Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_41_библиотеки_им_акад_М_И_Перельмана

Treatment intervention trials for sleep disturbance in pregnancy are limited. For pregnant women with SDB, small studies and case reports show that use of positive airway pressure is safe and appears to improve maternal blood pressure and insulin secretion, extend time in utero, and improve markers of maternal and fetal well­being [131–136]. For insomnia, cognitive behavioral therapy (CBTI) is efcacious during pregnancy [137, 138]. A 5-week CBTI program for pregnant women demon- strated signicant reductions in insomnia symptoms and increases in subjective sleep quality as well as less time in bed, shorter sleep-onset latency, increased sleep efciency, and increased subjective total sleep time. Importantly, symptoms of depression, pregnancy-specic anxiety, and fatigue all decreased over the course of treatment [138]. Moreover, since access to trained clinicians can be challenging to many women, delivery of digital CBTI online has also been shown to improve sleep onset and maintenance symptoms as well as sleep duration [139]. Importantly, CBTI during pregnancy appears to protect against sleep loss after childbirth. Support for other therapies to improve sleep quality such as yoga/mindfulness, relaxation, herbal therapies, and acupuncture has also been reported (see Bacaro [140] for a review). However, whether these interventions translate to improvements in fetal outcomes is yet to be tested. Effective treatments, either via therapies such as posi­tive airway pressure for SDB or behavioral strategies to promote good hygiene, should be aggressively pursued in order to reduce the short- and long-term burden of the consequences of sleep deciency during pregnancy.