Association between sleep disorders and preeclampsia: a systematic review and meta-analysis

Sleep disorders are prevalent during pregnancy and are associated with unfavorable outcomes. The meta-analysis evaluated the association between sleep disturbances and preeclampsia.

We systematically searched in English and Persian databases, including Web of Science, Scopus, PubMed, ProQuest, Google Scholar, SID, IRANDOC, and MagIran, for studies published up to September 12, 2024. Eligibility was restricted to observational studies including cohort, case-control, and cross-sectional designs on expectant mothers diagnosed with preeclampsia and sleep disorders. The population studied comprised pregnant mothers with preeclampsia and diagnosed sleep disorders, diagnosed using polysomnography. The common sleep disorders investigated included insomnia, poor sleep quality, breathing problems, sleep apnea, and restless legs syndrome. Two authors independently reviewed and assessed the quality of the studies using the Newcastle-Ottawa Scale. Heterogeneity was evaluated using the I² statistic. Data were analyzed using RevMan 5, presenting results as random effects odds ratios (ORs) and standardized mean differences (SMDs), each with 95% confidence intervals (CIs).

A total of 25 articles involving 3,992 participants were included in this analysis. Subgroup analysis showed that sleep disturbances significantly increased preeclampsia risk in pregnant women (Qualitative Sleep Disorder Indices OR = 6.79, 95% CI: 3.54-13.71; Quantitative Sleep Disorder Indices SMD = 3.91, 95% CI: 2.11-5.70, p < 0.001). Although high heterogeneity was observed among studies on sleep disorders (I² = 82%, 96%), heterogeneity was low within studies focusing on sleep duration and quality (I² = 0%). The meta-analysis found significantly higher systolic (29.42 mmHg) and diastolic (16.67 mmHg) blood pressure, as well as increased BMI and maternal age, in the preeclampsia group compared to controls (p < 0.01).

Sleep disorders, including sleep-disordered breathing, obstructive sleep apnea, insomnia, and poor sleep quality, significantly increase the risk of developing preeclampsia. Prioritizing the diagnosis and treatment of these sleep disorders is crucial for improving pregnancy outcomes.