妊娠期睡眠呼吸障碍的发生及其高危因素

The occurrence of sleep-disordered breathing and the risk factors during pregnancy

目的:分析不同孕期妇女睡眠呼吸障碍(SDB)的发生情况,探讨SDB高危因素及其与妊娠结局的关系。方法:选取90例妊娠中期及139例妊娠晚期孕妇,进行流行病学的问卷调查。问卷内容包括一般资料、家族史、个人史、吸烟史、饮酒史、孕期睡眠情况,身高、体重、颈围;并记录孕妇的产检及分娩情况,包括妊娠结局、合并症及新生儿出生体重、Apgar评分等。将结果进行统计学分析。结果:妊娠期SDB的发生率较高,妊娠晚期的SDB发生率为38.13%,高于妊娠中期(24.44%),差异有统计学意义(P<0.05)。妊娠期睡眠障碍的相关症状发生率也随着孕周增加而增加,其中以夜间憋醒(P<0.05)、用口呼吸(P<0.05)、夜间多尿(P<0.01)、睡眠时多汗(P<0.01)明显。较粗的颈围(OR=1.309,P<0.01)及打鼾家族史(OR=2.885,P<0.01)为打鼾的危险因素。且当颈围≥36cm时,打鼾的发生风险明显增大(P<0.01)。打鼾可增加妊娠期发生高血压疾病的风险(12.0%vs 3.9%,P<0.05)。打鼾组的分娩前体重指数(BMI)、打鼾家族史及被动吸烟者均高于非打鼾组,差异有统计学意义(P<0.05)。结论:妊娠期SDB的发生率较高,随着孕周增加而增加,且与妊娠高血压疾病的发生相关;妊娠期可通过孕前BMI、颈围、被动吸烟等因素筛查SDB的高危孕妇,并尽早对其进行睡眠呼吸监测,以早期发现、早期干预。

Objective: To analyze the prevalence of sleep-disordered breathing( SDB)during different periods of gestation,the risk factors for SDB,and the relationship between SDB during pregnancy and perinatal outcomes. Methods: 90 pregnant women in the second trimester and 139 in the third trimester were recruited in the study and completed the epidemiological questionnaires. The questionnaire consisted of general data,family history,personal history,smoking habit,drinking history and sleep quality. Their body height,body weight as well as neck circumference( NC) were measured. Data were taken from the hospitalized medical record about pregnancy outcome,complications,the birth weights and Apgar scores of the neonates.Results: SDB was more prevalent during pregnancy,the incidence of SDB was 24. 44% in second trimester,which increased significantly in third trimester with the incidence of 38. 13%( P<0. 05). The incidence of correlated symptoms of SDB during pregnancy was increased with gestational age. There was significant difference about the incidence of night suppressed awaken,mouth breathing( P < 0. 05),nocturnal polyuria,polyhidrosis during sleep( P < 0. 01). It showed that,stubby neck circumference( OR: 1. 309,P < 0. 01) and family snoring( OR:2. 885,P<0. 01) were risk factors for SDB during pregnancy. When the neck circumference was thicker than 36 cm,the risk of snoring was significantly increased( P<0. 01). Snoring was more likely to develop hypertensive disorders of pregnancy( 12. 0% vs 3. 9%,P<0. 05). The snorers had a higher ante partum body mass index( BMI) than non-snorers( P < 0. 05). Conclusion:SDB is more prevalent during pregnancy,and it was increased with gestational age. SDB during pregnancy is associated with hypertensive disorders of pregnancy. We recommend pre-pregnancy BMI,NC,passive smoking as potential screening index for SDB during pregnancy. SDB will be early detected and early intervened.