Maternal Sleep-Disordered Breathing in Pregnancy and Risk of Adverse Health Outcomes in Mothers and Children
Authors List
Smocot J1, Constantin E1, Huynh N2, Sériès F3, Séguin J2, Marc I3, Kimoff RJ1, Fraser W4, Benedetti A1, Li P1, Zappitelli M5, Cohen T6, Pamidi S1
1McGill University, Research Institute of the McGill University Health Centre, Montreal, Canada; 2Université de Montréal, Montreal, Canada; 3Université Laval, Québec City, Canada; 4Université de Sherbrooke, Sherbrooke, Canada; 5Hospital for Sick Children, Toronto, Canada; 6University of British Columbia, Vancouver, Canada
Rationale
Sleep-disordered breathing (SDB) affects 17-45% of pregnant women and is associated with adverse health outcomes. However, it remains unclear whether exposure to maternal SDB during pregnancy adversely affects 1) health outcomes of offspring later in life and 2) indices of cardiometabolic health in mothers measured years after delivery. We are conducting a prospective cohort study which aims to address these important knowledge gaps.
Here, we report preliminary results from the pilot phase of this study, which aims to determine the feasibility of performing key home-based measurements in mothers and children including ambulatory sleep studies, 24-hour ambulatory blood pressure monitoring (ABPM), actigraphy, anthropometric measurements and questionnaires.
Methods
Mother-child dyads (~8-11 years after delivery) are recruited from the 3D (Design, Develop, Discover) pregnancy birth cohort in Québec City and Montreal. During a single home visit (to minimize participant burden), sleep study installation, instruction for next-day 24-hour ABPM, 7-day actigraphy, anthropometric measurements and sleep questionnaires are completed for both mother and child. While a sample size of n=160 for the exposed group (SDB during pregnancy) and n=232 for the unexposed group (no SDB during pregnancy) is planned for the larger study, the pilot phase includes a total of 40 participants. To diagnose SDB, American Academy of Sleep Medicine (AASM) criteria were used in children (Level 2 home sleep apnea test) and mothers (Level 3 home sleep apnea test).
Results
Since March 2022, 13 mother-child dyads have been recruited with (mean±SD) maternal age 43.7±2.8 years and child age of 9.9±0.7 years. The mothers had a mean BMI of 25.6±5.7 kg/m2 (5/13 (38.4%) were overweight or obese). All mothers completed sleep studies, having a mean AHI of 9.1±4.7 events/h and 3% ODI of 5.4±5.7 events/h. The oximeter signal for the maternal studies was reliable 97.0±6.9% of the time and the nasal cannula 100% of the time. For the children, BMI z-scores ranged from -0.82 to 2.0 (2/13 were at risk or were overweight). All children completed the sleep test. For the 5 sleep studies that have been scored to date, the mean AHI was 2.8±0.6 events/h, mean 3% ODI 1.1±0.4 events/h, and mean microarousal index 17.9±4.5 events/hour. The mean signal quality of the children’s oximeter studies was 84.5±20.0% and the nasal cannula was 84.4±34.8%. 85% of mothers (n=11) completed the ABPM. While 85% of children also completed the ABPM, 6/11 (54.5%) had more than 70% valid measurements. Actigraphy was accepted by all participants (mother and child) and the mean recording duration was 7±1 days for both mothers and children.
Conclusion
The pilot phase of the follow-up study of the 3D Cohort reveals that home-based simultaneous sleep study and outcome measurements in mothers and children are feasible, minimizing participant burden but also ensuring adequate signal quality. The funded, larger cohort study will yield invaluable insight on long-term maternal and child health outcomes linked to maternal SDB in pregnancy.
Research Funding Source: Canadian Institutes of Health Research (CIHR; PJT 165975) and the Fonds de Recherche du Québec-Santé Réseau en Santé Respiratoire Team Grant
Smocot J1, Constantin E1, Huynh N2, Sériès F3, Séguin J2, Marc I3, Kimoff RJ1, Fraser W4, Benedetti A1, Li P1, Zappitelli M5, Cohen T6, Pamidi S1
1McGill University, Research Institute of the McGill University Health Centre, Montreal, Canada; 2Université de Montréal, Montreal, Canada; 3Université Laval, Québec City, Canada; 4Université de Sherbrooke, Sherbrooke, Canada; 5Hospital for Sick Children, Toronto, Canada; 6University of British Columbia, Vancouver, Canada
Rationale
Sleep-disordered breathing (SDB) affects 17-45% of pregnant women and is associated with adverse health outcomes. However, it remains unclear whether exposure to maternal SDB during pregnancy adversely affects 1) health outcomes of offspring later in life and 2) indices of cardiometabolic health in mothers measured years after delivery. We are conducting a prospective cohort study which aims to address these important knowledge gaps.
Here, we report preliminary results from the pilot phase of this study, which aims to determine the feasibility of performing key home-based measurements in mothers and children including ambulatory sleep studies, 24-hour ambulatory blood pressure monitoring (ABPM), actigraphy, anthropometric measurements and questionnaires.
Methods
Mother-child dyads (~8-11 years after delivery) are recruited from the 3D (Design, Develop, Discover) pregnancy birth cohort in Québec City and Montreal. During a single home visit (to minimize participant burden), sleep study installation, instruction for next-day 24-hour ABPM, 7-day actigraphy, anthropometric measurements and sleep questionnaires are completed for both mother and child. While a sample size of n=160 for the exposed group (SDB during pregnancy) and n=232 for the unexposed group (no SDB during pregnancy) is planned for the larger study, the pilot phase includes a total of 40 participants. To diagnose SDB, American Academy of Sleep Medicine (AASM) criteria were used in children (Level 2 home sleep apnea test) and mothers (Level 3 home sleep apnea test).
Results
Since March 2022, 13 mother-child dyads have been recruited with (mean±SD) maternal age 43.7±2.8 years and child age of 9.9±0.7 years. The mothers had a mean BMI of 25.6±5.7 kg/m2 (5/13 (38.4%) were overweight or obese). All mothers completed sleep studies, having a mean AHI of 9.1±4.7 events/h and 3% ODI of 5.4±5.7 events/h. The oximeter signal for the maternal studies was reliable 97.0±6.9% of the time and the nasal cannula 100% of the time. For the children, BMI z-scores ranged from -0.82 to 2.0 (2/13 were at risk or were overweight). All children completed the sleep test. For the 5 sleep studies that have been scored to date, the mean AHI was 2.8±0.6 events/h, mean 3% ODI 1.1±0.4 events/h, and mean microarousal index 17.9±4.5 events/hour. The mean signal quality of the children’s oximeter studies was 84.5±20.0% and the nasal cannula was 84.4±34.8%. 85% of mothers (n=11) completed the ABPM. While 85% of children also completed the ABPM, 6/11 (54.5%) had more than 70% valid measurements. Actigraphy was accepted by all participants (mother and child) and the mean recording duration was 7±1 days for both mothers and children.
Conclusion
The pilot phase of the follow-up study of the 3D Cohort reveals that home-based simultaneous sleep study and outcome measurements in mothers and children are feasible, minimizing participant burden but also ensuring adequate signal quality. The funded, larger cohort study will yield invaluable insight on long-term maternal and child health outcomes linked to maternal SDB in pregnancy.
Research Funding Source: Canadian Institutes of Health Research (CIHR; PJT 165975) and the Fonds de Recherche du Québec-Santé Réseau en Santé Respiratoire Team Grant
