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Women with insomnia, sleep-disordered breathing at greater risk for adverse pregnancy outcomes

Sleep-disordered breathing and comorbid insomnia were associated with adverse pregnancy outcomes, according to findings presented at Sleep 2017, the Annual Meeting of the Associated Professional Sleep Societies.

Researchers noted that the outcomes were even in the absence of a relationship to sleep disordered breathing alone.

“Recent data indicate that habitual snoring, as a marker for obstructive sleep apnea, and insomnia appear to be on the rise. The co-occurrence of habitual snoring and insomnia has been described in nonpregnant cohorts with a prevalence of 30% to 50%. Independently, each is associated with increased risk for cardiovascular disease and psychiatric disease,” Louise M. O'Brien, PhD, MS, associate professor, Sleep Disorders Center, University of Michigan, told Healio Family Medicine. “When comorbid, risk for morbidity substantially increases above and beyond their independent presentation. To date, no study has examined the comorbid status or impact in pregnant women. Given the association of habitual snoring with poor pregnancy outcomes we sought to determine if women with a comorbid status were at particularly high risk.”

O’Brien and Michele Lee Okun, assistant professor, Trauma, Health and Hazard Center, University of Colorado, analyzed data from 439 women with a mean gestational age of 34.1 weeks who were administered the Insomnia Symptom Questionnaire. Of these participants, 161 had neither sleep-disordered breathing nor insomnia; 146 had insomnia but not sleep-disordered breathing; 63 had sleep-disordered breathing, but not insomnia and 69 had both sleep-disordered breathing and insomnia. Researchers then used logistic regression models to investigate the relationship between the groups and adverse outcomes after controlling for variables such as age, BMI, ethnicity, parity and smoking status.

O’Brien and Okun found that in separate logistic regressions, comorbid sleep-disordered breathing and insomnia was independently associated with gestational hypertension(aOR = 6.7; 95% CI, 1.7-23.3) but no association was found for either insomnia alone or sleep-disordered breathing alone. Insomnia alone was associated with a baby born large-for-gestational age (aOR = 3.4; 95% CI, 1.3-8.6), as was cormorbid sleep-disordered breathing and insomnia (aOR = 3, 95% CI, 1-9.5). In addition, women with sleep-disordered breathing alone had increased odds for an unplanned cesarean section (aOR = 2.6; 95% CI, 1.1-5.9,) as did those with comorbid sleep-disordered breathing and insomnia (aOR = 2.4; 95% CI, 1-5.4).

“These findings are clinically relevant since adverse pregnancy outcomes may have significant consequences for both the mother and the offspring,” O’Brien said in an interview. “Our findings add further evidence that evaluation of pregnant women — in particular hypertensive women — for comorbid sleep disorders should be a priority in order to improve maternal and infant outcomes.” – by Janel Miller

References:

O’Brien LM, Okun M. “Comorbid insomnia and sleep disordered breathing: Association with adverse pregnancy outcomes.” Sleep 2017, the Annual Meeting of the Associated Professional Sleep Societies; June 3-7; Boston.

Disclosure: Healio Family Medicine was unable to determine researchers’ relevant financial disclosures prior to publication.