Sleep in multiple pregnancy: Breathing patterns, oxygenation, and periodic leg movements,☆☆,

https://doi.org/10.1016/S0002-9378(96)70618-XGet rights and content

Abstract

OBJECTIVES: Our goal was to study whether multiple pregnancy at the third trimester predisposes to breathing disturbances and arterial oxyhemoglobin desaturation during sleep. STUDY DESIGN: Nocturnal breathing, oxygenation, and movement activity were studied in 10 mothers: 8 with twins, 1 with triplets, and 1 with quadruplets. RESULTS: No obstructive and few central sleep apnea episodes were observed. Four subjects had episodes of increased respiratory resistance, but only one, the mother with quadruplets, was significantly affected. Arterial oxyhemoglobin saturation was always maintained above 90%. Periodic leg movements were present in all mothers, with a frequency range of 3.7 to 49.7 movements per hour. CONCLUSIONS: In spite of the large uterus in multiple pregnancy, nocturnal breathing and oxygenation are well maintained. Increased motor activity and frequent awakenings suggest poor sleep quality, which may be further compromised by intensive periodic leg movements. (AM J OBSTET GYNECOL 1996;174:1622-5.)

Section snippets

SUBJECTS AND METHODS

We studied nocturnal breathing patterns and oxygenation in 10 mothers (26 to 39 years old) with multiple pregnancies at 30 to 36 gestational weeks. Eight of the mothers had twins, one had triplets, and one had quadruplets. All the women were healthy and none of them smoked or used alcohol or drugs during pregnancy. The body mass index before pregnancy was normal in nine subjects (mean 22.3 kg/m2, range 19.4 to 24.4 kg/m2) and slightly elevated in one (28.4 kg/m2).

Questionnaires were used

RESULTS

None of the subjects reported sleep disturbances before pregnancy. In all mothers the general sleep quality had been worsened by pregnancy. During the study night 4 women reported poor or very poor sleep, whereas the remaining 6 slept reasonably well. Still, 8 mothers considered their sleep quality worse in the laboratory than lately at home. All 10 mothers woke up several times during the night for reasons such as numbness of feet or hands, restless legs, need of urination, sweating, fetal

COMMENT

We found that in multiple pregnancy sleep apnea was rare and oxygenation well preserved throughout the night. The physical effects of the enlarging uterus lead to displacement of the lungs and tracheobronchial tree and result in an increase in upper airway resistance. These effects are accentuated in the lying position and further by sleep state through depression of the ventilatory responses to hypoxia and hypercapnia. We therefore suspected that mothers with a particularly large uterus (i.e.,

References (25)

  • G Contreras et al.

    Ventilatory drive and respiratory muscle function in pregnancy

    Am Rev Respir Dis

    (1991)
  • LG Brownell et al.

    Breathing during sleep in normal pregnant women

    Am Rev Respir Dis

    (1986)
  • Cited by (50)

    • Upper-airway flow limitation and transcutaneous carbon dioxide during sleep in normal pregnancy

      2017, Sleep Medicine
      Citation Excerpt :

      Pregnancy is a challenge for the cardiorespiratory system, particularly during sleep when the body needs to rest without compromising fetal oxygen supply and carbon dioxide removal. In normal pregnancy, breathing during sleep is well preserved [1]. Plasma concentrations of progesterone are elevated during pregnancy and contribute to the increased ventilatory responses to hypoxia [2] and hypercapnia [3].

    • Sleep in Women

      2012, Therapy in Sleep Medicine
    • Sleep-disordered Breathing in Pregnancy

      2011, Clinics in Chest Medicine
      Citation Excerpt :

      REM sleep seems to be reduced in pregnancy.17 Some studies have shown no oxygen desaturation during sleep in normal pregnant women,64,65 whereas others suggest significant desaturations.66,67 Circulating levels of progesterone increase very early in gestation.

    • Sleep Disturbances and Sleep-Related Disorders in Pregnancy

      2010, Principles and Practice of Sleep Medicine: Fifth Edition
    View all citing articles on Scopus

    From the Departments of Obstetrics and Gynecology,aClinical Neurophysiology,band Physiology and the Diseases of the Chest,cTurku University Central Hospital.

    ☆☆

    Reprint requests: Eeva Nikkola, BM, Department of Obstetrics and Gynecology, University of Turku, Kiinamyllynkatu 4-8, FIN-20520 Turku, Finland.

    0002-9378/96 $5.00 + 0 6/1/70418

    View full text