Epworth Sleepiness Scale scores and adverse pregnancy outcomes
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EDITORIAL(INVITED)
Epworth Sleepiness Scale scores and adverse pregnancy outcomes Sophia E. Schiza & Izolde Bouloukaki & Charalampos Mermigkis
Received: 8 January 2013 / Revised: 21 January 2013 / Accepted: 31 January 2013 # Springer-Verlag Berlin Heidelberg 2013
Sleep disturbances generally increase with the onset of pregnancy and continue to increase in frequency as pregnancy progresses [1–4]. Although these disturbances may arise as a consequence of numerous physiologic and hormonal changes accompanying pregnancy, it is important for clinicians to consider the possible presence of primary sleep-related breathing disorders (SRBD), such as snoring and sleep apnea [5]. Sleep apnea, snoring, and excessive sleepiness are identified as the most frequently sleep disturbances among pregnant women. There is conflictive evidence in regard to whether sleep-disordered breathing increases in prevalence during pregnancy, but existing research indicates that such disorders may enhance the risk of potentially adverse maternal–fetal outcomes by increasing the likelihood of preterm birth, preeclampsia, and gestational diabetes [6]. In this issue of Sleep and Breathing, Ghada Bourjeily and colleagues of The Warren Alpert Medical School of Brown University in their paper “Epworth Sleepiness Scale scores and adverse pregnancy outcomes” tried to investigate whether excessive daytime sleepiness (EDS) in snorers and non-snorers contributed to adverse pregnancy outcomes such as gestational hypertensive disorders, gestational diabetes, or mode of delivery. The authors found that there is an increased association between pregnant women with higher Epworth Sleepiness Scale (ESS) score and planned caesarean delivery. Although retrospective, this study extends previous observations that EDS and snoring are risk factors for gestational diabetes by showing that when higher cut off S. E. Schiza : I. Bouloukaki : C. Mermigkis Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Crete, Greece S. E. Schiza (*) Sleep Disorders Unit, Department of Thoracic Medicine, University of Crete, 71110 Heraklion, Crete, Greece e-mail: [email protected]
values of ESS were used, the risk of gestational diabetes was significantly elevated and sevenfold higher than women below the cutoff point, even after adjusting for confounders. However, in this study, neither gestational diabetes nor hypertensive disorder was associated with EDS, when EDS was defined as an ESS >10. In the literature, studies that address SRBD in pregnant women are scarce with the only available data come from case studies, case series, small cohort studies, and a few small longitudinal studies. As no large population-based epidemiological studies have been performed, the prevalence of obstructive sleep apnea in pregnant women is not known. Previously, the same authors found that snoring, gasping, and apneas, all three symptoms of SRBD, were associated with higher mean ESS scores [7]. Furthermore, they fou
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