Objectives/Background: Snoring is a hallmark of Sleep Disordered Breathing (SDB) and is seen more often in pregnancy. This study was conducted to determine the frequency of snoring in pregnancy-induced hypertension and to observe its impact on feto-maternal outcomes.
Participants/Methods: Sixty-five women with preeclampsia and gestational hypertension comprised the study group, whereas 85 normotensive, age, and gestation matched women were the controls. All the subjects were questioned about habitual snoring and they were followed to study their feto-maternal outcomes.
Results and Conclusions: Snoring was seen more frequently in the cases (OR 16.9, 95% CI 6.8-41.7) as compared to controls even after controlling for BMI. The severity of hypertension was more in snorers (p=0.021). The adverse pregnancy outcomes were more severe in the snorers in the cases as well as the controls. The fetal outcomes were more severely affected by snoring.
Conclusions: Snoring is more prevalent among women with pregnancy-induced hypertension and is associated with more severe hypertension and adverse outcomes.
Izci B, Vennelle M, Liston WA, et al. Sleep-disordered breathing and upper airway size inpregnancy and postpartum. EurRespir J 2006; 27:321.
Pilkington S, Carli F, Dakin MJ, et al. Increase in Mallampati score during pregnancy. Br J Anaesth 1995; 74:638.
Facco FL, Kramer J, Ho KH, et al. Sleep disturbances in pregnancy. ObstetGynecol 2010; 115:77.
David P White. Pathogenesis of obstructive and centralsleepapnea Am J Respir Crit Care Med 2005;172(11):1363–70.
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.
Bliwise DL, Nekich JC, Dement WC. Relative validity of self-reported snoring as a symptom of sleep apnea in a sleep clinic population. Chest 1991;99(3):600–8.
Hedman C, Pohjasvaara T, Tolonen U, Suhonen-Malm AS, Myllyla VV. Effects of pregnancy on mothers’ sleep. Sleep Med 2002; 3(1):37–42. [PubMed: 14592252]
Pien GW, Fife D, Pack AI, Nkwuo JE, Schwab RJ. Changes in symptoms of sleep-disordered breathing during pregnancy. Sleep 2005; 28(10):1299–305. [PubMed: 16295215]
Loube DI, Poceta JS, Morales MC, Peacock MD, Mitler MM. Self-reported snoring in pregnancy association with fetal outcome. Chest 1996;109:885–9.
Franklin KA, Holmgren PA, Jonsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancyinduced hypertension, and growth retardation of the fetus. Chest 2000; 117(1):137–41.
Louise M O'Brien, Alexandra S Bullough, Jocelynn T Owusu, Kimberley A Tremblay,Cynthia A Brincat,Mark C Chames, John D Kalbfleisch,Ronald D Chervin. Pregnancyonsethabitualsnoring, gestationalhypertension, andpreeclampsia: prospectivecohortstudy. Am J Obstet Gynecol 2012; 207(6): 487.
Calaora-Tournadre D, Ragot S, Meurice JC, et al. Obstructive sleep apnea syndrome during pregnancy: prevalence of main symptoms and relationship with pregnancy-induced-hypertension and intra-uterine growth retardation. Rev Med Interne 2006; 27: 291–5.
Schutte S, Del Conte A, Gross A, et al. Self-reported snoring and sleep in high-risk pregnancies. Sleep Res 1995; 24: 342.
Aggarwal M, Suri JC,Suri S, Sen MK. Maternal and fetal outcomesof sleep-disordered breathing in pregnancy. Indian J Sleep Med 2008;3(1):25–9.
Suri JC, Sen MK, Suri J, Vaidya S, Adhikari T. Epidemiology of sleep disorders in pregnant patients: a questionnairebased survey. Indian J Sleep Med2009; 4(3):106–1.
Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apneasyndrome in middleaged men and women. Sleep 1997; 20(9):705–6.
Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342(19):1378–84.
Newman AB, Nieto FJ, Guidry U, et al. Relation of sleepdisordered breathing to cardiovascular disease risk factors: the SleepHeartHealthstudy. Am J Epidemiol 2001; 154(1):50–9.
Young T, Peppard P. Sleep-disordered breathing and cardiovascular disease: epidemiologic evidence for a relationship. Sleep 2000;23(Suppl 4):S122–S126.
Granger JP, Alexander BT, Llinas MT, Bennett WA, Khalil RA. Pathophysiology of preeclampsia: linking placental ischemia/hypoxia with microvascular dysfunction. Microcirculation 2002;9:147-60.
Hypertension in pregnancy Report of the American College of Obstetricians and Gynaecologists’ Task Force on Hypertension in Pregnancy. ObstetGynecol 2013; 122:1122.
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.
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.
L. Duley. Pre-eclampsia and the hypertensive disorders of pregnancy. Br Med Bull 2003;67:161–76.
Sibai BM, Caritis S, HauthJ. What we have learned about preeclampsia, Seminars in Perinatology 2003;27(3):239-46.
Izci B, Martin SE, Dundas KC, Liston WA, Calder AA, Douglas NJ. Sleep complaints: snoring and daytime sleepiness in pregnant and pre-eclamptic women. Sleep Med 2005;6(2):163–9.
Facco FL, Kramer J, Ho KH, Zee PC, Grobman WA. Sleep disturbances in pregnancy. Obstet Gynecol 2010;115(1):77–83.
Sahota PK, Jain SS, Dhand R. Sleep disorders in pregnancy. CurrOpinPulm Med 2003;9(6):477–83.
Santiago JR, Nolledo MS, Kinzler W, Santiago TV. Sleep and sleep disorders in pregnancy. Ann Intern Med 2001;134(5):396-408.
Bourjeily G, Raker CA, Chalhoub M, Miller MA. Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing. EurRespir J 2010;36(4):849–55.
Kump K, Whalen C, Tishler PV, Browner I, Ferrette V, Strohl KP, et al. Assessment of the validity and utility of a sleepsymptom questionnaire. Am J Respir Crit Care Med 1994;150(3):735–41.
Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the sleephearthealth study. Arch Intern Med 2002;162(8):893–900.
Bradley TD, Brown IG, Grossman RF, Zamel N, Martinez D, Phillipson EA, Hoffstein V. Pharyngeal size in snorers, nonsnorers, and patients with obstructive sleep apnea. N Engl J Med 1986;315:1327–31.
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.
BilgayIzci, Renata L Riha, Sascha E Martin, Marjorie Vennelle, Wang A Liston, Kirsty C Dundas, Andrew A Calder, Neil J Douglas. The upperairway in pregnancy and pre-eclampsia. Am J Respir Crit Care Med 2003;167(2):137-40.
Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J ClinEndocrinolMetab 2000;85:1151–8.
Jordan AS, White DP, Fogel RB. Recent advances in understanding the pathogenesis of obstructive sleep apnea. CurrOpinPulm Med 2003;9:459–64.
Young T, Peppard PE, Taheri S. Excess weight and sleepdisordered breathing. J ApplPhysiol 2005;99:1592–9.
Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T. Progression and regression of sleep-disordered breathing with changes in weight: the sleephearthealthstudy. Arch Intern Med 2005; 165: 2408-13.
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.
Edwards N, Blyton DM, Kirjavainen T, Sullivan CE. Hemodynamic responses to obstructive respiratory events during sleep are augmented in women with preeclampsia. Am J Hypertens 2001;14:1090-5.
Tauman R, Many A, Deutsch V, Arvas S, Ascher-Landsberg J, Greenfeld M, et al. Maternal snoring during pregnancy is associated with enhanced fetal erythropoiesis-a preliminary study. Sleep Med2011;12(5):518-22.
Hermansen MC. Nucleated red blood cells in the fetus and newborn. Arch Dis Child Fetal Neonatal Ed2001;84(3):F211-5.