Introduction: With the increasing incidence of obesity world wide the number of pregnancies affected with obesity and morbidly obesity will also continue to increase, thus increasing the rates of hypertensive disease in pregnancy (HDP) and sleep disordered breathing (SDB) within the pregnant population group. The aims of this research were to establish the prevalence of SDB in the pregnant population in SSWAHS (NSW, Australia) and determine if SDB impacts on HDP by utilizing various degrees of intensity of sleep testing tools and intermittent overnight blood pressure. Methods: Patients were recruited from the outpatients department at an outer western metropolitan hospital in NSW, Australia; they were multicultural and were recruited independent of gestational age, obesity or maternal age or multiplicity. There were 2309 women who participated in a survey between February 2009 and February 2013. The study was designed as a cross sectional study and included participants from multiple entry points. Demographic and anthropometric measures were made. Measures of HDP, sleep and SDB were taken and pregnancy outcomes derived. The singleton only participants then underwent varying degrees of intensity of maternal and fetal sleep testing and nocturnal blood pressure monitoring. Sleepiness was measured with the Epworth Sleepiness Scale (ESS) and the Berlin score. The presence of SDB was defined as an AHI = 5 events/hour and severe SDB >30 events/ hour. Results: The prevalence population results demonstrated 45.5% self report snoring and 48% report daytime sleepiness with 3% falling asleep while driving. The more intensive testing went on to demonstrate 67% snoring for >20% of the night and demonstrated AHI >15 events/hour. Sleep disordered breathing criteria participants had a larger neck circumference and a higher prepregnant and recruitment BMI (kg/m2) and a greater change in BMI (kg/m2) over the gestation of the pregnancy. Stepwise logistic regression identified neck circumference, BMI (kg/m2), snoring and ESS were found to be statistically significant predictors of an increased AHI events/hour. Snoring was statistically significantly associated with larger neck circumferences and higher BMI's. Raised systolic and diastolic blood pressure was statistically significantly associated with>20% of the night snoring, neck circumference and BMI. Conclusion: Birth and neonatal outcomes were assessed at all levels of testing and SDB was demonstrated to have a greater impact on neonatal weight when combined with undiagnosed nocturnal hypertension. All birth and neonatal outcomes suffered when SDB and/or HDP diagnosis were involved. When analysed separately those participants who met SDB criteria with blatant HDP had worse outcomes for both birth timing and neonatal outcomes. Birth weight changes (although not statistically significant) reached levels of up to 605grams difference which, if confirmed by other studies would be clinically relevant.
Date of Award | 2014 |
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Original language | English |
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- pregnancy
- complications
- hypertension in pregnancy
- sleep apnea syndromes
- New South Wales
Sleep disordered breathing and hypertension in pregnancy
Robertson, A. J. (Author). 2014
Western Sydney University thesis: Doctoral thesis