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Updated: Sep 19, 2025
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
Sleep quality measured by cardiopulmonary coupling spectrogram in pregnant women predicts neonatal outcomes
Yue-Nan Ni1,2, Hugi Hilmisson3, Solveig Magnusdottir3
1Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China.
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.
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