وصف
Pregnant women are at a higher risk for sleep apnea, a condition where breathing stops during sleep. RLS is a condition that causes an uncomfortable feeling in the legs and an urge to move them, interfering with sleep. Hormonal changes during pregnancy can cause night sweats, leading to disrupted sleep. Aches and pains in the joints and muscles can make it difficult to get comfortable and fall asleep .Gastrointestinal issues like Heartburn, nausea, and other digestive problems can interfere with sleep during pregnancy.
ملخص
- Sleep is defined as a reversible neurobehavioral state of disengagement from and unresponsiveness to the environment, typically accompanied by postural recumbence, behavioral quiescence, and closed eyes. Good sleep is linked to several benefits, including clear thinking, improved memory, and maintaining a healthy immune system.
- Sleep is divided into two main phases: non-rapid eye movement (NREM) sleep, which has three stages, and rapid eye movement (REM) sleep. Each stage plays a different role in body repair, memory consolidation, and overall cognitive function. Interruptions in sleep can disrupt these cycles, diminishing the benefits.
- Sleep disturbances are highly prevalent in pregnancy, with studies showing rates ranging from 46% to over 80%. Physiological changes like increased respiratory rate, gastroesophageal reflux, increased urinary frequency, hormonal shifts, and psychological stress contribute to sleep problems.
- Sleep disorders in pregnancy are classified as sleep-disordered breathing (including snoring and obstructive sleep apnea), insomnia, and sleep-related movement disorders like restless legs syndrome. Each disorder requires a specific approach to assessment and treatment.
- Assessment of sleep is conducted using the Pittsburgh Sleep Quality Index (PSQI), a questionnaire assessing sleep quality and patterns. Polysomnography, which records various physiological parameters during sleep, can further assess sleep disorders.
- Obstructive sleep apnea (OSA) occurs due to narrowing of the upper airway and is linked to complications like gestational hypertension, diabetes, pre-eclampsia, fetal growth restriction, and preterm birth. Screening involves assessing risk factors and using questionnaires like the STOP-Bang.
- Treatment for OSA includes maintaining a healthy weight, using oral appliances, and positional therapy. Continuous positive airway pressure (CPAP) therapy is a first-line treatment option to keep upper airways open, with small trials that showcase improvement in the maternal and fetal outcome.
- Restless legs syndrome (RLS) is characterized by an urge to move the legs accompanied by uncomfortable sensations. It is linked to dopamine dysfunction and iron deficiency. Management involves non-pharmacological methods such as exercise, massage, good sleep hygiene, and iron supplementation when needed.
- Insomnia, defined as difficulty initiating and maintaining sleep, is treated through education on sleep hygiene. It is advised to reduce screen time and avoid tea or coffee before sleeping. Cognitive behavioral therapy is also known to aid in treatment. Medications are generally avoided during pregnancy, unless necessary with close monitoring.
- Narcolepsy, a rare condition of excessive daytime sleepiness, requires a multidisciplinary approach. Modafinil, a common treatment, is contraindicated during pregnancy. Parasomnias, such as disturbing dreams or sleepwalking, also occur. This requires a similar assessment, weighing potential benefits and risks with minimal pharmacological intervention.
نموذج شهادة
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الدكتور كريشي جودرا
بكالوريوس الطب والجراحة، ماجستير العلوم، عضو الكلية الملكية لأطباء النساء والتوليد، أخصائي أمراض النساء والتوليد في مستشفى زليخة دبي
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