Sleep Habits of Women with Infertility

Context Sleep plays important roles in metabolic and reproductive function, and polycystic ovary syndrome (PCOS) is associated with sleep disturbances including increased prevalence of obstructive sleep apnea. Objective We sought to evaluate sleep parameters in infertile women with PCOS compared to women with unexplained infertility (UI) and identify risk factors for disturbed sleep. Design Prospective cohort of women diagnosed with PCOS or UI from two randomized clinical trials. Setting Private and academic ambulatory gynecology and infertility practices. Participants 1603 infertile women enrolled in two concurrent randomized clinical trials. Intervention(s) None. Main Outcome Measure(s) Self-reported sleep measures. Results Sleep duration <6 hours (6.1% vs. 2.7%; P<.001), habitual snoring (37.8% vs. 19.0%; p<.001), and clinical sleepiness (12.0% vs. 8.6%; P<0.026) were more common in women with PCOS than those with UI. After adjusting for covariates, PCOS and elevated fasting insulin were associated (p=0.010) with clinical symptoms of obstructive sleep apnea (OSA) diagnosis, whereas PCOS, elevated insulin (p=0.003), waist circumference >88 cm (p=0.003), and current smoking (p=0.012) were associated with habitual snoring. Clinical depression score (p<0.001) and PCOS diagnosis (p=0.002) were associated with perceived daytime sleepiness. Short sleep duration and clinical symptoms of OSA were not associated with conception and live birth rates. Conclusions Infertile women with PCOS more commonly report sleep disturbances than those with UI. Markers of insulin resistance are associated with previous diagnosis of OSA, habitual snoring and short sleep duration. Presence of clinical symptoms of OSA or short sleep duration does not affect fertility treatment response.

Snoring and environmental exposure: results from the Swedish GA2LEN study

ObjectiveHabitual snoring is associated with fatigue, headaches and low work performance. This cross-sectional study aimed to investigate if snoring is affected by environmental factors such as home dampness and exposure to air pollution.SettingGeneral population sample from four Swedish cities.Participants25 848 participants from the Swedish part of the epidemiological Global Asthma and Allergy and European network of excellence study carried out in 2008. The participants completed a postal questionnaire on snoring and, indoor and outdoor environmental exposure as well as potential confounders including smoking, weight, height and educational level.ResultsOf the participants, 4211 (16.3%) were habitual snorers. Habitual snorers reported water damage (8.3% vs 7.0% p<0.0001), floor dampness (4.6% vs 3.8% % p<0.0001) and visible mould (5.2% vs 3.8% p<0.0001) in their homes more often than non-snorers. Habitual snorers stated being annoyed by air pollution more often than non-snorers with habitual snorers reporting being irritated with the air in their residential area to a higher extent (sometimes 16.2% vs 13.9%, and daily 4.6% vs 3.1%) as well as annoyance from traffic fumes (somewhat 19% vs 18.5% and very 5% vs 3.6%) (p<0.0001). These results remained significant after adjustment for age, body mass index, smoking history and educational level.ConclusionSnoring is more prevalent in subjects reporting home dampness and air pollution. These association should be confirmed in further research using objective measurements and a longitudinal approach.

544 Burden of Sleep Disturbance in Black Pregnant Women

Introduction Black women disproportionately experience poor perinatal outcomes compared to other racial/ethnic groups. Poor sleep has emerged as a strong contributor to adverse pregnancy outcomes and, in the non-pregnant population, sleep-wake disturbances have a high prevalence with often greater severity among Blacks. Nonetheless, the majority of studies have included largely White populations which has restricted our understanding of race-specific burdens and morbidities of sleep disturbance. The goal was to describe the burden of sleep-wake disturbance in Black pregnant women and associations with pregnancy outcomes. Methods Black women at least 18years and &gt;28 weeks pregnant were recruited from prenatal clinics. All women completed questionnaires about their sleep including the presence and timing of habitual-snoring (pre-pregnancy or pregnancy-onset), the Epworth Sleepiness Scale (ESS), and the General Sleep Disturbances Scale (GSDS) to determine poor sleep quality and poor daytime function as well as symptoms of insomnia. We also analyzed three commonly-reported sleep problems as individual question items (difficulty getting to sleep, wake up during sleep period, and wake up too early at the end of a sleep period). Demographic information and diagnoses were abstracted from medical records. Results Overall, 235 women enrolled; mean age was 27.6 + 6.2 years, mean BMI 31.7 + 9.8kg/m2, and 64% were in receipt of Medicaid. Eighty-percent of women reported &gt;three sleep-wake disturbances, and almost half experienced a burden of &gt;five disturbances. Women with pregnancy-onset habitual-snoring (but not those with pre-pregnancy habitual-snoring) had increased odds of poor sleep quality aOR 8.2 (95% CI 1.9, 35.9), trouble staying asleep aOR 3.6 (95% CI 1.0, 12.5), waking up too early aOR 2.7 (95% CI 1.1, 6.2), excessive daytime sleepiness aOR 2.3 (95% CI 1.1, 4.7), and poor daytime function aOR 8.7 (95% CI 2.5, 29.9). In contrast, women with pre-pregnancy habitual-snoring had increased odds for chronic hypertension, preterm delivery and fetal growth restriction; aOR 2.6 (95% CI 1.1, 6.3), aOR 2.8 (95% CI 1.1, 6.9), and aOR 5.1 (95% CI 1.7, 15.2), respectively. Conclusion Black women have a significant burden of sleep-wake disturbances. These findings highlight the excess risk that habitual-snoring confers to sleep-wake disturbances and perinatal outcomes in an infrequently studied yet highly vulnerable population. Support (if any) NIH NHLB-IHL089918

470 Maternal Habitual Snoring and Blood Pressure Trajectories in Pregnancy

Introduction Habitual snoring has been associated with hypertensive disorders of pregnancy. However, exactly when blood pressure (BP) trajectories diverge between pregnant women with and without habitual snoring is unknown. Moreover, the potentially differential impact of chronic versus pregnancy-onset habitual snoring on maternal BP trajectories during pregnancy has not been examined. Methods In a cohort study of 1,305 pregnant women from a large Midwestern medical center, participants were asked about habitual snoring (≥3 nights/week) and whether their symptoms began prior to or during pregnancy. Demographic and BP data throughout pregnancy, systolic (SBP) and diastolic (DBP) were abstracted from medical charts. Linear mixed models were used to examine associations between habitual snoring-onset and pregnancy BP trajectories. Results Thirty percent of women reported snoring before pregnancy (chronic snoring) and an additional 23% reported pregnancy-onset snoring. Overall, women with pregnancy-onset snoring had higher mean SBP and DBP compared to those with chronic habitual snoring or controls (non-habitual snoring). In gestational week-specific comparisons with controls, SBP became significantly higher around 20 weeks’ gestation among women with pregnancy-onset snoring and in the third trimester among women with chronic snoring. Pairwise mean differences in DBP were significant only among women with pregnancy-onset snoring relative to controls, after 15 weeks’ gestation. Conclusion In a large cohort of pregnant women, those with pregnancy-onset or chronic habitual snoring had significantly elevated systolic BP in comparison to non-habitual snoring controls, in the second and third trimester, respectively. The findings of divergent BP trajectories suggest the two groups of women with habitual snoring in pregnancy should be considered separately when evaluating gestational ‘windows’ for increased BP monitoring and provide insight into pathophysiologic changes. Support (if any) Dr. Dunietz was supported by an F32 National Research Service Award from the National Institute of Child Health and Development (NIH/NICHD F32 HD091938); Dr. O’Brien was supported by the following during the course of this study: the Gene and Tubie Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research (MICHR) grants UL1RR024986 and UL1TR000433, MICHR seed pilot grant F021024, the National Heart, Lung, and Blood Institute (R21 HL089918 and K23 HL095739) and in part by R21 HL087819.

Risk factors for habitual snoring in children aged 2--14 years

Background: Habitual snoring (HS), a prominent symptom of sleep-disordered breathing , is important to also consider the associated, multidimensional risk factors for HS in children. Aim: To identify risk factors for HS in children. Methods: A cross-sectional survey was performed in Chengdu. Children aged 2–14 years from four districts were randomly chosen to participate.Questionnaires were voluntarily completed by the children’s guardians. Results: The survey included 926 boys and 622 girls, who were an average of 7.11 5.25 years old. The sample included 463 habitual snorers (30.38%), 683 occasional snorers (44.82%), and 402 non-snorers (26.38%). HS was found in 51.84% of preschool children and 26.6% of school children.Among the HS group, 31.3% had a maternal education of a college degree or higher and 86.6%had an immediate family member who snores. Breastfeeding duration among the HS group was significantly less than among the occasional snoring and non-snoring groups. History of symptoms of allergic rhinitis, rhinosinusitis, tonsillitis, and pneumonia/bronchitis in the past six months were associated with HS. Likewise, maternal smoking during pregnancy, maternal exposure to secondhand smoke during pregnancy , and child exposure to secondhand smoke were also associated with HS. Conclusion: The prevalence of HS was higher in preschool children. Having a mother with more education, a family history of snoring, a shorter period of breastfeeding, upper respiratory tract inflammation, and passive smoking are important risk factors for HS.