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Celik S, Nazik E. The effect of aromatherapy applied to pregnant women on sleep quality and fatigue level: A randomized clinical trial. Explore (NY) 2025; 21:103157. [PMID: 40132277 DOI: 10.1016/j.explore.2025.103157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 03/14/2025] [Accepted: 03/17/2025] [Indexed: 03/27/2025]
Abstract
INTRODUCTION Sleep disturbances and fatigue can negatively impact pregnancy. The purpose of this study is to assess changes in sleep quality and fatigue levels pre- and post-aromatherapy intervention using lavender oil inhalation in pregnant women in the third trimester. MATERIALS AND METHODS The research was conducted in the gynecology and obstetrics outpatient clinic of a training and research hospital between October 2022 and March 2023. The study was designed as a randomized controlled experimental trial with a pretest-posttest control group. The sample consisted of a total of 74 pregnant women (37 intervention and 37 control). Aromatherapy with lavender oil was applied to pregnant women in the intervention group for one month using the "Inhalation Application Form." "Personal Information Form", "Visual Analog Scale (VAS)", "Pittsburg Sleep Quality Index (PSQI)" and " Visual Analogue Scale for Fatigue (VASF)" were used to collect data. Percentage distributions, chi-square significance test, t-test in independent groups, and Mann-Whitney U and Wilcoxon tests were used to evaluate the data. RESULTS In the study, the post-test PSQI score average of the pregnant women in the intervention group who received lavender oil inhalation was 4.10±1.36, it was 5.45±2.48 in the control group. The post-test fatigue score average of the pregnant women in the intervention group was 65.91±7.02, it was 75.40±10.79 in the control group. A statistically significant difference was found between the post-test PSQI and VAS-F total score averages of the pregnant women in the intervention and control groups (p < 0.05). CONCLUSION The study findings indicate that aromatherapy applied via inhalation to pregnant women improved sleep quality and reduced fatigue levels. According to these findings, lavender oil aromatherapy can be recommended to improve sleep quality and reduce fatigue levels in pregnant women during the third trimester.
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Affiliation(s)
- Sule Celik
- Adana City Training&Research Hospital, Adana, Turkey
| | - Evşen Nazik
- Department of Obstetric and Gynecological Nursing, Cukurova University, Faculty of Health Sciences, 01330, Adana, Turkey.
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Battisha A, Kahlon A, Kalra DK. Sleep-Disordered Breathing and Hypertension-A Systematic Review. J Clin Med 2025; 14:3115. [PMID: 40364148 PMCID: PMC12072724 DOI: 10.3390/jcm14093115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2025] [Revised: 04/21/2025] [Accepted: 04/28/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: Sleep-disordered breathing (SDB), historically referred to as "sleep apnea syndrome", particularly obstructive sleep apnea (OSA), is an independent risk factor for hypertension (HTN), stroke, heart failure, arrhythmias, and other cardiovascular disorders. Despite the well-established link between OSA and HTN and its high occurrence in cardiovascular disorders, the focus on the complex OSA-HTN axis is often overlooked or inadequately managed, which might explain the lack of notable improvements in cardiovascular outcomes for this patient population. Understanding the complex relationship between OSA and HTN is crucial due to its significant implications for clinical practice and public health. Methods: Using an expanded list of relevant MeSH terms, including "sleep-disordered breathing" and "sleep apnea syndrome", and following the PRISMA model, peer-reviewed articles were systematically selected. Studies published from January 2000 through December 2024 were identified and screened based on predefined inclusion and exclusion criteria. Results: This review emphasizes both OSA's independent and interaction effects on cardiovascular health and outcomes across different populations. It identifies key factors mediating the association between OSA and HTN. Conclusions: Multimodal management, including continuous positive airway pressure and lifestyle modification, is essential for treating hypertension related to OSA. Effective management of the OSA-HTN relationship is vital to improving cardiovascular outcomes.
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Affiliation(s)
| | | | - Dinesh K. Kalra
- Division of Cardiology, Department of Medicine, University of Louisville, 201 Abraham Flexner Way, Suite 600, Louisville, KY 40202, USA; (A.B.); (A.K.)
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La Verde M, Marrapodi MM, Palma M, Pisani D, Russo D, Ronsivalle V, Cicciù M, Minervini G. Effect of the maternal sleep disturbances and obstructive sleep apnea on feto-placental Doppler: A systematic review. J Sleep Res 2025:e14460. [PMID: 39815441 DOI: 10.1111/jsr.14460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 12/19/2024] [Accepted: 12/23/2024] [Indexed: 01/18/2025]
Abstract
Literature evidenced an association of maternal sleep disturbances and maternal obstructive sleep apnea with significant obstetric complications. Moreover, the maternal sleep disturbances effect on feto-placental circulation had not been extensively examined. Our objective is to explore the possible maternal sleep disturbances impact on the feto-placental indices evaluated through the Doppler study. A systematic review of the following databases was performed: PubMed, EMBASE, Cochrane Library and Google Scholar from the beginning to June 2024. Only studies that enrolled pregnant women with signs and symptoms of maternal sleep disturbances or obstructive sleep apnea diagnosis, which analysed the feto-placental Doppler parameters, were considered eligible (PROSPERO ID: CRD42024553926). We included a total of four studies with 1715 cases of pregnant women. Various instrumental and non-instrumental diagnostic methods were adopted for detection of maternal sleep disturbances. The ultrasound exam was performed mainly in the third trimester of pregnancies, and all the studies explored the uterine Doppler parameters. Only two studies explore the foetal Doppler parameters. Only one study disclosed that maternal sleep disturbances are related to altered uterine Doppler indices with probable placental dysfunction. This review did not evidence a significant influence of maternal sleep disturbances and obstructive sleep apnea on foetal Doppler indices. Moreover, one large prospective study showed a possible impact of maternal sleep disturbances on uterine Doppler with a potential impairment of the placentation function. Additional studies with detailed data and larger samples are needed to throw light on this relationship and its impact on the foetal outcomes.
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Affiliation(s)
- Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marica Palma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Davide Pisani
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Diana Russo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Ronsivalle
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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Gao H, Miao C, Liu W, Sun Y, Li H, Wu Z, Li W, Xu L, Sun B, Zheng B, Zhu Y. Association of sleep duration and sleep quality with gestational diabetes mellitus in pregnant women after treatment with assisted reproductive technology: A birth cohort study. J Sleep Res 2024; 33:e14191. [PMID: 38499503 DOI: 10.1111/jsr.14191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/22/2024] [Accepted: 02/24/2024] [Indexed: 03/20/2024]
Abstract
Maternal sleep is closely related to subsequent gestational diabetes mellitus (GDM) in natural pregnancies. However, whether this connection exists in pregnant women conceiving with the help of assisted reproductive technology (ART) has not been confirmed. Hence, in this study, we evaluated whether early pregnancy sleep duration or sleep quality is associated with gestational diabetes mellitus in ART-pregnant women, as well as the influence of maternal age on this association. This prospective birth cohort study included 856 pregnant women who successfully conceived with the help of ART treatment. The sleep parameters of ART-pregnant women were assessed using the Pittsburgh Sleep Quality Index (PSQI) in early pregnancy. We explored the association between sleep and the risk of gestational diabetes mellitus using an unconditional binary logistic regression model. Different models were constructed to examine the robustness of the estimation by incorporating different confounding factors. Multivariable logistic regression revealed that sleep duration of more than 10 h among ART-pregnant women was significantly associated with the risk of GDM, and the association between sleep duration and gestational diabetes mellitus varied by maternal age. We found an increased risk of subsequent gestational diabetes mellitus with increasing sleep duration only in pregnant women aged <35 years. Additionally, no statistically significant association between sleep quality and gestational diabetes mellitus was found in this study. In conclusion, excessive sleep duration (≥10 h) is associated with a high risk of gestational diabetes mellitus in pregnant women who conceived with the help of assisted reproductive technology, and maternal age may modify this effect.
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Affiliation(s)
- Haiyan Gao
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - Chong Miao
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wenjuan Liu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Children's Hospital, Fuzhou, China
| | - Yan Sun
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Haibo Li
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zhengqin Wu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - Wei Li
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Obstetrics and Gynecology Hospital, Fuzhou, China
| | - Liangjie Xu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Bin Sun
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Beihong Zheng
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yibing Zhu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Kiyak S, Batı S. The relationship between sleep quality, depression, and smartphone addiction in pregnant women: a mediation analysis. Women Health 2024; 64:839-847. [PMID: 39462679 DOI: 10.1080/03630242.2024.2420215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 10/12/2024] [Accepted: 10/18/2024] [Indexed: 10/29/2024]
Abstract
In recent years, the prevalence of smartphone addiction has significantly increased. This situation has raised concerns about its potential impact on health aspects, such as sleep quality and mental health, particularly among vulnerable populations like pregnant women. This study aimed to identify the factors that determine sleep quality in pregnant women and examine the relationship between smartphone addiction, depression, and sleep quality. This descriptive correlational study included 257 pregnant women in their second and third trimesters who were registered at six family health centers between September 2022 and March 2023. Data were collected using a sociodemographic questionnaire, the Smartphone Addiction Scale Short Form, Edinburgh Postnatal Depression Scale, and Pittsburgh Sleep Quality Index. Regression and mediation analyses were performed for the data. Of the participants, 44.4 percent had poor sleep quality. Depression and third trimester were significant determinants of sleep quality. The bootstrapping results revealed that smartphone addiction led to an increase in the level of depression (β = 0.145; p < .001). Depression worsened sleep quality (β = 0.262; p < .001). The smartphone addiction did not significantly affect sleep quality (β = 0.020; p = .279). Depression mediates the relationship between sleep quality and smartphone addiction (β = 0.038; 95 percent CI [0.018: 0.062]). The study highlights that while smartphone addiction does not directly impact sleep quality in pregnant women, it is associated with increased depression levels, which subsequently worsen sleep quality. It is recommended that healthcare providers monitor smartphone usage and mental health in pregnant women to mitigate the risk of sleep disturbances and improve overall well-being.
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Affiliation(s)
- Sibel Kiyak
- Department of Nursing, Seydişehir Kamil Akkanat Faculty of Health Sciences, Necmettin Erbakan University, Konya, Turkey
| | - Serap Batı
- Department of Nursing, Seydişehir Kamil Akkanat Faculty of Health Sciences, Necmettin Erbakan University, Konya, Turkey
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Miller HE, Simpson SL, Hurtado J, Boncompagni A, Chueh J, Shu CH, Barwick F, Leonard SA, Carvalho B, Sultan P, Aghaeepour N, Druzin M, Panelli DM. Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study. BMC Pregnancy Childbirth 2024; 24:366. [PMID: 38750438 PMCID: PMC11094949 DOI: 10.1186/s12884-024-06540-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy. METHODS This was a prospective pilot cohort of pregnant people between 23 to 36 weeks' gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters. RESULTS Among the 60 participants who completed the study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: β 6.1, p = 0.01, MAP: β 6.2 p < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: β 9.6, p = 0.01, DBP: β 8.1, p < 0.001, and MAP: β 8.8, p < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP. CONCLUSIONS When including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1-9.6 mmHg higher SBP, 6.1-8.1 mmHg higher DBP, and 6.2-8.8 mmHg higher MAP than people without anxiety.
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Affiliation(s)
- Hayley E Miller
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Obstetrics, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA.
| | - Samantha L Simpson
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Obstetrics, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Janet Hurtado
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Obstetrics, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | | | - Jane Chueh
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Obstetrics, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Chi-Hung Shu
- Department of Anesthesiology, Division of Obstetric Anesthesiology and Maternal Health, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Fiona Barwick
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephanie A Leonard
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Obstetrics, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Brendan Carvalho
- Department of Anesthesiology, Division of Obstetric Anesthesiology and Maternal Health, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Pervez Sultan
- Department of Anesthesiology, Division of Obstetric Anesthesiology and Maternal Health, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Division of Obstetric Anesthesiology and Maternal Health, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Maurice Druzin
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Obstetrics, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
| | - Danielle M Panelli
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Obstetrics, Stanford University School of Medicine, 453 Quarry Road, Stanford, Palo Alto, CA, 94304, USA
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Pallanti S. The role of benzodiazepines in common conditions: a narrative review focusing on lormetazepam. Int Clin Psychopharmacol 2024; 39:139-147. [PMID: 38277240 PMCID: PMC10965132 DOI: 10.1097/yic.0000000000000529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/17/2023] [Indexed: 01/28/2024]
Abstract
This review aimed to examine the place of benzodiazepines, specifically lormetazepam, in the treatment of insomnia, including during pregnancy or in patients with psychodermatoses. PubMed was searched for the term "lormetazepam" in association with MeSH terms encompassing anxiety, insomnia/sleep disorders, pregnancy/gestation, and psychodermatoses/skin disorders. English-language articles up to 31 July 2022 were identified. Ad hoc searches for relevant literature were performed at later stages of review development. Multiple randomized, placebo-controlled studies have demonstrated that lormetazepam dose-dependently increases total sleep time, decreases wakefulness over a dosing range of 0.5-2.0 mg, and improves subjective assessments of sleep quality. Lormetazepam is as effective as other benzodiazepines in improving sleep duration and quality, but is better tolerated than the long-acting agents with minimal next-day effects. Benzodiazepines can be used as short-term monotherapy at the lowest effective dose during the second or third trimesters of pregnancy; lormetazepam is also a reasonable choice due to its limited transplacental passage. Insomnia associated with skin disorders or pregnancy can be managed by effective symptom control (especially itching), sleep hygiene, treatment of anxiety/depression, and a short course of hypnotics.
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Affiliation(s)
- Stefano Pallanti
- Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, New York, USA
- Istituto di Neuroscienze Firenze, Florence, Italy
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Shkurenko YV, Ibatov AD, Aliyeva UE, Trofimova SY, Einullayeva SE. [Sleep disorders during pregnancy]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:99-104. [PMID: 38934673 DOI: 10.17116/jnevro202412405299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Pregnancy is associated with a number of physiological changes in a woman's body, which in turn affect the quality and duration of sleep. According to research, insomnia and other sleep disorders are associated with a high risk of adverse pregnancy outcomes, as well as postpartum complications. Understanding the mechanisms of sleep disorders during pregnancy is necessary to form an integrated approach in the management of this group of patients. The appointment of medicinal and non-medicinal therapies, as well as general recommendations for lifestyle correction in order to treat sleep disorders, is focused on the safe and prolific effect of a particular drug on the mother and fetus. This review also examined the safety profile of commonly used groups of drugs for sleep disorders during pregnancy.
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Affiliation(s)
- Yu V Shkurenko
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A D Ibatov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - U E Aliyeva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S Yu Trofimova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S E Einullayeva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Kember AJ, Elangainesan P, Ferraro ZM, Jones C, Hobson SR. Common sleep disorders in pregnancy: a review. Front Med (Lausanne) 2023; 10:1235252. [PMID: 37671402 PMCID: PMC10475609 DOI: 10.3389/fmed.2023.1235252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023] Open
Abstract
In this review, we provide a comprehensive overview of common sleep disorders during pregnancy, including their characterization, prevalence, risk factors, and possible contribution to maternal and fetal outcomes. We conducted a quasi-systematic literature search of the MEDLINE database and identified 744 studies from 1991 through 2021, inclusive, that met our inclusion criteria. We synthesized the existing literature on sleep disorders during pregnancy and highlighted controversies, research gaps, and needed clinical developments. Our review covers a range of sleep disorders, including insomnia, obstructive sleep apnea, restless legs syndrome, and circadian rhythm disorders. We discuss the prevalence of these disorders in pregnancy and their potential impact on maternal and fetal health outcomes. We also explore the relationship between sleep disorders, pre-pregnancy comorbidities such as obesity, and pregnancy-related conditions such as gestational diabetes mellitus and preeclampsia. In addition to summarizing the existing literature on sleep disorders during pregnancy, we also highlight opportunities for further research in this area. We suggest that future studies should strive to employ validated and objective measurement tools for sleep disorders and prioritize utilization of longitudinal methods with participant follow-up through postpartum, mid-life, menopause, and beyond. We also put forward investigation into the impact of circadian rhythm disruption on reproductive physiology and early pregnancy outcomes as an area of important work. Overall, our review provides valuable insights on sleep and reproduction and into common sleep disorders during pregnancy and their potential impact on maternal and fetal health outcomes.
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Affiliation(s)
- Allan J. Kember
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Shiphrah Biomedical Inc., Toronto, ON, Canada
| | - Praniya Elangainesan
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
| | - Zachary M. Ferraro
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Claire Jones
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Reproductive Endocrinology and Infertility, Mount Sinai Hospital, Toronto, ON, Canada
| | - Sebastian R. Hobson
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada
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Louis JM, Parchem J, Vaught A, Tesfalul M, Kendle A, Tsigas E. Preeclampsia: a report and recommendations of the workshop of the Society for Maternal-Fetal Medicine and the Preeclampsia Foundation. Am J Obstet Gynecol 2022; 227:B2-B24. [PMID: 39491898 DOI: 10.1016/j.ajog.2022.06.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preeclampsia is a substantial cause of perinatal and maternal morbidity and mortality. The prevalence of this condition has increased over the past several decades. Additional opportunities are needed to foster interdisciplinary collaborations and improve patient care in the setting of preeclampsia. In recognition of the Preeclampsia Foundation's 20th anniversary and its work to advance preeclampsia research and clinical agendas, a 2-day virtual workshop on preeclampsia was cosponsored by the Society for Maternal-Fetal Medicine and the Preeclampsia Foundation and held January 25-26, 2021 in conjunction with the 41st annual pregnancy meeting. Leaders with expertise in preeclampsia research, obstetrical care, primary care medicine, cardiology, endocrinology, global health, and patient advocacy gathered to discuss preeclampsia prediction, prevention, management, and long-term impacts. The goals of the workshop were to review the following issues and create consensus concerning research and clinical recommendations: This report, developed collaboratively between the SMFM and the Preeclampsia Foundation, presents the key findings and consensus-based recommendations from the workshop participants.
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Panyarath P, Goldscher N, Pamidi S, Daskalopoulou SS, Gagnon R, Dayan N, Raiche K, Olha A, Benedetti A, Kimoff RJ. Effect of Maternal Obstructive Sleep Apnea-Hypopnea on 24-Hour Blood Pressure, Nocturnal Blood Pressure Dipping and Arterial Stiffness in Hypertensive Disorders of Pregnancy. Front Physiol 2021; 12:747106. [PMID: 34733178 PMCID: PMC8558510 DOI: 10.3389/fphys.2021.747106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022] Open
Abstract
Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). Attenuation of the normal nocturnal blood pressure (BP) decline (non-dipping) is associated with adverse pregnancy outcomes. OSAH is associated with nocturnal non-dipping in the general population, but this has not been studied in pregnancy. We therefore analyzed baseline data from an ongoing RCT (NCT03309826) assessing the impact of OSAH treatment on HDP outcomes, to evaluate the relationship of OSAH to 24-h BP profile, in particular nocturnal BP dipping, and measures of arterial stiffness. Methods: Women with a singleton pregnancy and HDP underwent level II polysomnography. Patients with OSAH (apnea-hypopnea index (AHI) ≥ 5 events/h) then underwent 24-h ambulatory BP monitoring and arterial stiffness measurements (applanation tonometry, SphygmoCor). Positive dipping was defined as nocturnal systolic blood pressure (SBP) dip ≥ 10%. The relationships between measures of OSAH severity, measures of BP and arterial stiffness were evaluated using linear regression analyses. Results: We studied 51 HDP participants (36.5 ± 4.9 years, BMI 36.9 ± 8.6 kg/m2) with OSAH with mean AHI 27.7 ± 26.4 events/h at 25.0 ± 4.9 weeks’ gestation. We found no significant relationships between AHI or other OSA severity measures and mean 24-h BP values, although BP was generally well-controlled. Most women were SBP non-dippers (78.4%). AHI showed a significant inverse correlation with % SBP dipping following adjustment for age, BMI, parity, gestational age, and BP medications (β = −0.11, p = 0.02). Significant inverse correlations were also observed between AHI and DBP (β = −0.16, p = 0.01) and MAP (β = −0.13, p = 0.02) % dipping. Oxygen desaturation index and sleep time below SaO2 90% were also inversely correlated with % dipping. Moreover, a significant positive correlation was observed between carotid-femoral pulse wave velocity (cfPWV) and REM AHI (β = 0.02, p = 0.04) in unadjusted but not adjusted analysis. Conclusion: Blood pressure non-dipping was observed in a majority of women with HDP and OSAH. There were significant inverse relationships between OSAH severity measures and nocturnal % dipping. Increased arterial stiffness was associated with increasing severity of OSAH during REM sleep in unadjusted although not adjusted analysis. These findings suggest that OSAH may represent a therapeutic target to improve BP profile and vascular risk in HDP.
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Affiliation(s)
- Pattaraporn Panyarath
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada.,Division of Respiratory and Respiratory Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Noa Goldscher
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Sushmita Pamidi
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada.,Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada
| | - Stella S Daskalopoulou
- Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada.,Division of Internal Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Robert Gagnon
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada
| | - Natalie Dayan
- Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada.,Division of Internal Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Kathleen Raiche
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Allen Olha
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Andrea Benedetti
- Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology and Biostatistics, McGill University Health Centre, Montreal, QC, Canada
| | - R John Kimoff
- Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada.,Center for Outcomes Research, McGill University Health Centre, Montreal, QC, Canada
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Akpan U, Asibong U, Chidi O, Ekpenyong E, Asibong I, Etuk S. The prevalence, pattern, and predictors of sleep disorders among pregnant women attending antenatal clinic in a Southern Nigerian City. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_60_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Tanner RM, Bello NA. In Search of a Predictive Model for Preeclampsia: The Beat Goes On. Hypertension 2020; 76:1707-1708. [PMID: 33175630 DOI: 10.1161/hypertensionaha.120.15160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rikki M Tanner
- From the Department of Epidemiology, UAB School of Public Health, Birmingham, AL (R.M.T.)
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY (N.A.B.)
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