Associations Between Sleep Disorders and Hypertensive Disorders of Pregnancy and Materno-fetal Consequences
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SLEEP AND HYPERTENSION (S JUSTIN THOMAS, SECTION EDITOR)
Associations Between Sleep Disorders and Hypertensive Disorders of Pregnancy and Materno-fetal Consequences Gabriela Querejeta Roca 1 & Jacquelyne Anyaso 2 & Susan Redline 3 & Natalie A. Bello 4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of the Review To review the data supporting the associations between sleep disorders and hypertensive disorders of pregnancy, their diagnosis, consequences, treatment, and potential mechanisms. Recent Findings The prevalence of sleep-disordered breathing, insomnia, and restless legs syndrome increases as pregnancy progresses secondary to physiologic changes associated with pregnancy. Sleep-disordered breathing is strongly associated with the development of gestational hypertension and preeclampsia, both of which are associated with increased risk of perinatal complications. Diagnosing sleep disorders in pregnant presents added challenges, but polysomnography remains the gold standard for diagnosing sleep-disordered breathing in this group. Summary Sleep disorders, and especially sleep-disordered breathing, are highly prevalent among pregnant women and associated with hypertensive disorders of pregnancy. Clinicians should be mindful of this association and endeavor to identify at-risk women for further evaluation. Keywords Sleep-disordered breathing . Obstructive sleep apnea . Hypertension . Pregnancy . Hypertensive disorders of pregnancy
Introduction Sleep is a vital component of optimal health [1]. When sleep is disturbed whether in the form of shortened duration, or increased fragmentation and awakenings, it can have negative health consequences. Sleep disorders, including obstructive sleep apnea (OSA) and insomnia (Table 1), have been associated with an increased risk of cardiovascular morbidity and mortality [2, 3], in part through their associations with hypertension. In the case of OSA, intermittent hypoxia, oxidative This article is part of the Topical Collection on Sleep and Hypertension * Gabriela Querejeta Roca [email protected] 1
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
2
University of Illinois at Chicago College of Medicine, Chicago, IL, USA
3
Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, New York, NY, USA
4
Division of Cardiology, Columbia University Medical Center, New York, NY, USA
stress, and sympathetic overstimulation are considered key stressors that drive the development of hypertension [4]; the other sleep disorders follow similar pathophysiology [5]. There is also emerging data implicating an association between disordered sleep and hypertension during pregnancy. It is not uncommon for women to experience reduced quality of sleep while pregnant [6]. Additionally, hypertension is the most common medical problem encountered during pregnancy, affecting up to 10% of all pregnancies [7]. The question of whether alterations in sleep—and which ones and a
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