Sleep and Pregnancy: Sleep Deprivation, Sleep Disturbed Breathing and Sleep Disorders in Pregnancy

There are many factors that can influence an individual’s sleep pattern and quantity and quality of sleep. These factors can be cultural, social, psychological, behavioural, pathophysiological and environmental. Sleep patterns can also be influenced by society and by changes within society. In recent times we have seen the introduction of longer working hours, more shift-work and 24-7 availability of commodities. At the same time secular trends of curtailed duration of sleep to fewer hours per day across westernized populations (Akerstedt & Nilsson 2003) has led to increased reporting of fatigue, tiredness and excessive daytime sleepiness (Bliwise, 1996). It is of interest that whilst some studies indicate that women may have better sleep than men in general (Lindberg et al, 1997; Goel et al, 2005), they also report a larger difference in the estimated time of sleep that they believe they require and the actual sleep time they achieve than men. This might indicate that their sleep debt (amount of sleep deprivation) is higher in women than in men (Lindberg et al, 1997). There is now a wealth of evidence to support the epidemiological link between quantity of sleep (short and long duration) and quality of sleep (like difficulties in falling asleep or of maintaining sleep) and cardiovascular risk factors. These include hypertension (Cappuccio et al, 2007; Stranges et al, 2010), type-2 diabetes (Cappuccio et al, 2010a) and obesity (Cappuccio et al, 2008; Stranges et al, 2008; Cappuccio et al 2011a) as well as cardiovascular outcomes (Cappuccio et al, 2011b) and all-cause mortality (Ferrie et al, 2007; Cappuccio et al, 2010b). Additionally, there may be important gender differences in sleep and associated health outcomes (Miller, 2009 et al; Cappuccio et al, 2007). The deleterious effects of sleep deprivation can be seen on a variety of systems within the body, with detectable changes in metabolic (Knutson, et al. 2007; Spiegel, et al. 2009), endocrine (Spiegel, et al. 1999; Taheri, et al. 2004) and immune pathways (Miller & Cappuccio 2007; Miller et al, 2009). The physiological and hormonal changes that occur in pregnancy increase the risk of developing Sleep Disordered Breathing (SDB). It has been estimated that 10-27% of pregnant women may suffer from habitual snoring (Pien & Schwab, 2004) and there is growing evidence to suggest that snoring and sleep apnoea during pregnancy are associated with an increased risk of gestational hypertension and pre-eclampsia. SDB and short sleep duration in pregnant women may also be associated with the risk of gestational diabetes.