Sleep Patterns in Late Pregnancy and Risk of Preterm Birth and Fetal Growth Restriction
Abstract
BACKGROUND: During pregnancy, women are at particular risk for sleep deprivation and snoring because of the physiologic and hormonal changes of pregnancy. There is limited evidence for the association between sleep patterns in pregnancy and adverse birth outcomes. We examined the association of sleep duration and snoring in late pregnancy with the risk of preterm birth and fetal growth restriction. METHODS: We used data from the prospective mother-child cohort "Rhea" study in Crete, Greece 2007-2009. The analysis included 1091 women with singleton pregnancies, providing complete data on sleeping habits at the third trimester of gestation and birth outcomes. Fetal growth restriction was based on a customized model, and multivariate log-binomial regression models were used to adjust for confounders. RESULTS: Women with severe snoring were at high risk for low birth weight (relative risk = 2.6 [95% confidence interval = 1.2-5.4]), and fetal-growth-restricted neonates (2.0 [1.0-3.9]) after adjusting for maternal age, education, smoking during pregnancy, and prepregnancy body mass index (BMI). Women with sleep deprivation (≤5 hours sleep) were at high risk for preterm births (1.7 [1.1-2.8]), with the highest risk observed for medically indicated preterm births (2.4 [1.0-6.4]) after adjusting for maternal age, education, parity, smoking during pregnancy, and prepregnancy BMI. CONCLUSIONS: These findings suggest that women with severe snoring in late pregnancy have a higher risk for fetal-growth-restricted neonates; and women with sleep deprivation have a higher risk for preterm births. The mechanisms underlying these associations remain unclear.
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The results are largely consistent with some prior studies [11,29,30], though not all [12,13], that assessed the relationship between sleep duration and preterm birth.
“These results are largely consistent with some [11, 29, 30], though not all [12, 13], prior studies that have assessed the relationship between sleep duration and preterm birth.”
From Sleep duration, vital exhaustion, and odds of spontaneous preterm birth: a case–control study (2014) · cites this paper as [11]
Other studies have found that a short duration and poor quality of sleep were both risk factors for preterm birth.
“whereas others have found that a short duration and poor quality of sleep were both risk factors for preterm birth [13, 14].”
From Association between maternal sleep duration and quality, and the risk of preterm birth: a systematic review and meta-analysis of observational studies (2020) · cites this paper as [13]
Cites
A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale
Johns, M. W. (1991) · Sleep · doi:10.1093/sleep/14.6.540 · Cited by 17,364 · see citing works
Inflammation and metabolic disorders
Hotamisligil, G. S. (2006) · Nature · doi:10.1038/nature05485 · Cited by 9,199 · see citing works
A systematic review of screening questionnaires for obstructive sleep apnea
Abrishami, A., Khajehdehi, A., & Chung, F. (2010) · Canadian Journal of Anesthesia/Journal canadien d'anesthésie · doi:10.1007/s12630-010-9280-x · Cited by 581 · see citing works
The Metabolic Syndrome: Inflammation, Diabetes Mellitus, and Cardiovascular Disease
Haffner, S. M. (2005) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2005.11.010 · Cited by 563 · see citing works
Sleep apnea is a manifestation of the metabolic syndrome
Vgontzas, A. N., Bixler, E. O., & Chrousos, G. P. (2005) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2005.01.006 · Cited by 556 · see citing works
Insomnia With Objective Short Sleep Duration Is Associated With Type 2 Diabetes
Vgontzas, A. N., Liao, D., Pejovic, S., Calhoun, S., Karataraki, M., & Bixler, E. O. (2009) · Diabetes Care · doi:10.2337/dc09-0284 · Cited by 551 · see citing works
Association of Hypertension and Sleep-Disordered Breathing
Bixler, E. O., Vgontzas, A. N., Lin, H.-M., Have, T. T., Leiby, B. E., Vela‐Bueno, A., & Kales, A. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.15.2289 · Cited by 538 · see citing works
Snoring, Pregnancy-Induced Hypertension, and Growth Retardation of the Fetus
Franklin, K. A., Holmgren, P. Å., Jönsson, F., Poromaa, N., Stenlund, H. C., & Svanborg, E. (2000) · CHEST Journal · doi:10.1378/chest.117.1.137 · Cited by 439 · see citing works
Sleep Disturbances in Pregnancy
Facco, F. L., Kramer, J., Ho, K. H., Zee, P. C., & Grobman, W. A. (2010) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e3181c4f8ec · Cited by 403 · see citing works
Sleep in late pregnancy predicts length of labor and type of delivery
Lee, K. A., & Gay, C. (2004) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.05.086 · Cited by 401 · see citing works
Sleep Duration and Cardiovascular Disease: Results from the National Health Interview Survey
Sabanayagam, C., & Shankar, A. (2010) · SLEEP · doi:10.1093/sleep/33.8.1037 · Cited by 357 · see citing works
Sleep Disorders During Pregnancy
Pien, G. W., & Schwab, R. J. (2004) · SLEEP · doi:10.1093/sleep/27.7.1405 · Cited by 352 · see citing works
Self-reported short sleep duration and frequent snoring in pregnancy: impact on glucose metabolism
Facco, F., Grobman, W. A., Kramer, J., Ho, K. H., & Zee, P. C. (2010) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2010.03.041 · Cited by 319 · see citing works
Ford, E. S. (2003) · Atherosclerosis · doi:10.1016/s0021-9150(03)00134-5 · Cited by 315 · see citing works
Smith, G. C. S., Shah, I., Pell, J. P., Crossley, J. A., & Dobbie, R. (2006) · American Journal of Public Health · doi:10.2105/ajph.2005.074294 · Cited by 249 · see citing works
Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing
Bourjeily, G. R., Raker, C., Chalhoub, M. N., & Miller, M. A. (2010) · European Respiratory Journal · doi:10.1183/09031936.00021810 · Cited by 231 · see citing works
Sleep-Related Disordered Breathing During Pregnancy in Obese Women
Maasilta, P. K., Bachour, A., Teramo, K. A., Polo, O. J., & Laitinen, L. A. (2001) · CHEST Journal · doi:10.1378/chest.120.5.1448 · Cited by 206 · see citing works
Changes in Symptoms of Sleep-Disordered Breathing During Pregnancy
Pien, G. W., Fife, D., Pack, A. I., Nkwuo, J. '., & Schwab, R. J. (2005) · Sleep · doi:10.1093/sleep/28.10.1299 · Cited by 202 · see citing works
Metabolic Syndrome in Early Pregnancy and Risk of Preterm Birth
Chatzi, L., Plana, E., Daraki, V. N., Karakosta, P., Alegkakis, D., Tsatsanis, C., Kafatos, A., Koutis, A. D., & Kogevinas, M. (2009) · American Journal of Epidemiology · doi:10.1093/aje/kwp211 · Cited by 198 · see citing works
Self-citationSelf-reported Snoring in Pregnancy
Loube, I. M. D., Poceta, J. S., Morales, M. C., Peacock, D. M. M., & Mitler, M. M. (1996) · CHEST Journal · doi:10.1378/chest.109.4.885 · Cited by 184 · see citing works
Sahota, P. K., Jain, S. S., & Dhand, R. (2003) · Current Opinion in Pulmonary Medicine · doi:10.1097/00063198-200311000-00005 · Cited by 157 · see citing works
Williams, M. A., Miller, R. S., Qiu, C., Cripe, S. M., Gelaye, B., & Enquobahrie, D. A. (2010) · SLEEP · doi:10.1093/sleep/33.10.1363 · Cited by 155 · see citing works
Identifying Sleep Apnea from Self-Reports
Kapuniai, L. E., Andrew, D. J., Crowell, D. H., & Pearce, J. W. (1988) · SLEEP · doi:10.1093/sleep/11.5.430 · Cited by 145 · see citing works
Obstructive sleep apnea in pregnancy and fetal outcome
Şahin, F. K., Köken, G., Çoşar, E., Saylan, F., Fidan, F., Yılmazer, M., & Unlu, M. (2007) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2007.08.012 · Cited by 141 · see citing works
Izci‐Balserak, B., & Pien, G. W. (2010) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0b013e32833f0d55 · Cited by 131 · see citing works
Sleep disordered breathing and pregnancy
Edwards, N. (2002) · Thorax · doi:10.1136/thorax.57.6.555 · Cited by 131 · see citing works
Respiratory Effects of Gestational Intermittent Hypoxia in the Developing Rat
Gozal, D., Reeves, S. R., Row, B. W., Neville, J. J., Guo, S. Z., & Lipton, A. S. (2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200208-963oc · Cited by 130 · see citing works
Definition of Fetal Growth Restriction According to Constitutional Growth Potential
MAMELLE, N., Cochet, V., & Claris, O. (2001) · Neonatology · doi:10.1159/000047157 · Cited by 117 · see citing works
Pulmonary responses to exercise in pregnancy
Artal, R., WISWELL, R. A., Romem, Y., & Dorey, F. J. (1986) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(86)90675-7 · Cited by 100 · see citing works
Maternal sleep deprivation is a risk factor for small for gestational age: A cohort study
Abeysena, C., Jayawardana, P. L., & Seneviratne, R. D. A. (2009) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.1479-828x.2009.01010.x · Cited by 90 · see citing works
Ursavaş, A., Karadağ, M., Savaş, N. N., Ercan, İ., & Gözü, R. O. (2007) · Respiration · doi:10.1159/000107735 · Cited by 83 · see citing works
Ultrasonic fetal measurements: new Australian standards for the new millennium
Westerway, S. C., Davison, A., & Cowell, S. F. (2000) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.1479-828x.2000.tb03338.x · Cited by 73 · see citing works
Precipitation of obstructive sleep apnea during pregnancy.
Kowall, J., Clark, G., Nino‐Murcia, G., et al. (1989) · PubMed · Cited by 56 · see citing works
Disturbed sleep and preterm birth: a potential relationship?
Strange, L. B., Kp, P., Ml, M., Strickland, O. L., & Bliwise, D. L. (2009) · PubMed · Cited by 50 · see citing works
Brief, Intermittent Hypoxia Restricts Fetal Growth in Sprague-Dawley Rats
Schwartz, J. E., Kovách, A. G., Meyer, J., McConnell, C., & Iwamoto, H. S. (1998) · Neonatology · doi:10.1159/000013990 · Cited by 46 · see citing works
Normative data on snoring: a comparison between younger and older adults
Stoohs, R. A., Blum, H., Haselhorst, M., Duchna, H., Guilleminault, C., & Dement, W. C. (1998) · European Respiratory Journal · doi:10.1183/09031936.98.11020451 · Cited by 43 · see citing works
Obstructive sleep apnea (OSA)-implications in maternal-fetal medicine. A hypothesis
Schoenfeld, A., Ovadia, Y., Neri, A., & Freedman, S. (1989) · Medical Hypotheses · doi:10.1016/0306-9877(89)90125-4 · Cited by 42 · see citing works
Björkstén, B. (2009) · Current Opinion in Allergy and Clinical Immunology · doi:10.1097/aci.0b013e32832abfc2 · Cited by 36 · see citing works
Defining common outcome metrics used in obstructive sleep apnea
Al-Shawwa, B. A., Badi, A. N., Goldberg, A. N., & Woodson, B. T. (2008) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2008.07.008 · Cited by 28 · see citing works
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Cited by
Sorted by citations
Lu, Q., Zhang, X., Wang, Y., Li, J., Xu, Y., Song, X., Su, S., Zhu, X., Vitiello, M. V., Shi, J., et al. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101436 · Cited by 311 · see citing works
Warland, J., Dorrian, J., Morrison, J. L., & O'Brien, L. M. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2018.03.004 · Cited by 224 · see citing works
Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome
Palagini, L., Gemignani, A., Banti, S., Manconi, M., Mauri, M., & Riemann, D. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.02.013 · Cited by 220 · see citing works
Blair, L. M., Porter, K., Leblebicioglu, B., & Christian, L. M. (2015) · Sleep · doi:10.5665/sleep.4904 · Cited by 179 · see citing works
Sleep Disorder Diagnosis During Pregnancy and Risk of Preterm Birth
Felder, J. N., Baer, R. J., Rand, L., Jelliffe-Pawlowski, L. L., & Prather, A. A. (2017) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000002132 · Cited by 139 · see citing works
Cerritelli, F., Frasch, M. G., Antonelli, M. C., Viglione, C., Vecchi, S., Chiera, M., & Manzotti, A. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.721605 · Cited by 108 · see citing works
Sleep disturbances during pregnancy are associated with cesarean delivery and preterm birth
Li, R., Zhang, J., Zhou, R., Liu, J., Dai, Z., Liu, D., Wang, Y., Zhang, H., Li, Y., & Zeng, G. (2017) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2016.1183637 · Cited by 98 · see citing works
Sleeping for Two: An Open-Pilot Study of Cognitive Behavioral Therapy for Insomnia in Pregnancy
Tomfohr-Madsen, L. M., Clayborne, Z. M., Rouleau, C. R., & Campbell, T. S. (2017) · Behavioral Sleep Medicine · doi:10.1080/15402002.2016.1141769 · Cited by 86 · see citing works
Wang, L., & Jin, F. (2020) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-020-2814-5 · Cited by 73 · see citing works
Maternal Sleep-Disordered Breathing
Pamidi, S., & Kimoff, R. J. (2018) · Chest · doi:10.1016/j.chest.2017.10.011 · Cited by 61 · see citing works
Sleep duration, vital exhaustion, and odds of spontaneous preterm birth: a case–control study
Kajeepeta, S., Sanchez, S. E., Gelaye, B., Qiu, C., Barrios, Y. V., Enquobahrie, D. A., & Williams, M. A. (2014) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-14-337 · Cited by 51 · see citing works
Subjective reports versus objective measurement of sleep latency and sleep duration in pregnancy
Wilson, D. L., Fung, A., Walker, S. P., & Barnes, M. (2013) · Behavioral Sleep Medicine · doi:10.1080/15402002.2012.670674 · Cited by 52 · see citing works
Guendelman, S., Pearl, M., Kosa, J. L., Graham, S., Abrams, B., & Kharrazi, M. (2013) · Maternal and Child Health Journal · doi:10.1007/s10995-012-1052-5 · Cited by 43 · see citing works
Zemet, R., Schiff, E., Manovitch, Z., Cahan, T., Yoeli-Ullman, R., Brandt, B., Hendler, I., Dorfman-Margolis, L., Yinon, Y., Sivan, E., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0198949 · Cited by 23 · see citing works
- Authors
- Micheli, K., Komninos, I., Bagkeris, E., Roumeliotaki, T., Koutis, A., Kogevinas, M., & Chatzi, L.
- Affiliations
- University of Crete (GR)
- Corresponding author
- Chatzi, Leda
- Venue
- Epidemiology
- Published
- 2011-09
- Volume
- 22
- Issue
- 5
- Pages
- 738-744
- ISSN
- 1044-3983 (ISSN-L)
- OpenAlex
- W2016200072
- Cited by
- 227
- References
- 39
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 9 · 2023: 15 · 2022: 23 · 2021: 13 · 2020: 21 · 2019: 15 · 2018: 18 · 2017: 19 · 2016: 17 · 2015: 15 · 2014: 14 · 2013: 18 · 2012: 12
- FWCI
- 18.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- snoring, sleep deprivation, sleep duration, preterm birth, fetal growth restriction, low birth weight, third trimester, adverse birth outcomes
- MeSH terms
- Adult, Female, Fetal Growth Retardation, Humans, Infant, Low Birth Weight, Infant, Newborn, Pregnancy, Pregnancy Trimester, Third, Prospective Studies, Risk, Sleep Deprivation, Snoring, Linear Models, Premature Birth, Self Report
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