title: Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study.
abstract: OBJECTIVE
  Sleep disturbances such as insomnia, nocturnal awakenings, restless legs syndrome, habitual snoring, and excessive daytime sleepiness are frequent during pregnancy, and these have been linked to adverse maternal and fetal outcomes.
  
  
  METHODS
  A prospective observational study was performed in high-risk Indian pregnant women. We used modified Berlin questionnaire (MBQ), Pittsburgh sleep quality index (PSQI), International Restless Legs Syndrome Study Group 2011 criteria, and Epworth sleepiness scale to diagnose various sleep disorders, such as symptomatic OSA, poor sleep quality and insomnia, RLS, and excessive daytime sleepiness, respectively, in successive trimesters of pregnancy. Outcome variables of interest were development of gestational hypertension (GH), gestational diabetes mellitus (GDM), and cesarean delivery (CS); the Apgar scores; and low birth weight (LBW). The relationship between sleep disorders and outcomes was explored using logistic regression analysis.
  
  
  RESULTS
  Outcome data were obtained in 209 deliveries. As compared to nonsnorers, women who reported snoring once, twice, and thrice or more had odds ratios for developing GH-4.0 (95 % CI 1.3-11.9), 1.5 (95 % CI 0.5-4.5), and 2.9 (95 % CI 1.0-8.2) and for undergoing CS-5.3 (95 % CI 1.7-16.3), 4.9 (95 % CI 1.8-13.1), and 5.1 (95 % CI 1.9-14.9), respectively. Pregnant women who were persistently positive on MBQ had increased odds for GH and CS.
  
  
  CONCLUSIONS
  Snoring and high-risk MBQ in pregnant women are strong risk factors for GH and CS. In view of the significant morbidity and health care costs, simple screening of pregnant women with questionnaires such as MBQ may have clinical utility.
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India. sksharma.aiims@gmail.com.
authors.forename: S K
authors.initials: SK
authors.lastname: Sharma
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: A
authors.initials: A
authors.lastname: Nehra
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: S
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: M
authors.initials: M
authors.lastname: Soneja
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: K
authors.initials: K
authors.lastname: Sunesh
authors.affiliation: Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: V
authors.initials: V
authors.lastname: Sreenivas
authors.affiliation: Department of Radio-Diagnosis, PGIMS, Rohtak, 124001, Haryana, India.
authors.forename: D
authors.initials: D
authors.lastname: Vedita
mesh_terms: D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section; D016640:Diabetes, Gestational / Q000175:diagnosis; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis; D007194:India; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis; D012893:Sleep Wake Disorders / Q000175:diagnosis*; D013223:Statistics as Topic; D055815:Young Adult
keywords: Cesarean delivery; Gestational hypertension; Modified Berlin questionnaire; Obstructive sleep apnea; Pittsburgh sleep quality index; Restless legs syndrome