Pre-eclampsia, fetal activity levels, sleep-disordered breathing, and CPAP

Pre-eclampsia occurs high blood pressure and protein in the urine develops in a woman at least 20 weeks pregnant. It is associated with maternal death and fetal growth restriction. Some studies have shown an association of sleep disordered breathing (SDB), like obstructive sleep apnea (OSA), with pregnancy-induced high blood pressure. Pre-eclampsia goes away with delivery. However, if it's too early, delivery is delayed as long as possible.

Fetal movements are a normal part of pregnancy. Frequent movements are good, lack of movements is bad. In the Journal Sleep is a study where researchers quantified fetal movements in pregant patients with and without pre-eclampsia. They then did sleep studies on those with moderate to severe pre-eclampsia and observed some of them on CPAP for one night.

The results showed that pre-eclampsi reduced fetal movements. CPAP also raised fetal activity in women with pre-eclampsia, even thought the pre-eclampsia did not go away. The results are a little hard to interpret, because both pre-eclamptic and control patients had OSA based on the charts in the study, and the controls did not receive CPAP.

But if the results hold up in larger, better defined studies, treating women with pre-eclampsia with CPAP if they have sleep disordered breathing may allow obstetricians to delay delivery until a safer time.

Effectiveness of insomnia medications

Newer insomnia drugs include Ambien, Lunesta, and Sonata. These are similar, but chemically different than older sleep aids like Valium or Restoril. Here is an article that summarized 13 clinical trials of the newer insomnia drugs as submitted to the FDA. All of these trials were placebo-controlled. The trials involved sleep studies and subjective ratings by the trial participants.

The results showed significant reductions in time to fall asleep in both the drugs and the placebo, but the drugs did reduce time to fall asleep more than the placebo. However, the difference is small and clinical significance is not known. As documented on the sleep study, it took participants 22 minutes longer to fall asleep in the placebo group. As per subjective rating, participants felt it took them 7 minutes longer to fall asleep on placebo than on the drug.

The study authors concluded from their analysis that the placebo response is a major contributor to the effectiveness of these newer sleep medications. In other words, these new drugs work because participants think they are taking a medication for sleep, not necessarily because the medicine actually makes them sleep better.

Asthma linked to insomnia

This article is about research showing asthmatics have a higher rate of insomnia. And the worse the asthma, the more frequent the insomnia. Also, nasal congestion along with asthma increased risk of insomnia. This study was only a survey, but a large one. However, other sleep disorders could contribute to insomnia in asthmatics, such as obstructive sleep apnea. Some asthma medications can also reduce sleep quality.

More research linking obesity to sleep deprivation

Here is an article that reviews a paper that summarizes research studies done on obesity and sleep deprivation over the past 15 years. The study authors concluded that partial sleep deprivation, defined as sleeping less than 6 hours per night can contribute to weight gain. It could be that sleep loss affect certain hormones that can regulate appetite. I'm still not convinced that if Americans slept longer, the pounds would drop off - that's too easy. To me, diet is so much more important than sleep quantity for controlling obesity.

More sleep at night can reduce sports-related injuries in teens

Here is an article about research showing that adolescents were less likely to get injured while playing sports if they got at least 8 hours of sleep.

Vitamin D deficiency and daytime sleepiness

In the last few years, it seems that vitamin D deficiency was present in many patients I saw in clinic. Vitamin D deficiency has been found to be associated with chronic pain conditions like fibromyalgia. Vitamin D deficiency is also associated with fatigue and sleepiness. Dr. McCarty et al at LSU did a study looking at vitamin D levels and subjective sleepiness in patients referred to his sleep clinic. Interestingly, the results showed that vitamin D deficiency was associated with more subjective sleepiness, but only in black patients. The same effect was not seen in white patients. The author did not have an explanation for the racial differences. It could be that the black patients in this study had more obstructive sleep apnea - this sleep disorder was not measured during this study.

Ten percent of young children have sleep-disordered breathing

This article describes a Finnish study that demonstrates that one in ten children, aged 6-8 years old, have sleep-disordered breathing. Hopefully, the word is getting out to parents and pediatricians to increase screening, especially by asking about snoring.