SEGMENT 2: Dr. Phyllis Zee discusses sleep apnea and targeted research into sleep apnea in a population of pregnant women Dr. Gary H. Gibbons, Director, National Heart, Lung, and Blood Institute: I know that some of your research has delved into one particular set of sleep disorders related to sleep apnea. Could you give us an update on what you’re learning there either from advances in genetics or new interventions or treatment strategies that are emerging? Dr. Phyllis Zee, Northwestern University: Sleep apnea is one of the most common sleep disorders that affects a large segment of our population. Over the last several years there’s been growing evidence that sleep apnea, perhaps even independent sleep durations, which we spoke about as a risk factor for poor health outcomes, and more recently, we know it’s not just an association, but it is an independent risk factor for the development of cardiovascular disorders as well as metabolic disorders such as diabetes. Our research lately has focused on two lines, one is – now we’re very interested in not only, the effect of sleep disorder breathing in the general population but also in populations there are particular risks. We have studies on aging, we have studies which is funded by NHLBI, on pregnancy, and if I could just talk a little bit about the pregnancy study. Dr. Gibbons: Please do. Dr. Zee: It is just amazing to me that until very recently that there’s been very little, if any, studies with regards to sleep disorder breathing, and for that matter, just sleep quality in pregnancy as a potential risk for poor pregnancy outcomes or adverse pregnancy outcomes. Dr. Gibbons: That is surprising. Dr. Zee: It is really surprising. Dr. Gibbons: Having slept with my wife through three children I would think that would be an early topic of discussion is how pregnancy and sleep might influence each other. Dr. Zee: Yes, and it’s even more surprising to me that when I first started inquiring about this area that the obstetricians and gynecologists – it was not even on their radar scan… Dr. Gibbons: Interesting. Dr. Zee: Although they would toss it up to well, of course, you’re pregnant so you’re uncomfortable so you can’t sleep as well. But what – I mean, knowing what we already now know about this importance of sleep in the general population or in the aging population with regards to the potential adverse effects or if you take it on the flip side, the potential health benefits of having a good night’s sleep, I was really surprised. But this was the first opportunity – large study, that could prospectively look at this, understand this relationship better, this was a great opportunity. It was a large study funded by the NICHD to identify risk factors during pregnancy that would translate into poor pregnancy outcomes. So we had this great opportunity to add sleep measures, both sleep quality measures as well as sleep disorder breathing assessment during pregnancy– in the first trimester as well as the third trimester. We had sleep questionnaires in nearly 10,000 nullipaous pregnant women, followed them throughout their pregnancy with a very, very rich database from the Parent Study looking at risk factors, inflammatory markers, cardiovascular markers as well as just kind of anatomical markers like cervical length and so forth in these pregnant women. The study is nearing its end, but we were able to assess sleep disorder breathing for the first time objectively at home in approximately a little over 3,700 women. In addition to just looking at the prevalence and understanding the relationship and the risk factor potentially for cardiovascular – poor cardiovascular outcomes like SOS, gestational diabetes or gestational hypertension or preeclampsia. We’ll also be able to look at it, the progression of sleep disorder breathing across a pregnancy. Does it really get worse and what is the risk? Is it early pregnancy having sleep disorder breathing or is it later in pregnancy that increases the risk, for example, for poor pregnancy outcomes? So shortly we will have some results from this first study. The work that we’ve done that preceded the new moms – this is called a New Moms-to-Be Study, is that we have in our lab found that sleep disorder breathing is a risk factor for some adverse pregnancy outcomes, and the strongest relationship that we find is that with gestational diabetes. What I think is surprising to me was that it wasn’t just having sleep disorder breathing, meaning that you had an apnea hypopnea index of let’s say five or greater, which clinically we think of as being significant sleep disorder breathing, but just having snoring itself – so a potentially – a gynecologist or an obstetrician could just be asking about snoring in a pregnant women, that snoring itself was a risk factor for gestational diabetes. Dr. Gibbons: Oh, that’s very interesting. Is that something that corresponds to weight gain and/or effect of the growing uterus and how it affects the physiology breathing, is there an interaction there? Dr. Zee: Yes. Our data also show that those women who have a higher BMI are at risk – that interacts with having sleep disorder breathing in increasing the risk for gestational diabetes. So there is an interaction, but I think that the large data set from New Moms-to-Be will have enough power in that study to adjust, for example, for BMI, across the entire pregnancy so we’re going to be able to more definitively answer that question with regards is it just a sleep disorder breathing? Is it the weight, the obesity, the changes in the redistribution of fluid? We’ll be able to answer some of those questions in this larger data set. Dr. Gibbons: That’s very exciting. We’ll be looking forward to the findings from that study.