Indian Journal of Sleep Medicine

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VOLUME 4 , ISSUE 3 ( July-September, 2009 ) > List of Articles

ORIGINAL ARTICLE

Epidemiology of sleep disorders in pregnant subjects: A questionnaire based survey

Tulsi Adhikari, M K Sen, J. C. Suri, Sonali Vaidya

Citation Information : Adhikari T, Sen MK, Suri JC, Vaidya S. Epidemiology of sleep disorders in pregnant subjects: A questionnaire based survey. Indian Sleep Med 2009; 4 (3):106-113.

DOI: 10.5005/ijsm-4-3-106

License: CC BY-SA 4.0

Published Online: 01-09-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction There are several changes which occur during the pregnant state that can impact directly or indirectly on breathing. A questionnaire based survey of sleep disorders amongst pregnant subjects attending a tertiary care hospital in New Delhi. Material & Methods The study was based on a questionnaire. It contained, besides personal identification of the subject, a set of 35 questions. In addition it also had the Epworth Sleep Questionnaire. A validated questionnaire for anxiety and depression was also used. Details of present pregnancy (parity, gravida, last menstrual period, expected date of delivery and period of gestation) was also recorded. The total number of pregnant subjects interviewed was 325. They were selected randomly from those attending the ante-natal clinic of Safdarjang Hospital & Vardhman Mahavir Medical College, New Delhi. Observations The overall prevalence of snoring was 13.5%. It correlated positively with depression (p<0.075) and gestation period (p<0.016). The overall prevalence of SDB was 9.5%. It correlated positively with gestation period (p<0.042) BMI (p<0.05) and disorders of initiation & maintenance of sleep (DIMS) (p<0.005) and depression (p<0.021). The overall prevalence of DIMS was 47.6%. The prevalence of DIMS was maximum in the third trimester; and it showed a positive correlation with rising gestation period. The overall prevalence of Restless Leg Syndrome (RLS) was 15.7%. It was most prevalent in age group 21-25 years (p<0.045). It showed rising trend with increase in gestation period (p<0.049), increasing parity (p<0.071) and decreasing hemoglobin concentration (p<0.047). The overall prevalence of depression was 11.4%. It correlated positively with increasing parity (p<0.045). The overall prevalence of anxiety was 18.1%. It correlated negatively with increasing age (p<0.057) & BMI (p<0.067) and positively with increasing gestation period (p<0.099). The overall prevalence of excessive daytime sleepiness (EDS) was 30.5%. It correlated negatively, with gestation period (p<0.005) and parity (p<0.001). The overall prevalence of Sleep Deprivation was 11.0%. It correlated with the presence of disorders of initiation and maintenance of sleep (DIMS). Sleep deprivation was also found to the maximally present in the third trimester. Conclusions SDB that develops or worsens during pregnancy affects a significant number of pregnant subjects and can predispose them to pre-eclampsia. It can serve as a pointer towards a sinister maternal and/or fetal complication and necessary action may be taken early. In our country, women are less likely than men to report symptoms of snoring/snorting and gasping due to social/ cultural reasons. Hence OSA in pregnant women is likely to go undiagnosed. Moreover, symptoms like EDS and nocturnal insomnia are often assumed to be less discriminatory for OSA in pregnant women. Hence a high index of suspicion and vigilance is required. The indications for polysomnography in pregnant women should probably include those with hypertension, previous babies with unexplained IUGR, and persistent sleep-related symptoms (hypersomnia or insomnia) associated with snoring and/or obesity. The prevalence of such complications during pregnancy is significant in our country. In view of these facts, an awareness needs to be created amongst pregnant subjects, their caregivers and the healthcare community at large to detect typical and atypical manifestation of SDB (like anxiety, depression, RLS, DMIS, fatigue) early and undertake remedial measures.


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  1. Davies RJO, Stradling JR. The epidemiology of sleep apnea. Thorax 1996; 51:S65-S70.
  2. Ulliel S, Tauman R, Green Field M et al. Chest 2004; 125:872-878.
  3. American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine, 2005.
  4. Houri P, Linde S. What kind of insomniac are you? In: No More Sleepless Nights. John Wiley & Sons Inc. New York. 1996; 23-42.
  5. Young T, R. Hutton, L. Finn, S. Badr and M. Palta. The gender bias in sleep apnea diagnosis. Are women missed because they havae different symptoms? Arch Intern Med, 1996; 156(21):2445-2451.
  6. Shepertycky M., K. Banno and M. Kryger. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep, 2005; 28(3):309-314.
  7. Hall JE, J.P. Sullivan and G.S. Richaradson,Brief wake episodes modulate sleep-inhibited luteininzing hormone secretion in the early follicular phase. J Clin Endocrinol Metab, 2005; 90(4):2050-2055.
  8. Rossmanith W.G, S. boscher, W. Kern and H. L. Fehm. Impact of sleep on the circadian excursions in the pituitary gonadotropin responsiveness of ealy follicular phase women. J Clin Endocrinol Metab, 1993; 76(2):330-336.
  9. National Sleep disorders research plan 2nd ed. 2003, Bethesda: National Center on Sleep Disorders Research, U.S. Department of Health and Human Services, National Institutes of Health, National heart, Lung and Blood institute. 152
  10. Moline M.L, L. Broch and R.Zak. Sleep in women across the life cycle from adulthood through menopause. Sleep Med Rev, 2003; 7(2):155-177.
  11. Attarian HP. Epidemiology of Sleep disorder in women. In Eds Attarian HP (Ed). “Sleep Disorder in women” Humana Press NJ 2006; 9-17.
  12. Wolfson A.R, S. J. Crowley, U. Anwer and J.L. Bassett. Changes in sleep patterns and depressive symptoms in first-time mothers: last trimester to 1-year postpartum. Behav Sleep Med, 2003; 1(1):54-67.
  13. Sharma S, R. Franco. Sleep and its disorders in pregnancy. Sleep 2004; 27(7):1405-1417.
  14. Lee K.A., Alterations in sleep during pregnancy and postpartum: a review of 30 years of research. Sleep Med Rev, 1998; 2(4):231-242.
  15. Pien GW, Schwab RJ. Sleep disorders during pregnancy. Sleep 2004; 27:1405-1417.
  16. Krystal AD. Depression and insomnia in women. Clin Cornerstone, 2004, 6 Suppl; 1B:S19-S-28.
  17. Manconi M, V. Govoni, A. De Vito et al. Restless legs syndrome and pregnant. Neurology, 2004; 63(6):1065-1069.
  18. Suzuki K, Ohida T, Sone et al. The prevalence of restless legs syndrome among pregnant women in Japan and the relationship between restless legs syndrome and sleep problems. Sleep, 2003; 26(6):673-677.
  19. Manconi M, V. Govoni, A. De Vito et al. Pregnancy as a risk factor for restless legs syndrome. Sleep Med, 2004; 5(3):305- 308.
  20. Young T, P.E. Peppard and D. J. Gottlieb. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med, 2002; 165(9):1217-1239.
  21. Izci B, S. E. Martin, K C Dundas, W A Liston, A A Calder and N. J. Douglas. Sleep complaints: snoring and daytime sleepiness in pregnant and pre-eclamptic women. Sleep Med, 2005; 6(2):163-169.
  22. Hannhart B, C.K. Pickett and L.G. Moore. Effects of estrogen and progesterone on carotid body neural output responsiveness to hypoxia. J Appl Physiol, 1990; 68(5):1909-1916.
  23. Mozurkewich EL, B. Luke, M Avni and F.M. Wolf. Working conditions and adverse pregnancy outcome: a meta-analysis. Obstet Gynecol, 2000; 95(4):623-635.
  24. Loube DI et al. Self-reported snoring in pregnancy. Associated with fetal outcome. Chest 1996;109(4):885-889.
  25. Franklin K A, P.A. Holmgren, F. Jonsson, N. Poromaa, H Stenlund, and E. Svanborg. Snoring, lpergnancy-induced hypertension and growth retardation of the fetus. Chest, 2000; 117(1):137- 141.
  26. Loube DI, Poceta JS, Morales MC, Peacock MD, Mitter MM. Self-reported snoring in pregnancy Associated with fetal outcome. Chest 1996; 109(4):885-889.
  27. Guilleminault C, Querra-Salva M, Chowdhuri S, Poyares D. Normal pregnancy, daytime sleeping, snoring and blood pressure. Sleep Med 2000; 1(4):289-297.
  28. Franklin KA, Holmgren PA, Jonsson F, Poromaa N, Stenlund H, Svanborg F. Snoring, pregnancy-induced hypertension and growth retardation in the fetus. Chest 2000; 117(1):137-141.
  29. Young T,M. Palta, J. Dempsey, J. Skatrud, S. Weber and S. Badr. The occurrence of sleep-disordred breathing among middleaged adults. N Engl J Med, 1993; 328(17):1230-1235.
  30. Bixler EO, A. N. Vgontzas, H. M. Lin et al. prevalence of sleepdisodered breathing in women: effects of gender. Am J Respir Crit Care Med, 2002; 165(9):1217-1239.
  31. Connolly G, Razak AR, Hayanga A et al. Inspiratory flow limitation during sleep in pre-eclampsia: comparison with normal pregnant and non pregnant women. Eur Respir J, 2001; 18(4):672-676.
  32. Lindberg E, C. Janson, T. Gislason, E. Bornsson, J. Hetta and G. Boman. Sleep disturbances in a young adult population: can gender differences be explained by differences in psychological status? Sleep, 1997; 20(6):381-387.
  33. Doi Y and M. Minowa. Gender differences in excessive daytime sleepiness among Japanese workers. Soc Sci Med, 2003; 56(4):883-894.
  34. Hara C, F. Lopes Rocha and M. F. Lima-costa. Prevalence of excessive daytime sleepiness and associated factors in a Brazilian community: the Bambui study. Sleep Med 2004; 5(1):31-36.
  35. Aggarwal M, Suri JC, Suri S, Sen MK. Maternal and fetal outcomes of sleep disorders breathing in pregnancy. Indian J Sleep Med 2008; 3.1:25-29.
  36. Suri JC, Sen MK, Adhikari T. Epidemiology of sleep disorders in the adult population of Delhi: A Questionnaire based study. Indian J Sleep Med 2008; 3.4,128-137
  37. Hanson M, M. Honour, A. Sigleton, et al. Analysis of familial and sporadic restless legs syndrome in age of onset, gender and severity features. J Neurol, 2004; 5(5):435-440.
  38. Van De Vijver, D.A., T. Walley and H. Petri. Epidemiology of restless legs syndrome as diagnosed in UK primary care. Sleep Med, 2004; 5(5):435-440.
  39. Kapsimalis F, Kryger MH. Gender and obstructive sleep apnea syndrome, Part I: Clinical features. Sleep 2002; 25:412-419.
  40. Gold AR, Dipalo F, Gold MS et al. The symptoms and signs of upper airway resistance syndrome: a link to the functional somatic syndromes. Chest 2003; 123:87-95.
  41. Chervin RD. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 2000; 118:372-379.
  42. Roth dach AR, Trenkwalder J, Haberstock UK, Berger K. Prevalence and risk factors of RLS in an elderly population: The MEMO study. Memory and Morbidityi in Augsburg Elderly. Neurology, 2000; 54(5):1064-1068.
  43. Guilleminault C, Stoohs R, Kim YD et al. Upper airway sleep disordered breathing in women. Ann Intern Med 1995; 122:493-501.
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