Relationship between sleep-disordered breathing and perinatal outcome in pregnant women Relationship between sleep-disordered breathing and perinatal outcome in pregnant women

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<B>妊婦の睡眠呼吸障害と周産期outcomeとの関係</B><br>宮川幸代<sup>*1</sup>,江守陽子<sup>*1</sup>,川野亜津子<sup>*1</sup>,櫻井 進<sup>*2</sup>,谷川 武<sup>*2</sup><br><sup>*1</sup>筑波大学大学院人間総合科学研究科<br><sup>*2</sup>愛媛大学大学院医学系研究科<br><B>目 的</B><br> 本研究の目的は,妊婦の睡眠呼吸障害(Sleep Disordered Breathing: SDB)が出産のアウトカムに及ぼす影響を検討することにある。<br><B>方 法</B><br> 妊婦健康診査を受けている妊娠28週以降の妊婦179名を対象とし,パルスオキシメータにより,夜間睡眠中の睡眠1時間あたりの末梢動脈血中の酸素飽和度低下指数(oxygen desaturation index: ODI)を算出した。判定基準はSDBなし(3%ODI<0.5),正常範囲内(0.5≦3%ODI<5),軽度(5≦3%ODI<15),中等度(15≦3%ODI<30),重度(3%ODI≧30)の5区分とした。分析は,多重ロジスティック回帰分析によって,SDBと出産のアウトカムとの関連を検討した。<br><B>結 果</B><br> ODI判定は3%ODI<0.5は38名(21.2%),0.5≦3%ODI<5は119名(66.5%),5≦3%ODI<15は22名(12.3%),15≦3%ODIは0名であった。したがって,軽度SDB群(3%ODI≧5)22名と正常群(3%ODI<5)157名の2群間の比較を行なった。出産歴および肥満を交絡因子とした調整オッズ比は,「自然出産」を基準とすると「予定or緊急帝王切開出産Cesarean Birth(CB)・吸引出産」での調整ORは3.03(95%CI: 1.10-8.33),「予定CB・自然出産」を基準とすると「緊急CB・吸引出産」での調整ORは5.18(95%CI: 1.44-18.65)であった。<br><B>結 論</B><br> 妊娠女性におけるSDBは軽度でも出産のアウトカムに問題となることが示唆されたことから,自然流産歴を持つ経産婦,夜間の覚醒回数や睡眠問題について訴えの多い妊婦に対しては,パルスオキシメータによるスクリーニングを有効に活用するとともに,より安全な出産ケアの提供のためには速やかな睡眠状況の改善や睡眠問題の治療のための介入が必要と思われる。

<B>Objective</B><br> The purpose of this study is to investigate the influence of sleep-disordered breathing (SDB) in pregnant women on birth outcomes.<br><B>Methods</B><br> The subjects were 179 females after Week 28 of pregnancy who had undergone pregnancy checkups in one obstetric hospital. We calculated the peripheral arterial blood ODI per hour during sleep at night by dividing the frequency at which the oxygen saturation did not reach the reference value by the duration of examination using a pulse oximeter.<br>Concerning the criteria, patients with a 3%ODI of less than 0.5 were regarded as showing the absence of SDB, those with values ranging from 0.5 to 4.9 as showing the normal range, those with values ranging from 5 to 14.9 as having mild SDB, those with values ranging from 15 to 29.9 as having moderate SDB, and those with a 3%ODI of 30 or more as having severe SDB.<br>Multiple logistic regression analysis was performed to assess the birth outcomes associated with SDB.<br><B>Results</B><br> The 3%ODI was less than 0.5 in 38 (21.2%), 0.5 to 4.9 in 119 (66.5%), and 5 to 14.9 in 22 (12.3%). Therefore, we compared a mild SDB group (3%ODI≥5, n=22) with a normal group (3%ODI<5, n=157).<br> We calculated the adjusted odds ratio (OR), regarding parity and obesity as confounding variables. Regarding spontaneous vaginal birth as the baseline, the adjusted OR of elective or emergency cesarean birth (CB)/vacuum extraction was 3.03 (95% Confidence Interval (CI): 1.10-8.33). Regarding elective CB/spontaneous vaginal birth as the baseline, the adjusted OR of emergency CB/vacuum extraction was 5.18 (95%CI: 1.44-18.65).<br><B>Conclusion</B><br> Mild SDB in pregnant women suggested that influence to the birth outcomes. Therefore, screening with a pulse-oximeter should be effectively utilized in multiparas with a history of spontaneous abortion and pregnant women complaining of frequent awakening at night or sleep disturbance. In addition, early intervention to improve the state of sleep and treat sleep disturbance may be necessary to promote a safer pregnancy.


  • Journal of Japan Academy of Midwifery

    Journal of Japan Academy of Midwifery 25(1), 5-12, 2011

    Japan Academy of Midwifery


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