目的:探讨孕妇孕早期体重指数(BMI)与子代睡眠呼吸暂停诊断的关系。
方法:我们在瑞典1983-2015年出生的3,281,803例单胎活产婴儿中进行了一项全国性队列研究。使用具有预期记录信息的国家登记册,我们跟踪参与者从2岁到35岁的睡眠呼吸暂停诊断.我们使用风险比(HR)和调整后的Cox模型的95%置信区间(CI)比较了妊娠早期BMI类别的睡眠呼吸暂停风险。为了解决家庭内部共有因素的混淆,我们进行了兄弟姐妹对照分析,并研究了兄弟姐妹的母亲BMI与后代睡眠呼吸暂停风险的关系。
结果:有17,830次睡眠呼吸暂停诊断。母亲早孕BMI与子代睡眠呼吸暂停风险呈正相关;与BMI正常的女性(18.5-24.9)相比,母亲BMI类别25.0-29.9(超重)的后代睡眠呼吸暂停的校正HR(95%CI),30.0-34.9(肥胖I级),≥35.0(肥胖II级或III级),分别,1.14(1.09,1.19),1.28(1.20,1.36),和1.40(1.27,1.54)。来自同胞控制分析的相应HR代表孕妇之间BMI差异的风险变化,分别,1.13(1.01,1.26),1.17(0.97,1.42),和1.32(0.97,1.80)。兄弟姐妹的HR/母亲BMI减弱,表明共同的家庭因素的作用较弱。其他怀孕,出生,新生儿并发症与后代睡眠呼吸暂停风险有关,但并未实质性介导与母亲肥胖的关系.
结论:母亲超重和肥胖与子代睡眠呼吸暂停风险呈剂量反应关系。
OBJECTIVE: To investigate the association between maternal early pregnancy body mass index (BMI) and offspring sleep apnea diagnosis.
METHODS: We conducted a nationwide cohort study among 3,281,803 singleton live births in Sweden born 1983-2015. Using national registers with prospectively recorded information, we followed participants for a sleep apnea diagnosis from 2 to up to 35 years of age. We compared sleep apnea risks by early pregnancy BMI categories using hazard ratios (HR) with 95% confidence intervals (CI) from adjusted Cox models. To address confounding by factors shared within families, we conducted sibling-controlled analyses and studied the relation of siblings\' maternal BMI with index offspring\'s sleep apnea risk.
RESULTS: There were 17,830 sleep apnea diagnoses. Maternal early pregnancy BMI was positively associated with offspring sleep apnea risk; compared with women with normal BMI (18.5-24.9), adjusted HR (95% CI) of offspring sleep apnea for maternal BMI categories 25.0-29.9 (overweight), 30.0-34.9 (obesity class I), and ≥35.0 (obesity class II or III) were, respectively, 1.14 (1.09, 1.19), 1.28 (1.20, 1.36), and 1.40 (1.27, 1.54). Corresponding HR from sibling-controlled analyses representing risk change for maternal BMI differences between pregnancies were, respectively, 1.13 (1.01, 1.26), 1.17 (0.97, 1.42), and 1.32 (0.97, 1.80). HR by siblings\' maternal BMI were attenuated, suggesting a weak role for shared familial factors. Other pregnancy, birth, and neonatal complications were associated with offspring sleep apnea risk, but did not substantially mediate the association with maternal obesity.
CONCLUSIONS: Maternal overweight and obesity are associated with offspring sleep apnea risk in a dose-response manner.