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Changes in Sleep Characteristics and Breathing Parameters During Sleep in Early and Late Pregnancy

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Abstract

Study Objectives:

Few studies have objectively evaluated sleep characteristics during pregnancy or investigated the relationship between altered spectral electroencephalogram (EEG) bands and sleep-disordered breathing (SDB). The study aimed to describe changes in sleep as measured by polysomnography (PSG) and spectral EEG bands during pregnancy and to examine the relationship between delta power in non-rapid eye movement (NREM) sleep and SDB.

Methods:

This is a secondary analysis of a prospective study. One hundred twenty-three women underwent full PSG in early pregnancy, and 97 repeated PSG in late pregnancy. Spectral analysis of the EEG in NREM sleep was performed. We used linear and logistic mixed-model regression to analyze the sleep measures and linear regression to explore the association between delta power and apnea-hypopnea index (AHI) changes during pregnancy.

Results:

In late pregnancy, women had shorter sleep duration, poorer sleep efficiency, more awakenings, more stage N2 sleep, less slow wave sleep, less REM sleep, higher AHI, and higher periodic limb movement index compared to early pregnancy. The percentage of stage N1 sleep, sleep latency, REM sleep latency, and arousal index frequency did not change. Regarding EEG-spectra, delta and theta powers decreased, but beta-2 power increased during pregnancy. In multivariable analyses, greater reduction of delta power was associated with larger increases in AHI (β [95% confidence interval] = −0.038 [−0.073, −0.002], P = .040). Estimates suggest that each one-unit increase in AHI reduces delta power by 4% in late pregnancy.

Conclusions:

PSG-measured sleep characteristics change during pregnancy. Delta power decreases when the severity of SDB increases during pregnancy.

Commentary:

A commentary on this article appears in this issue on page 1095.

Citation:

Izci-Balserak B, Keenan BT, Corbitt C, Staley B, Perlis M, Pien GW. Changes in sleep characteristics and breathing parameters during sleep in early and late pregnancy. J Clin Sleep Med. 2018;14(7):1161–1168.

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Abbreviations

AHI:

apnea-hypopnea index

BMI:

body mass index

EEG:

electroencephalogram

NREM:

non-rapid eye movement

OSA:

obstructive sleep apnea

PLMI:

periodic limb movements index

PSG:

polysomnography

REM:

rapid eye movement

SD:

standard deviation

SDB:

sleep-disordered breathing

SE:

sleep efficiency

SWS:

slow wave sleep

TST:

total sleep time

WASO:

wake after sleep onset

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ACKNOWLEDGMENTS

The study was funded by the National Institute of Nursing Research (K99NR013187), Eunice Kennedy Shriver National Institute of Child Health & Human Development (K23HD041465), and National Heart, Lung, and Blood Institute (T32 HL07953). The authors thank Professor Allan Pack from the University of Pennsylvania for his advice and support with the research protocol.

Author information

Authors and Affiliations

  1. Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois, Chicago, Illinois, USA

    Bilgay Izci-Balserak PhD

  2. Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Brendan T. Keenan MS, Charles Corbitt MS, Beth Staley BA & Michael Perlis PhD

  3. School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA

    Grace W. Pien MD, MSCE

Authors
  1. Bilgay Izci-Balserak PhD
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  2. Brendan T. Keenan MS
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  3. Charles Corbitt MS
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  4. Beth Staley BA
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  5. Michael Perlis PhD
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  6. Grace W. Pien MD, MSCE
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Correspondence to Bilgay Izci-Balserak PhD.

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Izci-Balserak, B., Keenan, B., Corbitt, C. et al. Changes in Sleep Characteristics and Breathing Parameters During Sleep in Early and Late Pregnancy. J Clin Sleep Med 14, 1161–1168 (2018). https://doi.org/10.5664/jcsm.7216

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