Importance: 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.
Evidence Acquisition: 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.
Relevance: Pregnancy may offer a window of opportunity for identification and treatment of SDB, which could provide substantial health benefit for many years to come.
Target Audience: Obstetricians and gynecologists, family physicians
Learning Objectives: After completing this CME activity, physicians should be better able to evaluate the current evidence regarding the frequency of SDB in pregnancy, its risk factors, subsequent outcomes, and treatment.
*Doctoral Candidate, Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI; †Professor of Sleep Medicine and Neurology, and ‡Associate Professor, Department of Neurology, Sleep Disorders Center, University of Michigan, Ann Arbor, MI; §Associate Professor, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; and ¶Associate Research Scientist, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.
Dr O’Brien was supported in part by the Gene and Tubie Gilmore Fund for Sleep Research and the National Heart, Lung, and Blood Institute K23 HL095739.
Correspondence requests to: Louise Margaret O’Brien, PhD, MS, Michael Aldrich Sleep Disorders Laboratory, C728 Med Inn, Box 5845, 1500 East Medical Center Dr, Ann Arbor, MI 48109-0845. E-mail: email@example.com.