Five Questions With: Dr. Ghada Bourjeily

Dr. Ghada Bourjeily is an attending physician in pulmonary services and obstetric medicine and director of research at the Women’s Medicine Collaborative. She treats patients at Rhode Island Hospital and The Miriam Hospital. She is also an assistant professor of medicine at The Warren Alpert Medical School of Brown University. She received her medical degree from the Université Libanaise, Faculté des Sciences Medicales in Lebanon. She was named the 2015 recipient of Lifespan’s Bruce M. Selya Award for Excellence in Research. Her recent research has focused on sleep-disordered breathing and its impact on cardiovascular and metabolic outcomes during pregnancy.

PBN: How common are sleep-disordered breathing issues during pregnancy?

BOURJEILY: Sleep-disordered breathing is a spectrum of disorders which include snoring and obstructive sleep apnea, among other disorders. Pregnancy appears to predispose women to the development of sleep-disordered breathing. About a third of all pregnant women snore, a much higher proportion than that observed outside of pregnancy. Obstructive sleep apnea affects up to 10 percent of all pregnant women but is more common in women who were overweight before pregnancy, as excess weight is one of the most important risk factors for sleep-disordered breathing.

PBN: How serious can sleep-disordered breathing be for an expectant mother?

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BOURJEILY: Sleep-disordered breathing has been associated with conditions such as blood poisoning, gestational diabetes and possibly some adverse neonatal outcomes such as growth restriction. It is not clear, however, whether sleep-disordered breathing actually causes these conditions or whether sleep-disordered breathing and these conditions tend to occur in the same subset of patients at risk.

PBN: Do the symptoms typically resolve after giving birth, or do they linger in many cases?

BOURJEILY: Sleep worsens in general after delivery due to the nocturnal demands of the infant. It is possible that women who breastfeed have a deeper quality of sleep though. Snoring and obstructive sleep apnea, on the other hand, tend to improve some after pregnancy; however, it is not clear whether they resolve completely. This may depend of the amount and the distribution of weight retained after birth, but may also depend on other not-well-known factors. Further research is needed to better understand the natural history of sleep-disordered breathing after birth.

PBN: In layperson’s terms, how does the placenta affect the breathing of sleeping mothers and in some cases lead to this condition?

BOURJEILY: The association of the sleep-disordered breathing (mainly sleep apnea) with placental abnormalities may go in both directions, but this association has been very recently proposed by our research team. So far, the findings point toward sleep-disordered breathing likely leading to placental abnormalities. As sleep-disordered breathing is linked to intermittent reductions in oxygen levels during sleep and a surge of hormones such as adrenaline with recurrent limitations to airflow, these triggers may lead to decrease blood and oxygen supply the placenta, which in turn may lead to complications.

PBN: What are some of the good outcomes that have emerged from this research?

BOURJEILY: Our research so far has helped confirm associations of sleep-disordered breathing with adverse pregnancy outcomes, suggested that pregnant women with sleep-disordered breathing have different features on their sleep studies compared to non-pregnant women with these disorders. Our team has also shown that pregnant women are unlikely to develop the type of sleep-disordered breathing where signals from the brain are the cause, rather than obstruction of the upper airway during sleep. Our research linking sleep-disordered breathing to the placenta paves the way for interventions aiming at improving sleep-disordered breathing and testing the effect of various interventions on the health of the placenta as well as the clinical complications that an abnormal placenta may lead to.

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