【摘要】目的 探讨妊娠合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与不良妊娠结局之间相关关系。方法 选择2012年12月1日至2016年12月1日在石家庄市第一医院产科妊娠女性，比较200例合并OSAHS的妊娠女性和200例不合并OSAHS的妊娠女性的体重指数和性激素差异，随访妊娠结局，分析OSAH与高危妊娠及围产期不良妊娠结局之间的相关性。结果 合并OSAHS的孕妇超重和肥胖率为43.9%，明显高于无合并OSAHS的孕妇的23.5%（χ2=18.791，P＜0.001）；两组研究对象在妊娠高血压（χ2=18.561，P=0.002）和糖尿病（χ2=21.729，P＜0.001）发病率上差异具有统计学意义（P<0.05），合并OSAHS的孕妇妊娠高血压和糖尿病发病率更高；合并OSAHS的孕妇雌激素E2（t=-11.040，P＜0.001）和孕酮（ t=-6.322，P＜0.001）低于无合并OSAHS的孕妇，血清E2和P均与妊娠女性孕前BMI成负相关；合并OSAHS和和不合并OSAHS的孕妇在剖宫产、产后出血、胎儿生长受限、胎儿窘迫、早产、新生儿缺氧和妊娠期肝内胆汁淤积上例数分布差异具有统计学意义（P<0.05）。结论 合并OSAHS的孕妇妊娠高血压、妊娠糖尿病和不良妊娠结局发病率高于无合并OSAHS的孕妇，应加强围产期的预防保健工作，及时治疗，减少不良妊娠结局的发生。

【关键词】阻塞性睡眠呼吸暂停低通气综合征；妊娠；不良妊娠结局；性激素；肥胖
The correlation between adverse obstructive sleep apnea hypopnea and adverse pregnancy outcome
【Abstract】Objective To investigate the correlation between pregnancy combined with obstructive sleep apnea hypopnea syndrome (OSAHS) and adverse pregnancy outcome. Methods Collecting the pregnant women with OSAHS or not who were from December 1, 2012 to December 1, 2016 in the first hospital of Shijiazhuang City，and compared the different of BMI, sex hormone and pregnant outcome, and achieve the correlation between pregnant women with OSAHS and adverse pregnancy outcomes. Results The rate of overweight and obesity in OSAHS's pregnant women was 43.9%，was higher than that of the patients without OSAHS in pregnant women was 23.5%(X2=18.791, P < 0.001).The incidence rate of pregnant diabetes and pregnancy induced hypertension (X2=18.561, P=0.002) and diabetes (X2=21.729, P < 0.001) were different from the pregnant women OSAHS and without OSAHS. Serum estrogen E2 (t=-11.040, P < 0.001) and progesterone (t=-6.322, P < 0.001) were higher than that of pregnant women with OSAHS and without OSAHS. Serum E2 and progesterone were negatively correlated with the BMI of women before pregnancy. There were different from the pregnant women with OSAHS and without OSAHS in the incidence rate of cesarean section, postpartum hemorrhage, fetal growth restriction, fetal distress, premature birth, intrahepatic cholestasis(P<0.05). Conclusion The incidence of pregnant women induced hypertension, gestational diabetes mellitus and adverse pregnancy outcomes of pregnant women with OSAHS is higher than that of pregnant women without OSAHS. We should strengthen perinatal preventive care and timely treatment, so as to reduce the incidence of adverse pregnancy outcomes.

【Key words】 Obstructive sleep apnea hypopnea syndrome(OSAHS); pregnancy; adverse pregnancy outcome; sex hormone; obesity

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome，OSAHS) 是一种病因不明的睡眠呼吸疾病，临床表现有夜间睡眠打鼾伴呼吸暂停和白天嗜睡[1-2]。由于呼吸暂停引起反复发作的夜间低氧和高碳酸血症，可导致高血压，冠心病，糖尿病和脑血管疾病等并发症及交通事故，甚至出现夜间猝死。因此OSAHS是一种有潜在致死性的睡眠呼吸疾病。普通人群中OSAHS的发病率仅为2%~4%，但在妊娠期发病率高达18%[3]。多项研究发现，妊娠合并OSAHS的孕妇的肥胖率与激素水平与普通孕妇存在差异[4]。同时，妊娠合并OSAHS能够促进妊娠高血压和妊娠糖尿病的发生[5]，甚至早产[6]。但是，关于妊娠合并OSAHS的孕妇与不良妊娠结局的发生之间的关系的研究还鲜有报道。
本研究通过妊娠妇女进行研究，探讨妊娠合并OSAHS孕妇与未合并OSAHS孕妇之间体重指数、性激素以及不良妊娠结局之间的差异，为临床上妊娠期孕妇的预防保健工作提供科学理论依据。
作者：刘彬、薛林、赵辉明、薛静