Posted by Tech on April 25, 2002 at 14:46:35:In Reply to: pregnancy and sleep disorders posted by Paul Zolty on February 17, 2002 at 19:06:26:
I have found many great frefs @ Advance regaurding pregnancy and sleep. the following article was very useful. until this article, never did I even consider treating Preeclamptic women with CPAP.
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While You Were Sleeping
Snoring Endangers Preeclamptic Women and Their Unborn Children
By Tracy L. SchmiererPrecious smiles, wobbling steps and Little League games fill the dreams of expectant mothers. But for those who suffer from preeclampsia, the time they spend sleeping can turn into a nightmare.
Preeclampsia is the leading cause of hospital admissions for pregnant women, maternal and fetal illness, and mortality. The condition is characterized by hypertension during or immediately following pregnancy, fluid retention and the presence of protein in the urine.
Historically, doctors prescribed sleep for women with preeclampsia. Now, research proves that this could be the most detrimental and devastating advice for these patients.
Sleep Link Discovered
So what exactly happens to these women while they sleep? Colin E. Sullivan, MD, director of the center for respiratory failure and sleep disorders at the department of medicine, University of Sydney in Australia, and his associates attempted to discover what causes preeclampsia and what could prevent or treat this serious condition. Dr. Sullivan presented his group's findings during a press conference at the April 1999 American Lung Association/American Thoracic Society Conference in San Diego."Preeclampsia occurs in 10 percent of all normal pregnancies and is the result of placenta abnormality," Dr. Sullivan explained. "The placenta is sick and putting the mother's life at risk. Treatment is the removal of the placenta. So, management for preeclampsia is trying to keep the baby in [the womb] long enough so it can develop and survive, and trying to keep the mother alive. It is the major cause of fetal loss, major cause of fetal retardation and the major cause for admission into the neonatal intensive care unit."
The researchers put pieces of the preeclampsia puzzle together and made an important discovery. Their first clue was that the diurnal blood pressure pattern is flattened in preeclampsia. Second, they knew that snoring and partial airway obstruction are common in pregnancy. They speculated that these factors could be responsible for exacerbation of nocturnal hypertension in preeclampsia.
Dr. Sullivan and associates performed full polysomnography and continuous beat-to-beat blood pressure recordings on 21 women with severe preeclampsia and 10 women with normal pregnancy. They found that snoring and partial airway obstruction occurred in all preeclamptic women in all stages of sleep, though most evident in slow wave sleep (SWS). They also found that blood pressure increased steadily throughout the night, with the highest blood pressures recorded in association with increasing partial airway obstruction, as occurred in SWS.
"We think what's happening is that it's simply a small inhalation of CO2 during the night, which a lot of people have, and is otherwise irrelevant," Dr. Sullivan said. "The reason that it's not irrelevant in these women is ... their peripheral blood vessels are constantly constricted, so any stimulant makes it worse and leads to a rise in blood pressure."
Treatment
The researchers looked to treatments commonly used for severe snoring and for sleep apnea, Dr. Sullivan said, stressing that none of the women in the study had an apnea condition. The big difference between treating sleep apnea and a preeclamptic sleep disorder is the latter requires a very low amount of pressure.In nine of the study subjects, the researchers reversed the snoring by providing air pressure through a nasal mask. They found that minimizing upper airway obstruction with CPAP helps control blood pressure and thereby protects the fetus, Dr. Sullivan said, adding that other treatments, such as dental appliances, might help as well.
"What we've shown in those nine subjects is that all of them had a marked rise in blood pressure during the night," Dr. Sullivan said. "They started off with fairly normal 130/80, but at the end of the night went up to 160/110, which is a dangerous level for the mother, and it's a dangerous level for the fetus. And that change was completely reversed by eliminating the snoring."
One of the women in the study was able to postpone delivery for another 10 days, illustrating the treatment's effectiveness. The researchers found evidence that the health risk to the fetus was a problem with the umbilical blood flow. "I have no doubts that the fetus was kept and protected by controlling blood pressure at nighttime," Dr. Sullivan said.
In addition to reducing blood pressure, CPAP alleviates edema associated with preeclampsia. "In all of the women we studied, there was a clear reduction in peripheral edema following one night of use, seen by the ability for the women to put their wedding rings back on," Dr. Sullivan said.
These significant findings "will undoubtedly become part of how we assess and treat women with preeclampsia," he concluded.
And through successful treatment, your pregnant patients can spend their moments dreaming of a hopeful future, instead of fearing medical complications that could arise from something that can be treated simply and effectively.
Tracy Schmierer is associate editor of ADVANCE.
- Re: pregnancy and sleep disorders Frank Barch 17:44 4/03/03 (0)