睡眠呼吸障碍与自发性早产的巢式病例对照研究

目的:探讨妊娠晚期睡眠呼吸障碍是否为自发性早产的危险因素。方法:采用巢式病例对照研究,纳入从2018年10月-2019年5月在北京市大兴区人民医院住院妊娠晚期孕妇为研究对象。收集孕妇的相关资料,包括人口学信息、病史信息以及柏林问卷(Berlin Questionnaire,BQ)、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)和艾普沃斯嗜睡量表(Epworth Sleepiness Scale,ESS)。依据我国早产临床诊断与治疗指南(2014)诊断为自发性早产者为自发性早产组(46例),无早产等合并症的足月产孕妇为足月产组(407例)。比较2组孕妇的一般情况、睡眠呼吸障碍问卷评分等相关因素,并分析可能影响自发性早产的独立危险因素。结果:自发性早产组孕妇的年龄、孕前BMI、既往流产次数及早产史均高于足月分娩组,受教育程度低于足月分娩组,差异均有统计学意义(均P<0.05)。自发性早产组PSQI总分和BQ阳性率高于足月分娩组,差异均有统计学意义(均P<0.05)。Logistic回归分析显示在校正可能影响自发性早产的混杂因素后,BQ阳性孕妇发生自发性早产的风险约是BQ阴性孕妇的2.61倍(OR=2.61,95%CI:1.21~5.64,P=0.015)。结论:妊娠晚期具有阻塞性睡眠呼吸暂停高风险的孕妇发生自发性早产的可能性较高。

Nested Case Control Study of Sleep-Disorder Breathing and Spontaneous Preterm Birth

Objective:To explore whether sleep-disorder breathing is a risk factor of spontaneous preterm birth in late pregnancy. Methods:This is a nested case control study, from October 2018 to May 2019, pregnant women in the late pregnancy in People′s Hospital of Beijing Daxing District were collected as subjects. Relevant data of pregnant women were collected, including demographic information, medical history information, Berlin Questionnaire(BQ), Pittsburgh Sleep Quality Index(PSQI), and Epworth Sleepiness Scale(ESS). Spontaneous preterm birth was diagnosed according to the clinical diagnosis and treatment guidelines for preterm birth in China(2014). The spontaneous preterm birth group(46 cases) and the term birth group(407 cases) without complications at the same time were determined. The general situation of pregnant women, sleep disorders of breathing questionnaire scores were compared between the two groups. The independent risk factors of spontaneous premature birth were analyzed. Results:The age, body mass index before pregnancy, previous abortions frequent, and the history of preterm birth of the pregnant women in the spontaneous preterm birth group were higher than those in the term birth group, and the education level was lower than that in the term birth group, the differences were statistically significant(P<0.05). The PSQI score and the high risk of obstructive sleep apnea(BQ-positive) in spontaneous preterm birth group were higher than those in the term birth group(P <0.05). Logistic regression analysis showed that the risk of spontaneous preterm birth in BQ-positive pregnant women was 2.61 times higher than that in BQnegative pregnant women(OR=2.61, 95%CI: 1.21-5.64, P=0.015). Conclusions:Pregnant women with high risk of obstructive sleep apnea are more likely to have spontaneous preterm birth.