Analyse de la variabilité de la fréquence cardiaque chez les femmes enceintes atteintes d'apnée obstructive du sommeil
Purpose: Sleep breathing disorders are common during pregnancy and are associated with adverse consequences for the health of the mother and the fetus. These can be caused by changes in sympatho-vagal balance (SVB), which can be estimated through heart rate variability (HRV) analyses. The aim of the study is to assess the HRV in pregnant women with obstructive sleep apnea (OSA) at three time points. Methods: Seventeen pregnant women diagnosed with mild to moderate OSA performed 3 polysomnographic recordings (PSG): in the second trimester (PSG1), in the third trimester treated with a titrated oral appliance (OA) (PSG2) and 3-6 months post-partum. Data were analyzed in cumulative 5 minutes baseline interval samples (Baseline) and in cumulative 3 minutes interval samples before the onset of the OSA events (Event) for each sleep stages (NREM2, NREM3, REM) over the course of the night. Results: SVB (Low-/High-Frequency power ratio) was statistically significant for all cumulative PSGs per samples (Baseline sleep stages p < 0.01 and Event sleep stages p < 0.01 ; REM > NREM2 > NREM3). Significant diminution of apnea-hypopnea index (AHI) was observed at PSG2 (PSG1 vs PSG2; p < 0,01). In post hoc analysis, at PSG2 only, Event parasympathetic activity (Normalized High-Frequency % (Normalized HF %)) decreases significantly in NREM2 (p = 0.01) and NREM3 (p < 0.01) when compared to respective Baseline Normalized HF %. Conclusions: Results suggest normal shifts in SVB across sleep stages. Although AHI is reduced with the treatment of OA during pregnancy, the influence of the autonomic nervous system on respiratory events seems to remain mild.
Heart rate variability Obstructive sleep apnea Pregnancy Oral appliance