Sleep and pregnancy-induced hypertension: a possible target for intervention?

Abstract

Sleep disturbances in the general population are associated with elevated blood pressure. This may be due to several mechanisms, including sympathetic activation and hypothalamic-pituitary-adrenal (HPA) axis disturbance. Elevated blood pressure in pregnancy can have devastating effects on both maternal and fetal health and is associated with increased risk for preeclampsia and poor delivery outcomes. Preliminary evidence suggests that mechanisms linking sleep and blood pressure in the general population may also hold in the pregnant population. However, the effects of disturbed sleep on physiologic mechanisms that may directly influence blood pressure in pregnancy have not been well studied. The role that sleep disturbance plays in gestational blood pressure elevation and its subsequent consequences warrant further investigation. This review evaluates the current literature on sleep disturbance and elevated blood pressure in pregnancy and proposes possible treatment interventions.

Keywords: Sleep disturbance; blood pressure; hypertension; pregnancy; weight.

Figure 1. Proposed model of how physical and hormonal changes in pregnancy coupled with stress result in disturbed sleep which can result in elevated blood pressure

Normative physical changes, such as changes in body habitus, and hormonal changes, including dramatic increases in estrogen and progesterone, are recognized contributors to sleep disturbance in pregnancy. Subsequent to the sleep disturbance are various catecholamine and neuroendocrine changes which can negatively impact blood pressure. Concurrent stress, whether daily hassles or serious life events, is both an independent and dependent modifier of blood pressure. These associations are critical throughout pregnancy as elevated blood pressure is linked with increased risk of preeclampsia and preterm birth.