SESSION TITLE: Hot Topics in Pulmonary & Critical Care
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PM
PURPOSE: Sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA) are common in pregnancy and are associated with adverse outcomes including gestational diabetes and preeclampsia. In previous studies we demonstrated that levels of unconjugated estriol, placenta associated plasma protein-A (PAPP-A) and angiogenesis markers were altered in pregnant women with OSA compared to pregnant controls at low risk for OSA. As snoring, a result of partial airflow limitation, is one of the components of OSA, we aimed to examine the relationship between markers of placental and fetal wellbeing and snoring in pregnant women.
METHODS: A secondary analysis of a cohort of pregnant women screened for SDB in immediate post-partum period was performed. Non-snorers were defined as women answering “never” to question about snoring from the multivariable-apnea prediction index; snorers answered “frequently” or “always” to the same question. Women with available first and second trimester markers of fetal and placental wellbeing were selected. Marker levels were reported as multiples of median (MoM) and later adjusted in a regression analysis for body mass index (BMI).
RESULTS: The study identified 141 pregnant women with habitual snoring and 166 controls with available markers (mean age/mean BMI: 29/27.8 vs 28.1/24.1 respectively). Median levels of markers of fetal wellbeing (alpha feto-protein) and feto-placental wellbeing (unconjugated estriol) were significantly lower in snorers compared to non-snorers (0.9 + 0.38 (SD) compared to 1.0 + 0.42 (SD); p=0.026) and (0.95 + 0.37 (SD) compared to 1.06 + 0.33 (SD); p=0.016) respectively. This difference was no longer significant once adjusted for BMI (p=0.64; p=0.58). On the other hand, markers associated with preeclampsia (PAPP-A, inhibin-A and human chorionic gonadotropin) were not significantly different between snorers and non-snorers.
CONCLUSIONS: Our data show that snoring does not independently alter markers of placental and fetal wellbeing. The difference between these data and those found in women with OSA suggest that intermittent hypoxia and/or arousals are necessary to alter placental and fetal markers. The association of snoring with preeclampsia may be mediated by other mechanisms.
CLINICAL IMPLICATIONS: Alterations in placenta - secreted markers require a more profound insult than the partial airflow limitation associated with snoring.
DISCLOSURE: The following authors have nothing to disclose: Elie Zouein, Geralyn Lambert-Messerlian, Patrizia Curran, Kristen Butterfield, Elizabeth Eklund, Ghada Bourjeily
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