Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study

• Published in: Sleep & breathing Vol. 20; no. 1; pp. 87 - 93
• Main Authors: Sharma, S. K., Nehra, A., Sinha, S., Soneja, M., Sunesh, K., Sreenivas, V., Vedita, D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2016; Springer Nature B.V
• Subjects: Adult; Apgar Score; Cesarean Section; Clinical outcomes; Dentistry; Diabetes, Gestational - diagnosis; Female; Humans; Hypertension, Pregnancy-Induced - diagnosis; India; Infant, Low Birth Weight; Infant, Newborn; Internal Medicine; Medicine; Medicine & Public Health; Neurology; Odds Ratio; Original Article; Otorhinolaryngology; Pediatrics; Pneumology/Respiratory System; Pregnancy; Pregnancy Complications - diagnosis; Pregnancy Outcome; Prospective Studies; Sleep Apnea, Obstructive - diagnosis; Sleep disorders; Sleep Wake Disorders - diagnosis; Statistics as Topic; Young Adult; Cesarean delivery; Pittsburgh sleep quality index; Restless legs syndrome; Modified Berlin questionnaire; Obstructive sleep apnea; Gestational hypertension
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-015-1188-9

Purpose
Sleep disturbances such as insomnia, nocturnal awakenings, restless legs syndrome, habitual snoring, and excessive daytime sleepiness are frequent during pregnancy, and these have been linked to adverse maternal and fetal outcomes.
Methods
A prospective observational study was performed in high-risk Indian pregnant women. We used modified Berlin questionnaire (MBQ), Pittsburgh sleep quality index (PSQI), International Restless Legs Syndrome Study Group 2011 criteria, and Epworth sleepiness scale to diagnose various sleep disorders, such as symptomatic OSA, poor sleep quality and insomnia, RLS, and excessive daytime sleepiness, respectively, in successive trimesters of pregnancy. Outcome variables of interest were development of gestational hypertension (GH), gestational diabetes mellitus (GDM), and cesarean delivery (CS); the Apgar scores; and low birth weight (LBW). The relationship between sleep disorders and outcomes was explored using logistic regression analysis.
Results
Outcome data were obtained in 209 deliveries. As compared to nonsnorers, women who reported snoring once, twice, and thrice or more had odds ratios for developing GH—4.0 (95 % CI 1.3–11.9), 1.5 (95 % CI 0.5–4.5), and 2.9 (95 % CI 1.0–8.2) and for undergoing CS—5.3 (95 % CI 1.7–16.3), 4.9 (95 % CI 1.8–13.1), and 5.1 (95 % CI 1.9–14.9), respectively. Pregnant women who were persistently positive on MBQ had increased odds for GH and CS.
Conclusions
Snoring and high-risk MBQ in pregnant women are strong risk factors for GH and CS. In view of the significant morbidity and health care costs, simple screening of pregnant women with questionnaires such as MBQ may have clinical utility.