Sleep quality measured by cardiopulmonary coupling spectrum in pregnant women predicts neonatal outcomes.

Abstract

Study objectives: To assess the impact of objective sleep quality during pregnancy, estimated using cardiopulmonary coupling (CPC) sleep spectrograms, on neonatal outcomes.

Methods: A secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) study. Cardiopulmonary coupling analysis was done using the raw photoplethysmogram (PLETH) signal within the oximetry-sensor (PPG) from a home apnea sleep test. High and low frequency coupling (HFC, LFC) reflect stable and unstable sleep, respectively. A multi-component Sleep Quality Index integrates sleep stability, and fragmentation. Regression analysis was done to identify the relationship between CPC metrics and neonatal outcomes.

Results: Oximetry/PPG data from the early and middle term of pregnancy (3003 and 2168 subjects, ETP and MTP respectively) was available. A high SQI in ETP decreased the risk of small for gestational age (SGA) (OR 0.297, 95% CI 0.147-0.603, p < 0.01) and Apgar score < 7 at 5 minutes (OR 0.368, 95% CI 0.158-0.857, p: 0.02). A higher SQI in MTP was associated with Apgar score < 7 at 1(OR 0.472, 95% CI 0.275-0.810, p < 0.01) and 5 minutes (OR 0.274, 95% CI 0.107-0.704, p < 0.01). An increased HFC/LFC ratio in ETP was a predictor for reduced preterm birth risk (OR 0.955, 95% CI 0.920-0.991, p: 0.01) and it in MTP was related with increased preterm birth (OR 0.828, 95% CI 0.749-0.916, p: 0.01) and Apgar score < 7 at 5 minutes (OR 0.784, 95% CI 0.659-0.932, p < 0.01) risks. The increasing of eLFC_NB across pregnancy, which is a biomarker of sleep fragmentation, added the risk of SGA (OR 1.053, 95% CI 1.009-1.099, p < 0.01).

Conclusions: Sleep quality measured by CPC spectrograms were associated with neonatal outcomes. Sleep quality may be a target for clinical care during pregnancy.