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Study Objectives: <p>We assessed the impact of objective sleep quality during pregnancy, estimated using cardiopulmonary coupling sleep spectrograms, on neonatal outcomes.</p> Methods: <p>We conducted a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). Cardiopulmonary coupling analysis was done using the raw photoplethysmogram signal within the oximetry sensor (photoplethysmogram) from a home apnea sleep test. High- and low-frequency coupling reflect stable and unstable sleep, respectively. A multicomponent Sleep Quality Index integrates sleep stability and fragmentation. Regression analysis was done to identify the relationship between cardiopulmonary coupling metrics and neonatal outcomes.</p> Results: <p>Oximetry/photoplethysmogram data from the early and middle term of pregnancy (3,003 and 2,168 participants in early-term and middle-term pregnancy, respectively) were available. A high Sleep Quality Index score in early-term pregnancy decreased the risk of small gestational age (odds ratio [OR] 0.297, 95% confidence interval [CI] 0.147–0.603, <i>P</i> &lt; .01) and an Apgar score &lt; 7 at 5 minutes (OR 0.368, 95% CI 0.158–0.857, <i>P</i> = .02). A higher Sleep Quality Index score in middle-term pregnancy was associated with an Apgar score &lt; 7 at 1 (OR 0.472, 95% CI 0.275–0.810, <i>P</i> &lt; .01) and 5 minutes (OR 0.274, 95% CI 0.107–0.704, <i>P</i> &lt; .01). An increased high-frequency coupling/low-frequency coupling ratio in early-term pregnancy was a predictor for reduced preterm birth risk (OR 0.955, 95% CI 0.920–0.991, <i>P</i> = .01) and in middle-term pregnancy was related to increased preterm birth (OR 0.828, 95% CI 0.749–0.916, <i>P</i> = .01) and Apgar score &lt; 7 at 5 minutes (OR 0.784, 95% CI 0.659–0.932, <i>P</i> &lt; .01) risks. Increasing percentage of the narrow band of total estimated sleep time across pregnancy, which is a biomarker of sleep fragmentation, added the risk of small gestational age (OR 1.053, 95% CI 1.009–1.099, <i>P</i> &lt; .01).</p> Conclusions: <p>Sleep quality measured by cardiopulmonary coupling spectrograms was associated with neonatal outcomes. Sleep quality may be a target for clinical care during pregnancy.</p> Citation: <p>Ni Y-N, Hilmisson H, Magnusdottir S, Liang Z, Chen Y, Thomas RJ. Sleep quality measured by cardiopulmonary coupling spectrogram in pregnant women predicts neonatal outcomes. <i>J Clin Sleep Med.</i> 2025;21(9):1567–1577.</p>

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Sleep quality measured by cardiopulmonary coupling spectrogram in pregnant women predicts neonatal outcomes

  • 期刊论文

  • 发表日期：

    2025年9月1日

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  • Yue-Nan Ni,
  • Hugi Hilmisson,
  • Solveig Magnusdottir,
  • Zongan Liang,
  • Ying Chen,
  • Robert Joseph Thomas

摘要

Study Objectives:

We assessed the impact of objective sleep quality during pregnancy, estimated using cardiopulmonary coupling sleep spectrograms, on neonatal outcomes.

Methods:

We conducted a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). Cardiopulmonary coupling analysis was done using the raw photoplethysmogram signal within the oximetry sensor (photoplethysmogram) from a home apnea sleep test. High- and low-frequency coupling reflect stable and unstable sleep, respectively. A multicomponent Sleep Quality Index integrates sleep stability and fragmentation. Regression analysis was done to identify the relationship between cardiopulmonary coupling metrics and neonatal outcomes.

Results:

Oximetry/photoplethysmogram data from the early and middle term of pregnancy (3,003 and 2,168 participants in early-term and middle-term pregnancy, respectively) were available. A high Sleep Quality Index score in early-term pregnancy decreased the risk of small gestational age (odds ratio [OR] 0.297, 95% confidence interval [CI] 0.147–0.603, P < .01) and an Apgar score < 7 at 5 minutes (OR 0.368, 95% CI 0.158–0.857, P = .02). A higher Sleep Quality Index score in middle-term pregnancy was associated with an Apgar score < 7 at 1 (OR 0.472, 95% CI 0.275–0.810, P < .01) and 5 minutes (OR 0.274, 95% CI 0.107–0.704, P < .01). An increased high-frequency coupling/low-frequency coupling ratio in early-term pregnancy was a predictor for reduced preterm birth risk (OR 0.955, 95% CI 0.920–0.991, P = .01) and in middle-term pregnancy was related to increased preterm birth (OR 0.828, 95% CI 0.749–0.916, P = .01) and Apgar score < 7 at 5 minutes (OR 0.784, 95% CI 0.659–0.932, P < .01) risks. Increasing percentage of the narrow band of total estimated sleep time across pregnancy, which is a biomarker of sleep fragmentation, added the risk of small gestational age (OR 1.053, 95% CI 1.009–1.099, P < .01).

Conclusions:

Sleep quality measured by cardiopulmonary coupling spectrograms was associated with neonatal outcomes. Sleep quality may be a target for clinical care during pregnancy.

Citation:

Ni Y-N, Hilmisson H, Magnusdottir S, Liang Z, Chen Y, Thomas RJ. Sleep quality measured by cardiopulmonary coupling spectrogram in pregnant women predicts neonatal outcomes. J Clin Sleep Med. 2025;21(9):1567–1577.