Indian Journal of Sleep Medicine

Register      Login

VOLUME 10 , ISSUE 3 ( July-September, 2015 ) > List of Articles


Sleep-disordered breathing and preeclampsia

J.C. Suri

Keywords : Gestational hypertension, Preeclampsia, Sleep Disordered Breathing, Maternal outcome, Fetal outcome

Citation Information : Suri J. Sleep-disordered breathing and preeclampsia. Indian Sleep Med 2015; 10 (3):96-100.

DOI: 10.5958/0974-0155.2015.00014.5

License: CC BY-SA 4.0

Published Online: 01-07-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Preeclampsia is a common cause of maternal and fetal morbidity. Endothelial dysfunction(ED) is the most important pathophysiologic mechanism for preeclampsia. Sleep-disordered breathing (SDB) is an important underlying mechanismin cardiovascular complications such as hypertension and ischemic heart disease with ED. Physiological changes during pregnancy predisposewomen to increased prevalence of SDB during the third trimester of pregnancy. SDB is seen more often in preeclampsia and ED is seen in preeclampsia and SDB. ED in preeclampsia may be potentiated by SDB. SDB appears to contribute significantly to the severity of ED in preeclampsia leading to more severe maternal and fetal outcomes. Continuous positive airway pressure (CPAP) treatment has shown benefit in reducing the severity of preeclampsia and improving the maternal and fetal outcomes in some studies. Further research is warranted in this area, especially to study the impact of CPAP on the severity of preeclampsia.

PDF Share
  1. Granger JP, Alexander BT, Llinas MT, Bennett WA, Khalil RA. Pathophysiology of pre-eclampsia: linking placental ischemia/hypoxia with microvascular dysfunction. Microcirculation 2002;9:147–60.
  2. American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy; Report of the American College of Obstetricians and Gynaecologists’ Task Force on Hypertension in Pregnancy. ObstetGynaecol 2013; 122:1122.
  3. Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367(9516):1066–74.
  4. Charlton F, Tooher J, Rye KA, Hennessy A. Cardiovascular risk, lipids and pregnancy: preeclampsia and the risk of later life cardiovascular disease. Heart Lung Circ. 2014 Mar;23(3):203–12.
  5. Duley L. Pre-eclampsia and the hypertensive disorders of pregnancy. Br Med Bull.2003;67:161–176.
  6. Sibai BM, Caritis S, Hauth J. What we have learned about preeclampsia. SeminPerinatol. 2003;27(3):239–46.
  7. Powe CE, Levine RJ, Karumanchi SA. Preeclampsia, a disease of the maternal endothelium: the role of antiangiogenic factors and implications for later cardiovascular disease. Circulation 2011;123(24):2856–69.
  8. Izci B, Lee K. Sleep disturbances during pregnancy. In: Kryger M, Roth T, Dement W, editors. Principles and practice of sleep medicine. 5. Philadelphia: Saunders; 2010.
  9. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA 2004; 291:2013.
  10. Newman AB, Nieto FJ, Guidry U, et al. Relation of sleepdisordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol. 2001;154(1):50–9.
  11. Nieto FJ, Young TB, Lind BK, et al. Association of sleepdisordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000;283(14):1829–36.
  12. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000 May 11;342(19):1378–84.
  13. Young T, Peppard P. Sleep-disordered breathing and cardiovascular disease: epidemiologic evidence for a relationship. Sleep 2000;23(Suppl 4):S122–6.
  14. Young T, Peppard P, Palta M, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med. 1997;157(15):1746–52.
  15. Maski KP, Kothare SV. Searching for marker of REM sleep behavior disorder: submentalis muscle EMG amplitude analysis during sleep in patients with narcolepsy/cataplexy. Sleep 2009;32:137.
  16. Imadojemu VA, Gleeson K, Gray KS, Sinoway LI, Leuenberger UA.Obstructive apnea during sleep is associated with peripheral vasoconstriction. Am J RespirCrit Care Med 2002;165(1):61–6.
  17. Izci B, Vennelle M, Liston WA, et al. Sleep-disordered breathing and upper airway size in pregnancy and postpartum. EurRespir J 2006;27:321.
  18. Pilkington S, Carli F, Dakin MJ, et al. Increase in Mallampati score during pregnancy. Br J Anaesth. 1995;74:638.
  19. Facco FL, Kramer J, Ho KH, et al. Sleep disturbances in pregnancy. ObstetGynecol 2010;115:77.
  20. White DP. Pathogenesis of obstructive and central sleep apnea. Am J RespirCrit Care Med. 2005;172(11):1363-70.
  21. Louis JM, Mogos MF, Salemi JL, et al. Obstructive sleep apnea and severe maternal–infant morbidity/mortality in the United States, 1998-2009. Sleep 2014;37:843.
  22. Bourjeily G, Raker CA, Chalhoub M, Miller MA. Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing. EurRespir J 2010;36:849.
  23. Aggarwal M, Suri JC, Suri S, Sen MK. Maternal and fetal outcomes of sleep disordered breathing in pregnancy. Indian J Sleep Med.2008;3(1):25–9.
  24. Suri JC, Sen MK, Suri J, Vaidya S, Adhikari T., Epidemiology of sleep disorders in pregnant subjects: a questionnaire based survey Indian J Sleep Med 2009; 4(3):106–13.
  25. Pien GW, Pack AI, Jackson N, et al. Risk factors for sleepdisordered breathing in pregnancy. Thorax 2014;69:371.
  26. Franklin KA, Holmgren PA, Jonsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus. Chest 2000;117(1):137–41.
  27. Chen YH, Kang JH, Lin CC, et al. Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J ObstetGynecol 2012;206:136.e1.
  28. Louis JM, Auckley D, Sokol RJ, Mercer BM. Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy. Am J ObstetGynecol 2010;202:261.e1.
  29. Yinon D, Lowenstein L, Suraya S, et al. Preeclampsia is associated with sleep-disordered breathing and endothelial dysfunction. EurRespir J. 2006;27:328–33.
  30. Edwards N, Blyton DM, Kirjavainen T, Kesby GJ, Sullivan CE. Nasal continuous positive airway pressure reduces sleep-induced blood pressure increments in preeclampsia. Am J RespirCrit Care Med. 2000;162(1):252–7
  31. Blyton DM, Sullivan CE, Edwards N. Reduced nocturnal cardiac output associated with preeclampsia is minimized with the use of nocturnal nasal CPAP. Sleep 2004;27:79.
  32. Guilleminault C, Palombini L, Poyares D, et al. Preeclampsia and nasal CPAP: part 1. Early intervention with nasal CPAP in pregnant women with risk-factors for preeclampsia: preliminary findings. Sleep Med. 2007;9:9.
  33. Poyares D, Guilleminault C,Hachul H,Fujita L,Takaoka S,Tufik S,Sass N. Pre-eclampsia and nasal CPAP: part 2. Hypertension during pregnancy, chronic snoring, and early nasal CPAP intervention. Sleep Med.2007;9(1):15–21.
  34. Blyton DM, Skilton MR, Edwards N, Hennessy N, Celermajer DS, Sullivan CE.Treatment of sleep disordered breathing reverses low fetal activity levels in preeclampsia. Sleep 2013;36(1): 15–21.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.