Sleep-disordered Breathing in Pregnancy and after Delivery: Associations with Cardiometabolic Health
Francesca L. Facco, Susan Redline, Shannon M. Hunter, Phyllis C. Zee, William A. Grobman, Robert M. Silver, Judette M. Louis, Grace W. Pien, Brian Mercer, Judith H. Chung, C. Noel Bairey Merz, David M. Haas, Chia-Ling Nhan-Chang, Hyagriv N. Simhan, Frank P. Schubert, Samuel Parry, Uma Reddy, George R. Saade, Matthew K. Hoffman, Lisa D. Levine, Ronald J. Wapner, Janet M. Catov, Corette B. Parker
Abstract
Abstract Rationale Knowledge gaps exist regarding health implications of sleep-disordered breathing (SDB) identified in pregnancy and/or after delivery. Objectives To determine whether SDB in pregnancy and/or after delivery is associated with hypertension (HTN) and metabolic syndrome (MS). Methods nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be Heart Health Study) (N = 4,508) followed participants initially recruited during their first pregnancy. Participants returned for a visit 2–7 years after pregnancy. This study examined a subgroup who underwent SDB assessments during their first pregnancy (n = 1,964) and a repeat SDB assessment after delivery (n = 1,222). Two SDB definitions were considered: 1) apnea–hypopnea index (AHI) ⩾ 5 and 2) oxygen desaturation index (ODI) ⩾ 5. Associations between SDB and incident HTN and MS were evaluated with adjusted risk ratios (aRRs). Measurements and Main Results The aRR for MS given an AHI ⩾ 5 during pregnancy was 1.44 (95% confidence interval [CI], 1.08–1.93), but no association with HTN was found. ODI ⩾ 5 in pregnancy was associated with both an increased risk for HTN (aRR, 2.02; 95% CI, 1.30–3.14) and MS (aRR, 1.53; 95% CI, 1.19–1.97). Participants with an AHI ⩾ 5 in pregnancy that persisted after delivery were at higher risk for both HTN (aRR, 3.77; 95% CI, 1.84–7.73) and MS (aRR, 2.46; 95% CI, 1.59–3.76). Similar associations were observed for persistent ODI ⩾ 5 after delivery. Conclusions An AHI ⩾ 5 in pregnancy was associated with an increased risk of MS. An ODI ⩾ 5 in pregnancy was significantly associated with both HTN and MS. Participants with persistent elevations in AHI and ODI during pregnancy and at 2–7 years after delivery were at the highest risk for HTN and MS. Clinical trial registered with www.clinicaltrials.gov (NCT 02231398).