J.C. Suri

Obesity may be the common pathway for sleep-disordered breathing in women with polycystic ovary syndrome

OBJECTIVE Polycystic ovary syndrome (PCOS) is one of the most common endocrinological disorders in women of reproductive age, and is characterized by hyperandrogenism. It is associated with long-term metabolic dysfunctions including sleep-disordered breathing (SDB). We hypothesized that the increased prevalence of SDB in PCOS results from raised testosterone levels. METHODS This was a prospective, cross-sectional, case-control study in which 50 case patients with untreated PCOS and 100 control subjects were included. All the case patients and control subjects went through a detailed clinical, biochemical, and hormonal evaluation. Overnight polysomnography was performed in all case patients and the snorers (16 of 100) in the control group. RESULTS SDB was seen in 66% of the case patients and in 4% of control group with (odds ratio [OR] = 46.5, 95% confidence interval [CI] = 14.6-148.4; p <0.001). After adjustment for body mass index (BMI) and waist circumference (WC), the difference was not significant (p = 0.993 and p = 0.931, respectively). The SDB patients with PCOS showed significantly higher respiratory distress index (RDI) values than SDB patients in the control group (22.5 ± 21.5 vs 9.0 ± 5.6, p = 0.01). On the Epworth Sleepiness Scale the PCOS case patients reported feeling more sleepy than did the control subjects (12.5 ± 3.2 vs 9.32 ± 1.7, p <0.001). Free testosterone levels were also significantly higher in the PCOS group than in the control subjects (2.95 ± 3.44 vs 1.5 ± 1.0, p <0.001). There was a significant correlation between free testosterone level and RDI values (r = 0.377; p = 0.007), WC (r = 0.315; p = 0.026), and BMI (r = 0.398; p = 0.004). A significant correlation of WC (r = 0.551; p <0.001) and BMI (r = 0.572; p <0.001) was observed with RDI. CONCLUSION Testosterone-induced obesity is probably the common pathway for the development of SDB in PCOS.

The Impact of Sleep-Disordered Breathing on Severity of Pregnancy-Induced Hypertension and Feto-Maternal Outcomes

BackgroundThere is a close association between sleep-disordered breathing (SDB) and preeclampsia. Both conditions have poor pregnancy outcomes.MethodsForty women with new-onset hypertension of pregnancy and 60 age-matched normotensive pregnant women were subjected to polysomnography. The maternal and fetal outcomes of all the subjects were noted.ResultsSDB occurs more frequently (p = 0.018; OR 13.1) and with more severity (p 0.001; OR 1.8) in women with hypertensive disorders of pregnancy even after controlling for pre-pregnancy body mass index (BMI). Furthermore, the BMI significantly correlated with both the Apnea–Hypopnea Index (AHI; r = 0.745; p < 0.001) and the blood pressure (r = 0.617; p < 0.001) highlighting the contribution of obesity in the causation of hypertension and SDB. We also found a significant correlation between AHI and blood pressure even after adjustment for BMI pointing toward an independent role of SDB in the development of hypertension (r = 0.612; p = 0.01). Maternal and fetal complications significantly correlated with different parameters of SDB–AHI, Arousal Index and minimum oxygen saturation, in the cases and with the fetal complications in the controls as well.ConclusionSDB occurs more frequently and with more severity in women with pregnancy-induced hypertension and is associated with more severe preeclampsia and adverse feto-maternal outcomes.

Sleep-disordered breathing and preeclampsia

Preeclampsia is a common cause of maternal and fetal morbidity. Endothelial dysfunction(ED) is the most important pathophysiologic mechanism for preeclampsia. Sleep-disordered breathing (SDB) is an important underlying mechanismin cardiovascular complications such as hypertension and ischemic heart disease with ED. Physiological changes during pregnancy predisposewomen to increased prevalence of SDB during the third trimester of pregnancy. SDB is seen more often in preeclampsia and ED is seen in preeclampsia and SDB. ED in preeclampsia may be potentiated by SDB. SDB appears to contribute significantly to the severity of ED in preeclampsia leading to more severe maternal and fetal outcomes. Continuous positive airway pressure (CPAP) treatment has shown benefit in reducing the severity of preeclampsia and improving the maternal and fetal outcomes in some studies. Further research is warranted in this area, especially to study the impact of CPAP on the severity of preeclampsia.