Association between Sleep Disordered Breathing and Neonatal Outcomes in Nulliparous Individuals

Arlin Delgado; Anthony M Kendle; Tara Randis; Keyur Donda; Jason L Salemi; Francesca L Facco; Corette B Parker; Uma M Reddy; Robert M Silver; Robert C Basner; Judith H Chung; Frank P Schubert; Grace W Pien; Susan Redline; Samuel Parry; William A Grobman; Phyllis C Zee; Judette M Louis

doi:10.1055/a-2115-0147

Association between Sleep Disordered Breathing and Neonatal Outcomes in Nulliparous Individuals

Am J Perinatol. 2023 Jul 29. doi: 10.1055/a-2115-0147. Online ahead of print.

Authors

Arlin Delgado¹, Anthony M Kendle¹, Tara Randis², Keyur Donda², Jason L Salemi³, Francesca L Facco⁴, Corette B Parker⁵, Uma M Reddy⁶, Robert M Silver⁷, Robert C Basner⁶, Judith H Chung⁸, Frank P Schubert⁹, Grace W Pien¹⁰, Susan Redline¹¹, Samuel Parry¹², William A Grobman¹³, Phyllis C Zee¹⁴, Judette M Louis^{1

3}

Affiliations

¹ Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida.
² Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa Florida.
³ College of Public Health, University of South Florida, Tampa, Florida.
⁴ Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
⁵ RTI International, Research Triangle Park, North Carolina.
⁶ Department of Obstetrics and Gynecology, Columbia University, New York City, New York.
⁷ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah.
⁸ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Irvine, California.
⁹ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana.
¹⁰ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹¹ Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
¹² Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
¹³ Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
¹⁴ Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

PMID: 37380034
DOI: 10.1055/a-2115-0147

Abstract

Objective: Our objective was to determine whether objectively measured sleep-disordered breathing (SDB) during pregnancy is associated with an increased risk of adverse neonatal outcomes in a cohort of nulliparous individuals.

Study design: Secondary analysis of the nuMom2b sleep disordered breathing substudy was performed. Individuals underwent in-home sleep studies for SDB assessment in early (6-15 weeks' gestation) and mid-pregnancy (22-31 weeks' gestation). SDB was defined as an apnea-hypopnea index ≥5 events/h at either time point. The primary outcome was a composite outcome of respiratory distress syndrome, transient tachypnea of the newborn, or receipt of respiratory support, treated hyperbilirubinemia or hypoglycemia, large-for-gestational age, seizures treated with medications or confirmed by electroencephalography, confirmed sepsis, or neonatal death. Individuals were categorized into (1) early pregnancy SDB (6-15 weeks' gestation), (2) new onset mid-pregnancy SDB (22-31 weeks' gestation), and (3) no SDB. Log-binomial regression was used to calculate adjusted risk ratios (RR) and 95% confidence intervals (CIs) representing the association.

Results: Among 2,106 participants, 3% (n = 75) had early pregnancy SDB and 5.7% (n = 119) developed new-onset mid-pregnancy SDB. The incidence of the primary outcome was higher in the offspring of individuals with early (29.3%) and new onset mid-pregnancy SDB (30.3%) compared with individuals with no SDB (17.8%). After adjustment for maternal age, chronic hypertension, pregestational diabetes, and body mass index, new onset mid-pregnancy SDB conferred increased risk (RR = 1.43, 95% CI: 1.05, 1.94), where there was no longer statistically significant association between early pregnancy SDB and the primary outcome.

Conclusion: New onset, mid-pregnancy SDB is independently associated with neonatal morbidity.

Key points: · Sleep disordered breathing (SDB) is a common condition impacting pregnancy with known maternal risks.. · Objectively defined SDB in pregnancy was associated with a composite of adverse neonatal outcomes.. · New onset SDB in mid pregnancy conferred statistically significant increased risk..

Abstract

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