title: Association Between Sleep-Disordered Breathing and Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus.
abstract: To estimate whether sleep-disordered breathing during pregnancy is a risk factor for the development of hypertensive disorders of pregnancy and gestational diabetes mellitus (GDM).
  
  
  
  In this prospective cohort study, nulliparous women underwent in-home sleep-disordered breathing assessments in early (6-15 weeks of gestation) and midpregnancy (22-31 weeks of gestation). Participants and health care providers were blinded to the sleep test results. An apnea-hypopnea index of 5 or greater was used to define sleep-disordered breathing. Exposure-response relationships were examined, grouping participants into four apnea-hypopnea index groups: 0, greater than 0 to less than 5, 5 to less than 15, and 15 or greater. The study was powered to test the primary hypothesis that sleep-disordered breathing occurring in pregnancy is associated with an increased incidence of preeclampsia. Secondary outcomes were rates of hypertensive disorders of pregnancy, defined as preeclampsia and antepartum gestational hypertension, and GDM. Crude and adjusted odds ratios and 95% confidence intervals (CIs) were calculated from univariate and multivariate logistic regression models.
  
  
  
  Three thousand seven hundred five women were enrolled. Apnea-hypopnea index data were available for 3,132 (84.5%) and 2,474 (66.8%) women in early and midpregnancy, respectively. The corresponding prevalence of sleep-disordered breathing was 3.6% and 8.3%. The prevalence of preeclampsia was 6.0%, hypertensive disorders of pregnancy 13.1%, and GDM 4.1%. In early and midpregnancy the adjusted odds ratios for preeclampsia when sleep-disordered breathing was present were 1.94 (95% CI 1.07-3.51) and 1.95 (95% CI 1.18-3.23), respectively; hypertensive disorders of pregnancy 1.46 (95% CI 0.91-2.32) and 1.73 (95% CI 1.19-2.52); and GDM 3.47 (95% CI 1.95-6.19) and 2.79 (95% CI 1.63-4.77). Increasing exposure-response relationships were observed between apnea-hypopnea index and both hypertensive disorders and GDM.
  
  
  
  There is an independent association between sleep-disordered breathing and preeclampsia, hypertensive disorders of pregnancy, and GDM.
authors.affiliation: University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; RTI International, Washington, DC; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Utah, Salt Lake City, Utah; Case Western Reserve University, Cleveland, Ohio; Columbia University, New York, New York; the University of California-Irvine, Irvine, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; Northwestern University, Chicago, Illinois; Indiana University, Bloomington, Indiana; and the University of Texas Medical Branch, Galveston, Galveston, Texas.
authors.forename: Francesca L
authors.initials: FL
authors.lastname: Facco
authors.forename: Corette B
authors.initials: CB
authors.lastname: Parker
authors.forename: Uma M
authors.initials: UM
authors.lastname: Reddy
authors.forename: Robert M
authors.initials: RM
authors.lastname: Silver
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Koch
authors.forename: Judette M
authors.initials: JM
authors.lastname: Louis
authors.forename: Robert C
authors.initials: RC
authors.lastname: Basner
authors.forename: Judith H
authors.initials: JH
authors.lastname: Chung
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Nhan-Chang
authors.forename: Grace W
authors.initials: GW
authors.lastname: Pien
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Wing
authors.forename: Hyagriv N
authors.initials: HN
authors.lastname: Simhan
authors.forename: David M
authors.initials: DM
authors.lastname: Haas
authors.forename: Brian M
authors.initials: BM
authors.lastname: Mercer
authors.forename: Samuel
authors.initials: S
authors.lastname: Parry
authors.forename: Daniel
authors.initials: D
authors.lastname: Mobley
authors.forename: Shannon
authors.initials: S
authors.lastname: Hunter
authors.forename: George R
authors.initials: GR
authors.lastname: Saade
authors.forename: Frank P
authors.initials: FP
authors.lastname: Schubert
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Zee
mesh_terms: D000293:Adolescent; D000328:Adult; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D015994:Incidence; D017286:Polysomnography; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011264:Pregnancy Trimesters; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult