Mayu Niisaka, Jun Hosomichi, Sakina Mitsuishi, Shiho Kino, Takashi Ono
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引用次数: 0
Abstract
Introduction: Maternal obstructive sleep apnea (OSA) and the broader spectrum of sleep-disordered breathing (SDB) during pregnancy may be associated with fetal and neonatal outcomes, but the literature is heterogeneous and uses clinically distinct exposure definitions. This systematic review aimed to evaluate associations between maternal SDB and fetal/neonatal outcomes while preserving differences in exposure ascertainment.
Methods: Following PRISMA 2020, the review was re-audited using updated PubMed and Web of Science searches, backward and forward citation searching, and ClinicalTrials.gov and WHO ICTRP registry searches. Exposures were classified as (1) objectively confirmed OSA/SDB, (2) administrative-code-defined OSA, and (3) symptom-, snoring-, or questionnaire-defined SDB risk. No meta-analysis was conducted because clinically comparable subsets were insufficient for quantitative pooling.
Results: The completed re-audit identified 64 eligible publications mapped to 53 conservative cohort/dataset families (55 if two probable overlap pairs are treated as separate): 22 objective/physiologic, 11 administrative/clinical, and 31 symptom/questionnaire publications. Objective studies showed mixed findings, with fetal-growth or neonatal signals in selected cohorts but null findings in several other objectively assessed populations. Administrative-code OSA was repeatedly associated with preterm birth and selected neonatal outcomes, although exposure misclassification and residual confounding remain important. Symptom/questionnaire studies were heterogeneous, with associations varying by symptom definition, timing, and outcome.
Conclusion: Current evidence does not establish a consistent fetal or neonatal risk pattern for objectively confirmed maternal OSA/SDB. Administrative-code and symptom/questionnaire evidence suggests associations for selected outcomes, particularly preterm birth, but should not be interpreted as a single homogeneous OSA effect.
妊娠期母亲阻塞性睡眠呼吸暂停（OSA）和更广泛的睡眠呼吸障碍（SDB）可能与胎儿和新生儿结局有关，但文献不一致，临床使用不同的暴露定义。本系统综述旨在评估母亲SDB与胎儿/新生儿结局之间的关系，同时保留暴露确定的差异。方法：在PRISMA 2020之后，使用更新的PubMed和Web of Science检索、向后和向前引文检索以及ClinicalTrials.gov和WHO ICTRP注册表检索对该综述进行重新审核。暴露分为(1)客观确认的OSA/SDB，(2)行政代码定义的OSA，(3)症状、打鼾或问卷定义的SDB风险。没有进行荟萃分析，因为临床可比的亚群不足以进行定量池。结果：完成的重新审核确定了64篇符合条件的出版物，涉及53个保守队列/数据集家族（如果两个可能重叠的对被视为单独处理，则为55篇）：22篇客观/生理学出版物，11篇行政/临床出版物和31篇症状/问卷出版物。客观研究显示了不同的结果，在选定的队列中有胎儿生长或新生儿信号，但在其他几个客观评估的人群中没有发现。行政法规OSA反复与早产和某些新生儿结局相关，尽管暴露错误分类和残留混淆仍然很重要。症状/问卷研究是异质性的，其相关性因症状定义、时间和结果而异。结论：目前的证据并没有建立一致的胎儿或新生儿的风险模式，客观地证实了母亲的OSA/SDB。行政法规和症状/问卷证据表明与某些结果，特别是早产有关，但不应解释为单一的均匀OSA效应。系统评价注册：https://www.crd.york.ac.uk/PROSPERO/，标识符CRD420251110706。
期刊介绍：
Frontiers in Physiology is a leading journal in its field, publishing rigorously peer-reviewed research on the physiology of living systems, from the subcellular and molecular domains to the intact organism, and its interaction with the environment. Field Chief Editor George E. Billman at the Ohio State University Columbus is supported by an outstanding Editorial Board of international researchers. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
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