妊娠合并母体睡眠呼吸障碍的胎儿和新生儿结局：一项系统评价。

文献信息

中文摘要

引言： 妊娠期母体阻塞性睡眠呼吸暂停（OSA）及更广泛的睡眠呼吸障碍（SDB）谱系可能与胎儿和新生儿结局相关，但文献异质性大，且使用的暴露定义在临床上存在差异。本系统评价旨在评估母体SDB与胎儿/新生儿结局之间的关联，同时保留暴露确定方式的差异。
方法： 遵循PRISMA 2020，通过更新的PubMed和Web of Science检索、后向和前向引文检索，以及ClinicalTrials.gov和WHO ICTRP注册库检索，对本评价进行了重新审核。暴露被分类为：（1）客观确认的OSA/SDB；（2）行政编码定义的OSA；（3）症状、打鼾或问卷定义的SDB风险。由于临床上可比较的亚组不足以进行定量合并，未进行荟萃分析。
结果： 完成的重新审核识别出64篇符合条件的出版物，映射到53个保守的队列/数据集家族（若将两对可能重叠的配对视为独立，则为55个）：22篇客观/生理学、11篇行政/临床、31篇症状/问卷出版物。客观研究显示结果不一，在部分队列中可见胎儿生长或新生儿信号，但在其他若干经客观评估的人群中为阴性结果。行政编码定义的OSA反复与早产及部分新生儿结局相关，尽管暴露错分和残余混杂仍然重要。症状/问卷研究异质性大，关联随症状定义、时机和结局而变化。
结论： 当前证据尚不能为客观确认的母体OSA/SDB确立一致的胎儿或新生儿风险模式。行政编码和症状/问卷证据提示与部分结局（尤其是早产）存在关联，但不应将其解释为单一同质的OSA效应。
系统评价注册： https://www.crd.york.ac.uk/PROSPERO/，标识符CRD420251110706。

英文摘要

INTRODUCTION: Maternal obstructive sleep apnea (OSA) and the broader spectrum of sleep-disordered breathing (SDB) during pregnancy may be associated with fetal and neonatal outcomes, but the literature is heterogeneous and uses clinically distinct exposure definitions. This systematic review aimed to evaluate associations between maternal SDB and fetal/neonatal outcomes while preserving differences in exposure ascertainment.
METHODS: Following PRISMA 2020, the review was re-audited using updated PubMed and Web of Science searches, backward and forward citation searching, and ClinicalTrials.gov and WHO ICTRP registry searches. Exposures were classified as (1) objectively confirmed OSA/SDB, (2) administrative-code-defined OSA, and (3) symptom-, snoring-, or questionnaire-defined SDB risk. No meta-analysis was conducted because clinically comparable subsets were insufficient for quantitative pooling.
RESULTS: The completed re-audit identified 64 eligible publications mapped to 53 conservative cohort/dataset families (55 if two probable overlap pairs are treated as separate): 22 objective/physiologic, 11 administrative/clinical, and 31 symptom/questionnaire publications. Objective studies showed mixed findings, with fetal-growth or neonatal signals in selected cohorts but null findings in several other objectively assessed populations. Administrative-code OSA was repeatedly associated with preterm birth and selected neonatal outcomes, although exposure misclassification and residual confounding remain important. Symptom/questionnaire studies were heterogeneous, with associations varying by symptom definition, timing, and outcome.
CONCLUSION: Current evidence does not establish a consistent fetal or neonatal risk pattern for objectively confirmed maternal OSA/SDB. Administrative-code and symptom/questionnaire evidence suggests associations for selected outcomes, particularly preterm birth, but should not be interpreted as a single homogeneous OSA effect.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251110706.