Continuous positive airway pressure treatment of obstructive sleep apnea and hypertensive complications in high-risk pregnancy,Sleep and Breathing

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Continuous positive airway pressure treatment of obstructive sleep apnea and hypertensive complications in high-risk pregnancy
Sleep and Breathing ( IF 2.1 ) Pub Date : 2022-06-24 , DOI: 10.1007/s11325-022-02669-0
Alexandra Lauren Rice _{1,

2,

3} , Sakshi Bajaj ₁ , Abigail M Wiedmer _{1,

2,

3} , Natalie Jacobson _{2,

3} , Aleksandar K Stanic ₄ , Kathleen M Antony ₁ , Mihaela H Bazalakova ₃

Affiliation

Purpose

To evaluate whether or not continuous positive airway pressure (CPAP) treatment in pregnancies complicated by obstructive sleep apnea (OSA) is associated with a decrease in hypertensive disorders of pregnancy.

Methods

This was a retrospective cohort study of perinatal outcomes in women who underwent objective OSA testing and treatment as part of routine clinical care during pregnancy. Where diagnostic criteria for OSA were reached (respiratory event index (REI) ≥ 5 events per hour), patients were offered CPAP therapy. Obstetrical outcomes were compared between the control group (no OSA), the group with untreated OSA (OSA diagnosed, not CPAP compliant), and the group with treated OSA (OSA diagnosed and CPAP compliant), with CPAP compliance defined as CPAP use ≥ 4 h, 70% of the time or greater. A composite hypertension outcome combined diagnoses of gestational hypertension (gHTN) and preeclampsia (PreE) of any severity.

Results

The study comprised outcomes from 177 completed pregnancies. Our cohort was characterized by obesity, with average body mass indices > 35 kg/m², and average maternal age > 30 years old. CPAP was initiated at an average gestational age of 23 weeks (12.1–35.3 weeks), and average CPAP use was 5.9 h (4–8.5 h). The composite hypertension outcome occurred in 43% of those without OSA (N = 77), 64% of those with untreated OSA (N = 77), and 57% of those with treated OSA, compliant with CPAP (N = 23) (p = 0.034).

Conclusion

Real-world data in this small study suggest that CPAP therapy may modulate the increased risk of hypertensive complications in pregnancies complicated by OSA.

中文翻译：

持续气道正压通气治疗高危妊娠阻塞性睡眠呼吸暂停和高血压并发症

目的

评估妊娠合并阻塞性睡眠呼吸暂停 (OSA) 的持续气道正压通气 (CPAP) 治疗是否与妊娠期高血压疾病的减少相关。

方法

这是一项针对在怀孕期间接受客观 OSA 测试和治疗作为常规临床护理一部分的女性围产期结局的回顾性队列研究。当达到 OSA 诊断标准（呼吸事件指数 (REI) ≥ 5 次/小时）时，患者接受 CPAP 治疗。比较对照组（无 OSA）、未经治疗的 OSA 组（诊断为 OSA，不符合 CPAP）和接受治疗的 OSA 组（诊断为 OSA 且符合 CPAP）的产科结果，CPAP 依从性定义为 CPAP 使用≥ 4 h，70% 或更多的时间。复合高血压结果结合了妊娠高血压 (gHTN) 和任何严重程度的先兆子痫 (PreE) 的诊断。

结果

该研究包含 177 例完成妊娠的结果。我们的队列的特点是肥胖，平均体重指数> 35 kg/m ² ，平均产妇年龄> 30 岁。 CPAP 开始于平均胎龄 23 周（12.1-35.3 周），平均 CPAP 使用时间为 5.9 小时（4-8.5 小时）。复合高血压结果发生在 43% 的无 OSA 患者 ( N = 77)、64% 的未治疗 OSA 患者 ( N = 77) 和 57% 的接受 CPAP 治疗的 OSA 患者 ( N = 23) ( p = 0.034）。