment guidelines, it is necessary to identify the relationship between the presence of OSAS in a pregnant woman, the pathological course of pregnancy, and the neonatal status. Whether there is a link between snoring during pregnancy and adverse fetal outcomes is considered. The article also discusses the possibility of using non-invasive ventilation and its impact on the course of pregnancy and concomitant diseases in women with OSAS. Conclusion. Currently, no special studies aimed at elaborating algorithms for the management of such patients have been conducted. The early diagnosis and timely treatment of OSAS in pregnant women will improve the course and prognosis of pregnancy and lower the risk of adverse effects of intrauterine factors (hypoxia) on the fetus, which will be able to avoid premature birth and cesarean section and to prevent diseases of the cardiovascular and endocrine systems.

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About the authors

Anna Yu. Solomakha

Saint Petersburg State Pediatric Medical University, Ministry of Health of the Russian Federation

Email: anka.solomaha@yandex.ru
MD, Department of Propedeutics of Childhood Diseases with a Course of General Child Care 194100, Russia, Saint Petersburg, Litovskaya str., 2

Natalia A. Petrova

V.A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation

Email: natalja5@yandex.ru
MD, PhD, Head of Physiology and Pathology of Newborns Laboratory 197341, Russia, St. Petersburg, Akkuratova str., 2

Vitaly F. Bezhenar

Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation

Email: bez-vitaly@yandex.ru
MD, PhD, Dr. Med. Sci., Professor, Head of the Department of Obstetrics, Gynecology and Neonatology, Head of the Clinic of Obstetrics and Gynecology; Chief obstetrician-gynecologist of the Health Committee of the Government 197022, Russia, St. Petersburg, Lev Tolstoy str., 6-8

Dmitry O. Ivanov

Saint Petersburg State Pediatric Medical University, Ministry of Health of the Russian Federation

Email: spb@gpmu.org
MD, PhD, Dr. Med. Sci., Professor, Rector 194100, Russia, Saint Petersburg, Litovskaya str., 2

References

  1. Gislason T., Benediktsdottir B., Bjornsson J.K., Kjartansson G., Kjeld M., Kristbjarnarson H. Snoring, hypertension, and the sleep apnea syndrome. An epidemiologic survey of middle-aged women. Chest. 1993; 103(4): 1147-51. https://dx.doi.org/10.1378/chest.103.4.1147.
  2. Reichner C.A. Insomnia and sleep deficiency in pregnancy. Obstet. Med. 2015; 8(4): 168-71. https://dx.doi.org/10.1177/1753495X15600572.
  3. Wise R.A., Polito A.J., Krishnan V. Respiratory physiologic changes in pregnancy. Immunol. Allergy Clin. North Am. 2006; 26(1): 1-12. https://dx.doi. org/10.1016/j.iac.2005.10.004.
  4. Bobrowski R.A. Pulmonary physiology in pregnancy. Clin. Obstet. Gynecol. 2010; 53(2): 285-300. https://dx.doi.org/10.1097/GRF.0b013e3181e04776.
  5. Davies G.A., Maxwell C., McLeod L., Gagnon R., Basso M., Bos H. et al. SOGC Clinical Practice Guidelines: Obesity in pregnancy. No. 239, February 2010. Int. J. Gynaecol. Obstet. 2010; 110(2): 167-73. https://dx.doi.org/10.1016/ j.ijgo.2010.03.008.
  6. Izci B., Vennelle M., Liston W.A., Dundas K.C., Calder A.A., Douglas N.J. Sleep-disordered breathing and upper airway size in pregnancy and post-partum. Eur. Respir. J. 2006; 27(2): 321-7. https://dx.doi.org/10.1183/09031936.06. 00148204.
  7. Koo B.B., Dostal J., Ioachimescu O., Budur K. The effects of gender and age on REM-related sleep-disordered breathing. Sleep Breath. 2008; 12(3): 259-64. https://dx.doi.org/10.1007/s11325-007-0161-7.
  8. LUthi M., Roach D.E., Beaudin A.E., Debert C.T., Sheldon R.S., Poulin M.J. Effects of ovarian hormones and aging on respiratory sinus arrhythmia and breathing patterns in women. Clin. Auton. Res. 2008; 18(3): 134-44. https:// dx.doi.org/10.1007/s10286-008-0473-0.
  9. O’Brien L.M., Bullough A.S., Owusu J.T., Tremblay K.A., Brincat C.A., Chames M.C. et al. Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study. Am. J. Obstet. Gynecol. 2012; 207(6): 487. e.1-9. https://dx.doi.org/10.1016/j.ajog.2012.08.034.
  10. Cain M.A., Louis J.M. Sleep disordered breathing and adverse pregnancy outcomes. Clin. Lab. Med. 2016; 36(2): 435-46. https://dx.doi.org/10.1016/j. cll.2016.01.001.
  11. Pien G.W., Pack A.I., Jackson N., Maislin G., Macones G.A., Schwab R.J. Risk factors for sleep-disordered breathing in pregnancy. Thorax. 2014; 69(4): 371-7. https://dx.doi.org/ 10.1136/thoraxjnl-2012-202718.
  12. Sarberg M., Svanborg E., Wirehn A.B., Josefsson A. Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study. BMC Pregnancy Childbirth. 2014; 14: 15. https://dx.doi.org/10.1186/ 1471-2393-14-15.
  13. Reid J., Glew R.A., Skomro R., Fenton M., Cotton D., Olatunbosun F. et al. Sleep disordered breathing and gestational hypertension: postpartum follow-up study. Sleep. 2013; 36(5): 717-21B. https://dx.doi.org/10.5665/ sleep.2634.
  14. Facco F.L., Ouyang D.W., Zee P.C., Grobman W.A. Development of a pregnancy-specific screening tool for sleep apnea. J. Clin. Sleep Med. 2012; 8(4): 389-94. https://dx.doi.org/10.5664/jcsm.2030.
  15. Franklin K.A., Holmgren P.A., Jonsson F., Poromaa N., Stenlund H., Svanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus. Chest. 2000; 117(1): 137-41. https://dx.doi.org/10.1378/ chest.117.1.137.
  16. Романова В.В., Горшинова В.К., Шмаков Р.Г., Шифман Е.М. Роль сонного апноэ в развитии преэклампсии. Акушерство и гинекология. 2012; (4-2): 4-9.
  17. Qiu C., Enquobahrie D., Frederick I.O., Abetew D., Williams M.A. Glucose intolerance and gestational diabetes risk in relation to sleep duration and snoring during pregnancy: a pilot study. BMC Womens Health. 2010; 10: 17. https:// dx.doi.org/ 10.1186/1472-6874-10-17.
  18. Guilleminault C., Querra-Salva M., Chowdhuri S., Poyares D. Normal pregnancy, daytime sleeping, snoring and blood pressure. Sleep Med. 2000; 1(4): 289-97. https://dx.doi.org/10.1016/s1389-9457(00)00046-0.
  19. Loube D.I., Poceta J.S., Morales M.C., Peacock M.D., Mitler M.M. Self-reported snoring in pregnancy. Association with fetal outcome. Chest. 1996; 109(4): 885 https://dx.doi.org/10.1378/chest.109.4.885.
  20. Pamidi S., Marc I., Simoneau G., Lavigne L., Olha A., Benedetti A. et al. Maternal sleep-disordered breathing and the risk of delivering small for gestational age infants: a prospective cohort study. Thorax. 2016; 71(8): 719-25. https://dx.doi. org/10.1136/thoraxjnl-2015-208038.
  21. Fung A.M., Wilson D.L., Barnes M., Walker S.P. Obstructive sleep apnea and pregnancy: the effect on perinatal outcomes. J Perinatol. 2012; 32(6): 399-406. https://dx.doi.org/10.1038/jp.2012.14.
  22. Genbacev O., Joslin R., Damsky C.H., Polliotti B.M., Fisher S.J. Hypoxia alters early gestation human cytotrophoblast differentiation/invasion in vitro and models the placental defects that occur in preeclampsia. J. Clin. Invest. 1996; 97(2): 540-50. https://dx.doi.org/10.1172/JCI118447.
  23. Louis J.M., Mogos M.F., Salemi J.L., Redline S., Salihu H.M. Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009. Sleep. 2014; 37(5): 843-9. https://dx.doi.org/10.5665/sleep.3644.
  24. Chung F., Subramanyam R., Liao P., Sasaki E., Shapiro C., Sun Y. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br. J. Anaesth. 2012; 108(5): 768-75. https://dx.doi.org/10.1093/bja/aes022.
  25. Lockhart E.M., Ben Abdallah A., Tuuli M.G., Leighton B.L. Obstructive sleep apnea in pregnancy: assessment of current screening tools. Obstet. Gynecol. 2015; 126(1): 93-102. https://dx.doi.org/10.1097/AOG.0000000000000848.
  26. Facco F.L., Ouyang D.W., Zee P.C., Grobman W.A. Development of a pregnancy-specific screening tool for sleep apnea. J. Clin. Sleep Med. 2012; 8(4): 389-94. https://dx.doi.org/10.5664/jcsm.2030. Повтор № 14.
  27. Kapur V.K., Auckley D.H., Chowdhuri S., Kuhlmann D.C., Mehra R., Ramar K. et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine Clinical Practice Guideline. J. Clin. Sleep Med. 2017; 13(3): 479-504. https://dx.doi.ois/10.5664/jcsm.6506.
  28. Ghegan M.D., Angelos P.C., Stonebraker A.C., Gillespie M.D. Laboratory versus portable sleep studies: a meta-analysis. Laryngoscope. 2006; 116(6): 859-64. https://dx.doi.org/10.1097/01.mlg.0000214866.32050.2e.
  29. Epstein L.J., Kristo D., Strollo P.J. Jr., Friedman N., Malhotra A., Patil S.P. et al. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J. Clin. Sleep Med. 2009; 5(3): 263-76.
  30. Shah N., Hanna D.B., Teng Y., Sotres-Alvarez D., Hall M., Loredo J.S. et al. Sex-specific prediction models for sleep apnea from the Hispanic community health study/study of Latinos. Chest. 2016; 149(6): 1409-18. https://dx.doi. org/10.1016/j.chest.2016.01.013.

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