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Effects of Maternal Obstructive Sleep Apnoea on Fetal Growth: A Prospective Cohort Study
Open accessAbstract
OBJECTIVE: The objective of this study is to determine whether obstructive sleep apnea (OSA) is associated with reduced fetal growth, and whether nocturnal oxygen desaturation precipitates acute fetal heart rate changes. STUDY DESIGN: We performed a prospective observational study, screening 371 women in the second trimester for OSA symptoms. 41 subsequently underwent overnight sleep studies to diagnose OSA. Third trimester fetal growth was assessed using ultrasound. Fetal heart rate monitoring accompanied the sleep study. Cord blood was taken at delivery, to measure key regulators of fetal growth. RESULTS: Of 371 women screened, 108 (29%) were high risk for OSA. 26 high risk and 15 low risk women completed the longitudinal study; 14 had confirmed OSA (cases), and 27 were controls. The median (interquartile range) respiratory disturbance index (number of apnoeas, hypopnoeas or respiratory related arousals/hour of sleep) was 7.9 (6.1-13.8) for cases and 2.2 (1.3-3.5) for controls (p<0.001). Impaired fetal growth was observed in 43% (6/14) of cases, vs 11% (3/27) of controls (RR 2.67; 1.25-5.7; p = 0.04). Using logistic regression, only OSA (OR 6; 1.2-29.7, p = 0.03) and body mass index (OR 2.52; 1.09-5.80, p = 0.03) were significantly associated with impaired fetal growth. After adjusting for body mass index on multivariate analysis, the association between OSA and impaired fetal growth was not appreciably altered (OR 5.3; 0.93-30.34, p = 0.06), although just failed to achieve statistical significance. Prolonged fetal heart rate decelerations accompanied nocturnal oxygen desaturation in one fetus, subsequently found to be severely growth restricted. Fetal growth regulators showed changes in the expected direction- with IGF-1 lower, and IGFBP-1 and IGFBP-2 higher- in the cord blood of infants of cases vs controls, although were not significantly different. CONCLUSION: OSA may be associated with reduced fetal growth in late pregnancy. Further evaluation is warranted to establish whether OSA may be an important contributor to adverse perinatal outcome, including stillbirth.
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“The effects of SDB on early reproductive outcomes, including fertility, fecundity, and conception are not well understood and the majority of studies disproportionately address complications of established pregnancies, fetal or neonatal outcomes [8,9].”
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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
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Sleep Position, Fetal Growth Restriction, and Late-Pregnancy Stillbirth
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Predictors of sleep-disordered breathing in pregnancy
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Metadata
- Authors
- Fung, A. M., Wilson, D. L., Lappas, M., Howard, M., Barnes, M., O'Donoghue, F., Tong, S., Esdale, H., Fleming, G., & Walker, S. P.
- Affiliations
- Mercy Hospital for Women (AU)
- Austin Hospital (AU)
- The University of Melbourne (AU)
- Corresponding author
- Walker, Susan P.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-07-24
- Volume
- 8
- Issue
- 7
- Pages
- e68057
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3722214
- OpenAlex
- W2022586858
- Cited by
- 119
- References
- 47
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 9 · 2023: 7 · 2022: 12 · 2021: 9 · 2020: 12 · 2019: 9 · 2018: 12 · 2017: 5 · 2016: 10 · 2015: 10 · 2014: 8 · 2013: 3
- FWCI
- 7.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Austin Medical Research Foundation
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- obstructive sleep apnea, fetal growth restriction, fetal growth, nocturnal hypoxemia, fetal heart rate decelerations, body mass index, insulin-like growth factor I, IGFBP-1, IGFBP-2, cord blood biomarkers, pregnancy complications, respiratory disturbance index, fetal hypoxia, macrosomia
- MeSH terms
- Adult, Female, Heart Rate, Fetal, Humans, Pregnancy, Pregnancy Complications, Prospective Studies, Sleep Apnea, Obstructive, Fetal Development
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