孕期的体重变化与妊娠期高血压及睡眠呼吸暂停低通气综合征的关系

Influence of weight gain on the onset of hypertension and sleep apnea hyponea syndrome during pregnancy

目的 本研究拟通过病例对照研究,探讨孕期的体重变化与妊娠期高血压（PIH）及睡眠呼吸暂停低通气综合征（SAHS）的关系.方法 纳入2011 年2 月至2012 年2 月在北京大学深圳医院产科就诊的36 周以上、有打鼾症状的待产孕妇,分为PIH 组（n=64）与非PIH 组（n=73）.所有入选患者均在医院行8 h（22∶00～6∶00）夜间睡眠呼吸初筛仪监测.根据产检记录登记孕前、孕20 周、孕28 周及产前的体重、收缩压（SBP）、舒张压（DBP）.比较2 组孕妇的夜间低氧情况,在妊娠期间的血压与体重变化,分析孕期的体重变化与PIH、夜间低氧的关系.结果 PIH 组孕妇的睡眠呼吸暂停低通气指数（AHI,8.12±5.31）高于对照组孕妇（3.26±3.66）（P〈0.01）.产前血压与孕前血压、AHI 关系密切,其中与孕前血压的偏相关系数为0.566（P〈0.05）,与AHI 的偏相关系数为0.3（P〈0.05）;AHI 每上升10 次/h,或孕前血压每上升10 mmHg,产前血压约上升8 mmHg.PIH 的主要影响因素是孕前收缩压（OR 值为1.101,95%可信区间1.050～1.154）及AHI（OR 值为1.295,95%可信区间1.127～1.488）.SAHS 是PIH 的-个危险因素（OR 值为7.917,95% CI 为3.662～17.119,P〈0.001）.孕期体重值、体重增加值与血压值、血压增加值不相关,与夜间血氧各指标不相关（均P〉0.05）.结论 SAHS 可能是PIH 的危险因素;睡眠呼吸暂停低通气指数每上升10 次/h,产前血压约上升8 mmHg;孕期体重值、体重增加值与血压值、血压增加值不相关,与夜间血氧各指标不相关.

Objective A case-control study was designed to evaluate the influence of weight gain on the onset of pregnancy induced hypertension (PIH) and sleep apnea hyponea syndrome(SAHS) during pregnancy.Methods137 ante-partum women in our hospital (Hawaii Snoring Scale≥2) were enlisted during Feb. 2011 and Feb. 2012, and were divided in 2 parts, 73 non-PIH group and 64 PIH group. All participants underwent an overnight sleep monitor in hospital (22∶00-6∶00). The results of the maternal weight, height, blood pressure (BP) in pre-pregnancy, 20th gestational week, 28th gestational week and antepartum were taken from medical records. The data of maternal weight gain, blood pressure and nocturnal sleep monitor indices were analyzed between women with and without PIH.ResultsHigher value of AHI (apnea hyponea index) was observed in group PIH (8.12±5.31vs. 3.26±3.66,P<0.05). Prenatal BP was associated with pre-pregnant BP (r=0.566,P<0.05) and with apnea hyponea index (AHI) (r=0.3,P<0.05). Every time AHI increased 10/h or pre-pregnancy BP increased 10 mmHg, prenatal BP increased 8 mmHg. The main risk factors of PIH were pre-pregnancy systolic BP(OR 1.101, 95%CI 1.050-1.154) and AHI (OR 1.295, 95%CI 1.127-1.488). SAHS in pregnancy might be at high risk of PIH (OR 7.917, 95%CI&nbsp;3.662-17.119,P<0.001). The maternal weight at delivery and weight gain during pregnancy were not related with BP and BP elevation during pregnancy, nor with the indices of nocturnal sleep monitor. ConclusionSAHS may be a risk factor of PIH. Every time AHI increased 10/h, BP in the third trimester increased 8 mmHg. The maternal weight at delivery and weight gain during pregnancy were not related with PIH and SAHS.