title: Sleep-disordered breathing during pregnancy: future implications for cardiovascular health.
abstract: OBJECTIVE
  Cardiovascular disease (CVD) is a common condition in postreproductive females. Key risk factors for later-life CVD include gestational hypertension (GHTN) and preeclampsia (PE). Although several risk factors of hypertension in pregnancy are well recognized, a novel risk factor that has emerged recently is sleep-disordered breathing (SDB), a condition characterized by repeated closure of the upper airway during sleep with disrupted ventilation and sleep fragmentation. In the nonpregnant population, SDB is now known to play a causal role in future CVD.
  
  
  OBJECTIVE
  The aim of this study was to propose the hypothesis that occult SDB during pregnancy may play a role in long-term CVD in women who had hypertensive disorders of pregnancy.
  
  
  METHODS
  This study is a review and synthesis of empirical evidence that links SDB to GHTN/PE and GHTN/PE to future CVD.
  
  
  RESULTS
  An increasing body of evidence supports the relationship between SDB and hypertensive disorders of pregnancy via mechanisms of inflammation, oxidative stress, and endothelial dysfunction. It is well established that hypertensive disorders of pregnancy are associated with long-term risk for CVD via similar mechanisms. However, no studies have addressed the potential role of SDB in long-term outcomes of women with GHTN/PE during pregnancy.
  
  
  CONCLUSIONS
  Given the suggested mechanisms that explain these associations, it is plausible that SDB during pregnancy may increase long-term cardiovascular morbidity and mortality.
  
  
  CONCLUSIONS
  Pregnancy may offer a window of opportunity for identification and treatment of SDB, which could provide substantial health benefit for many years to come.
authors.affiliation: Doctoral Candidate, Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI.
authors.forename: Galit Levi
authors.initials: GL
authors.lastname: Dunietz
authors.affiliation: Professor of Sleep Medicine and Neurology, Sleep Disorders Center, University of Michigan, Ann Arbor, MI.
authors.forename: Ronald David
authors.initials: RD
authors.lastname: Chervin
authors.affiliation: Associate Professor, Department of Neurology, Sleep Disorders Center; Associate Professor, Department of Obstetrics and Gynecology; Associate Research Scientist, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Louise Margaret
authors.initials: LM
authors.lastname: O'Brien
mesh_terms: D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology*; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*
references.citation: Prog Cardiovasc Dis. 2009 Jan-Feb;51(4):303-12
references.pmid: 19110132
references.citation: Arch Gynecol Obstet. 2011 Feb;283(2):195-9
references.pmid: 20033421
references.citation: Nutr Clin Pract. 2009 Dec;24(6):675-87
references.pmid: 19955545
references.citation: Circulation. 2011 Jun 21;123(24):2856-69
references.pmid: 21690502
references.citation: J Clin Sleep Med. 2009 Jun 15;5(3):263-76
references.pmid: 19960649
references.citation: Sleep. 2011 Aug 01;34(8):1033-8
references.pmid: 21804665
references.citation: Obstet Gynecol. 2009 Nov;114(5):961-970
references.pmid: 20168095
references.citation: Eur Respir J. 2010 Oct;36(4):849-55
references.pmid: 20525714
references.citation: Hypertension. 2011 Jan;57(1):85-93
references.pmid: 21098311
references.citation: Sleep Med. 2004 Jan;5(1):43-51
references.pmid: 14725826
references.citation: Sleep Med. 2011 Apr;12(4):329-34
references.pmid: 21345723
references.citation: J Obstet Gynaecol Can. 2012 Sep;34(9):830-835
references.pmid: 22971451
references.citation: Circulation. 2010 Nov 2;122(18):1846-53
references.pmid: 20956209
references.citation: Respiration. 2008;76(1):33-9
references.pmid: 17728529
references.citation: Sleep. 2004 Feb 1;27(1):123-8
references.pmid: 14998248
references.citation: Eur Respir J. 2006 Feb;27(2):321-7
references.pmid: 16452587
references.citation: Hypertension. 2009 Jun;53(6):944-51
references.pmid: 19433776
references.citation: Stroke. 2011 Sep;42(9):2564-70
references.pmid: 21799174
references.citation: BMJ. 2001 Nov 24;323(7323):1213-7
references.pmid: 11719411
references.citation: BJOG. 2005 Nov;112(11):1486-91
references.pmid: 16225567
references.citation: Obstet Gynecol. 2013 May;121(5):1040-1048
references.pmid: 23635741
references.citation: Sleep. 1996 Feb;19(2):104-15
references.pmid: 8855032
references.citation: J Womens Health (Larchmt). 2011 Feb;20(2):287-93
references.pmid: 21265636
references.citation: Proc Am Thorac Soc. 2008 Feb 15;5(2):185-92
references.pmid: 18250211
references.citation: Am J Obstet Gynecol. 2002 Feb;186(2):198-203
references.pmid: 11854635
references.citation: Am J Obstet Gynecol. 2012 Dec;207(6):487.e1-9
references.pmid: 22999158
references.citation: J Clin Sleep Med. 2007 Mar 15;3(2):121-31
references.pmid: 17557422
references.citation: Chest. 2000 Jan;117(1):137-41
references.pmid: 10631211
references.citation: Sleep Med. 2007 Dec;9(1):9-14
references.pmid: 17644420
references.citation: Am J Obstet Gynecol. 2000 Jul;183(1):S1-S22
references.pmid: 10920346
references.citation: Womens Health (Lond). 2011 May;7(3):363-74
references.pmid: 21612356
references.citation: JAMA. 2000 Apr 12;283(14):1829-36
references.pmid: 10770144
references.citation: Hypertens Pregnancy. 2012;31(1):50-8
references.pmid: 21332326
references.citation: Obstet Gynecol. 2012 Nov;120(5):1085-92
references.pmid: 23090526
references.citation: Sleep Breath. 2012 Jun;16(2):571-8
references.pmid: 21681412
references.citation: Epidemiology. 2011 Sep;22(5):738-44
references.pmid: 21734587
references.citation: Int J Gynaecol Obstet. 2013 Jun;121(3):261-5
references.pmid: 23507553
references.citation: Reproduction. 2012 Dec;144(6):661-8
references.pmid: 23028125
references.citation: Expert Rev Respir Med. 2008 Feb;2(1):75-84
references.pmid: 20477224
references.citation: Womens Health (Lond). 2011 May;7(3):283-92
references.pmid: 21612350
references.citation: Am J Respir Crit Care Med. 2003 Jan 15;167(2):137-40
references.pmid: 12411285
references.citation: Circulation. 2010 Aug 10;122(6):579-84
references.pmid: 20660802
references.citation: BJOG. 2013 Jul;120(8):924-31
references.pmid: 23530583
references.citation: Sleep Med. 2005 Mar;6(2):163-9
references.pmid: 15716220
references.citation: Circulation. 2012 Mar 20;125(11):1367-80
references.pmid: 22344039
references.citation: Obstet Gynecol. 2010 Jan;115(1):77-83
references.pmid: 20027038
references.citation: J Am Acad Nurse Pract. 2012 Dec;24(12):695-703
references.pmid: 23190127
references.citation: BMJ. 2003 Apr 19;326(7394):845
references.pmid: 12702615
references.citation: Am Heart J. 2008 Nov;156(5):918-30
references.pmid: 19061708
references.citation: Am J Epidemiol. 2013 May 1;177(9):1006-14
references.pmid: 23589584
references.citation: BMC Pregnancy Childbirth. 2013 Jun 04;13:126
references.pmid: 23734952
references.citation: Curr Opin Pulm Med. 2010 Nov;16(6):574-82
references.pmid: 20859210
references.citation: Am J Hypertens. 2008 May;21(5):521-6
references.pmid: 18437143
references.citation: Maturitas. 2010 Dec;67(4):321-6
references.pmid: 20833489
references.citation: Semin Perinatol. 2009 Jun;33(3):130-7
references.pmid: 19464502
references.citation: Lancet. 2001 Jun 23;357(9273):2002-6
references.pmid: 11438131
references.citation: Am J Respir Crit Care Med. 2000 Jul;162(1):252-7
references.pmid: 10903250
references.citation: Epidemiology. 2005 Mar;16(2):206-15
references.pmid: 15703535
references.citation: Eur J Obstet Gynecol Reprod Biol. 2008 Nov;141(1):35-8
references.pmid: 18760871
references.citation: Circulation. 2001 Oct 30;104(18):2200-4
references.pmid: 11684631
references.citation: N Engl J Med. 2011 Dec 15;365(24):2277-86
references.pmid: 22168642
references.citation: Proc Am Thorac Soc. 2008 Feb 15;5(2):136-43
references.pmid: 18250205
references.citation: N Engl J Med. 1996 Sep 12;335(11):768-74
references.pmid: 8703181
references.citation: Acta Obstet Gynecol Scand. 2007;86(7):788-92
references.pmid: 17611822
references.citation: Sleep. 2004 Nov 1;27(7):1405-17
references.pmid: 15586794
references.citation: Eur Respir J. 2009 Mar;33(3):559-65
references.pmid: 19213789
references.citation: Am J Kidney Dis. 2003 Nov;42(5):982-9
references.pmid: 14582042
references.citation: Fertil Steril. 2012 Jul;98(1):36-40
references.pmid: 22658345
references.citation: JAMA. 2004 Apr 28;291(16):2013-6
references.pmid: 15113821
references.citation: Chest. 2007 Dec;132(6):1847-52
references.pmid: 17925415
references.citation: Epidemiology. 2006 Jul;17(4):428-34
references.pmid: 16755262
references.citation: Eur J Epidemiol. 2013 Jan;28(1):1-19
references.pmid: 23397514
references.citation: Hypertension. 2007 Aug;50(2):417-23
references.pmid: 17548722
references.citation: Stroke. 1997 Feb;28(2):280-3
references.pmid: 9040675
references.citation: Obstet Gynecol Surv. 2009 Apr;64(4):273-80
references.pmid: 19296861
references.citation: Am J Perinatol. 2012 Apr;29(4):277-82
references.pmid: 22105436
references.citation: Neurology. 1998 Dec;51(6):1622-8
references.pmid: 9855513
references.citation: Sleep. 2013 Nov 01;36(11):1625-32
references.pmid: 24179294
references.citation: Obstet Gynecol. 2005 Sep;106(3):509-16
references.pmid: 16135580
references.citation: JAMA. 2012 May 23;307(20):2169-76
references.pmid: 22618924
references.citation: Am J Obstet Gynecol. 2010 Mar;202(3):261.e1-5
references.pmid: 20005507
references.citation: Sleep. 1997 Sep;20(9):705-6
references.pmid: 9406321
references.citation: Sleep. 2004 Feb 1;27(1):79-84
references.pmid: 14998241
references.citation: Arch Intern Med. 2007 Apr 23;167(8):757-64
references.pmid: 17452537
references.citation: Circulation. 2008 Sep 2;118(10):1080-111
references.pmid: 18725495
references.citation: Ann Intern Med. 2012 Jan 17;156(2):115-22
references.pmid: 22250142
references.citation: JAMA. 2000 Dec 20;284(23):3015-21
references.pmid: 11122588
references.citation: N Engl J Med. 1996 Nov 14;335(20):1480-5
references.pmid: 8890098
references.citation: Eur J Clin Invest. 2004 Jun;34(6):443-8
references.pmid: 15200497
references.citation: Am Fam Physician. 2004 Dec 15;70(12):2317-24
references.pmid: 15617295
references.citation: Am J Med Sci. 2007 Oct;334(4):291-5
references.pmid: 18030186
references.citation: J Physiol. 2012 Aug 1;590(15):3535-43
references.pmid: 22687610
references.citation: Indian J Med Res. 2010 Feb;131:285-301
references.pmid: 20308754
references.citation: Circulation. 2011 Mar 29;123(12):1280-6
references.pmid: 21403097
references.citation: Sleep Breath. 2012 Mar;16(1):111-6
references.pmid: 21267663
references.citation: Curr Opin Pulm Med. 2003 Nov;9(6):477-83
references.pmid: 14534398
references.citation: Sleep Med. 2007 Dec;9(1):15-21
references.pmid: 17644475
references.citation: BMJ. 2007 Nov 10;335(7627):974
references.pmid: 17975258
references.citation: Am J Respir Crit Care Med. 2009 Feb 1;179(3):235-40
references.pmid: 19011148