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Sleep and Sleep Disorders in Pregnancy

Jennifer R. Santiago, MD; Michael S. Nolledo, MD; Wendy Kinzler, MD; and Teodoro V. Santiago, MD
[+] Article, Author, and Disclosure Information

From the Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson University Hospital, and St. Peter's University Hospital, New Brunswick, New Jersey.

Acknowledgment: The authors thank Marcella Spioch for assistance in preparing the manuscript.

Requests for Single Reprints: Teodoro V. Santiago, MD, Comprehensive Sleep Disorders Center, Robert Wood Johnson University Hospital, One Robert Wood Johnson Place, New Brunswick, NJ 08903; e-mail, santiate@umdnj.edu.

Current Author Addresses: Dr. J.R. Santiago: Department of Obstetrics and Gynecology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10013.

Dr. Nolledo: Department of Medicine, St. Peter's University Hospital, New Brunswick, NJ 08903.

Dr. Kinzler: Division of Maternal and Fetal Medicine, St. Peter's University Hospital, New Brunswick, NJ 08903.

Dr. T.V. Santiago: Division of Pulmonary and Critical Care Medicine, Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, One Robert Wood Johnson Place, New Brunswick, NJ 08903.

Ann Intern Med. 2001;134(5):396-408. doi:10.7326/0003-4819-134-5-200103060-00012
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Sleep problems are common in pregnant women. This review examines sleep in normal pregnancy; discusses the physiologic bases for alterations in sleep, including hormonal and mechanical factors; and correlates these factors with changes in sleep of pregnant women, as determined subjectively by surveys and objectively by polysomnographic studies. The changes in respiratory physiology during pregnancy, the possible predisposition of the pregnant woman to sleep-disordered breathing because of these changes, and results of published studies of sleep-disordered breathing in pregnancy are discussed. Finally, the effect of pregnancy on other sleep disorders and the management of these sleep disorders during pregnancy are outlined, including changes in management necessitated by this state. The paucity of available data and the need for further studies of incidence and outcomes of sleep disorders in the pregnant woman are emphasized.


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Central nervous system (CNS) structures involved in the sleep–wakefulness cycle and pregnancy influences on the cycle.REM

The biological clock (the suprachiasmatic nucleus), influenced by light and melatonin, interacts with brain neurons to generate a circadian timing for wakefulness and arousal and for rapid eye movement ( ) and non-REM sleep. Bidirectional changes in physiologic states can occur, with the exception of REM sleep and wakefulness. Physiologic and hormonal events in pregnancy promote (+) or reduce (−) time spent in each state through as yet unclear neural mechanisms. GI = gastrointestinal.

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