Нарушения сна у беременных: особенности диагностики и терапии

Бурчаков Д.И. Нарушения сна у беременных: особенности диагностики и терапии. Гинекология. 2022;24(6):471–477. DOI: 10.26442/20795696.2022.6.202028

© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.

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Burchakov DI. Sleep disturbances in pregnancy: features of diagnosis and therapy: A review. Gynecology. 2022;24(6):471–477. DOI: 10.26442/20795696.2022.6.202028

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Аннотация

Физиологические изменения во время беременности зачастую нарушают сон женщин. Если эти изменения сочетаются с другими факторами (ожирение, дефицит железа или магния, тревожность и др.), у беременной женщины могут сформироваться расстройства сна: синдром обструктивного апноэ сна, синдром беспокойных ног, судороги ног во сне (крампи), инсомния. Эти расстройства повышают риск осложнений беременности, снижают качество жизни женщины, формируют почву для соматических и психических расстройств в послеродовом периоде. Врачу – акушеру-гинекологу полезно ориентироваться в феноменологии, диагностике и лечении расстройств сна у беременных, чтобы своевременно их скорректировать или передать женщину под наблюдение невролога или психиатра. В настоящем обзоре дана краткая характеристика основных расстройств сна, которые встречаются у беременных, в особенности различных форм инсомнии (бессонницы). В заключение дана характеристика основных групп снотворных препаратов, из которых только доксиламин допустимо применять в рутинной практике ввиду его доказанной эффективности и безопасности во время беременности.

Ключевые слова: беременность, инсомния, доксиламин

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Physiological changes during pregnancy often disrupt women's sleep. If these changes are combined with other factors (obesity, iron or magnesium deficiency, anxiety, etc.), the pregnant woman may develop sleep disorders: obstructive sleep apnoea syndrome, restless legs syndrome, leg cramps, and insomnia. These disorders increase the risk of pregnancy complications, reduce the quality of a woman's life, and form the basis for somatic and mental disorders in the postpartum period. Therefore, the obstetrician has to be familiar with the phenomenology, diagnosis, and treatment of sleep disorders in pregnant women to treat them promptly or to refer a woman to a neurologist or psychiatrist. This review briefly describes the common sleep disorders occurring in pregnant women, especially the various types of insomnia. The main groups of sedative agents are characterized, of which only doxylamine is acceptable for use in routine practice because of its proven efficacy and safety during pregnancy.

Keywords: pregnancy, insomnia, doxylamine

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1. Wang R, Xu M, Yang W, et al. Maternal Sleep during Pregnancy and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis. J Diabetes Investig. 2022;13(7):1262-76. DOI:10.1111/jdi.13770
2. Hawkins M, Marcus B, Pekow P, et al. Physical Activity and Sleep Quality and Duration During Pregnancy Among Hispanic Women: Estudio PARTO. Behav Sleep Med. 2019;17(6):804-17.
3. Madaeva IM, Kolesnikova LI, Protopopova NV, et al. Features of the Sleep Pattern During Pregnancy. Annals of the Russian Academy of Medical Sciences. 2014;1-2:93-7 (in Russian).
4. Yang Z, Zhu Z, Wang C, et al. Association between Adverse Perinatal Outcomes and Sleep Disturbances during Pregnancy: A Systematic Review and Meta-Analysis. J Matern Fetal Neonatal Med. 2022;35(1):166-74.
5. Wong PF, D’Cruz R, Hare A. Sleep Disorders in Pregnancy. Breathe (Sheff). 2022;18:220004.
6. Roth T. Insomnia: Definition, Prevalence, Etiology, and Consequences. J Clin Sleep Med. 2007;3(5 Suppl):S7-10.
7. Poluektov MG, Tsenteradze SL. A contemporary conception of insomnia syndrome and its treatments in view of International classification of sleep disorders. Zhur Nevrol Psikhiatr im SS Korsakova. 2014;114(11):92-7.
8. Sedov ID, Anderson NJ, Dhillon AK, Tomfohr-Madsen LM. Insomnia Symptoms during Pregnancy: A Meta-Analysis. J Sleep Res. 2021;30(1):e13207.
9. Lee KA, Zaffke ME, McEnany G. Parity and Sleep Patterns during and after Pregnancy. Obstet Gynecol. 2000;95(1):14-8.
10. Kalmbach DA, Cheng P, Drake CL. A Pathogenic Cycle between Insomnia and Cognitive Arousal Fuels Perinatal Depression: Exploring the Roles of Nocturnal Cognitive Arousal and Perinatal-Focused Rumination. Sleep. 2021;44(6):zsab028. DOI:10.1093/sleep/zsab028
11. Lin X, Zhai R, Mo J, et al. How Do Maternal Emotion and Sleep Conditions Affect Infant Sleep: A Prospective Cohort Study. BMC Pregnancy Childbirth. 2022;22(1):237. DOI:10.1186/s12884-022-04504-6
12. Baratte-Beebe KR, Lee K. Sources of Midsleep Awakenings in Childbearing Women. Clin Nurs Res. 1999;8:386-97.
13. Liashenko IeA, Levin OS. Rasstroistva sna v klinicheskoi praktike. Sovremennaia terapiia v psikhiatrii i nevrologii. 2017;1:22-8 (in Russian).
14. Pollmann AS, Murphy AL, Bergman JC, Gardner DM. Deprescribing Benzodiazepines and Z-Drugs in Community-Dwelling Adults: A Scoping Review. BMC Pharmacol Toxicol. 2015;16:19.
15. Koren G, Pastuszak A, Ito S. Drugs in Pregnancy. N Engl J Med. 1998;338(16):1128-37.
16. Sullivan SS, Guilleminault C. Emerging Drugs for Insomnia: New Frontiers for Old and Novel Targets. Expert Opin Emerg Drugs. 2009;14(3):411-22.
17. McAllister-Williams RH, Baldwin DS, Cantwell R, et al. British Association for Psychopharmacology Consensus Guidance on the Use of Psychotropic Medication Preconception, in Pregnancy and Postpartum 2017. J Psychopharmacol. 2017;31(5):519-52.
18. Simons FER. Advances in H1-Antihistamines. N Engl J Med. 2004;351(21):2203-17.
19. Martínez-Gómez MA, Carril-Avilés MM, Sagrado S, et al. Characterization of Antihistamine-Human Serum Protein Interactions by Capillary Electrophoresis. J Chromatogr A. 2007;1147(2):261-9.
20. Friedman H, Greenblatt DJ, Scavone JM, et al. Clearance of the Antihistamine Doxylamine. Reduced in Elderly Men but Not in Elderly Women. Clin Pharmacokinet. 1989;16(5):312-6.
21. Burchakov DI, Tardov MV. Insomnia in general practice: the role of doxylamine. Meditsinskii sovet. 2020;2:45-53 (in Russian).
22. Strigin KN. The role of central histamine receptor blockers in the treatment of insomnia. Zhurnal Nevrologii i Psikhiatrii im. SS Korsakova. 2018;118(4-2):73-82 (in Russian).
23. Allison M, Hale C. A Phase I Study of the Pharmacokinetics and Pharmacodynamics of Intranasal Doxylamine in Subjects with Chronic Intermittent Sleep Impairment. Drugs R D. 2018;18(2):129-36.
24. Pelser A, Müller DG, du Plessis J, et al. Comparative Pharmacokinetics of Single Doses of Doxylamine Succinate Following Intranasal, Oral and Intravenous Administration in Rats. Biopharm Drug Dispos. 2002;23(6):239-44.
25. Friedman H, Greenblatt DJ. The Pharmacokinetics of Doxylamine: Use of Automated Gas Chromatography with Nitrogen-Phosphorus Detection. J Clin Pharmacol. 1985;25(6):448-51.
26. Hamelin B, Bouayad A, Méthot J, et al. Significant Interaction between the Nonprescription Antihistamine Diphenhydramine and the CYP2D6 Substrate Metoprolol in Healthy Men with High or Low CYP2D6 Activity. Clin Pharmacol Ther. 2000;67(5):466-77.
27. Lessard E, Yessine MA, Hamelin BA, et al. Diphenhydramine Alters the Disposition of Venlafaxine through Inhibition of CYP2D6 Activity in Humans. J Clin Psychopharmacol. 2001;21(2):175-84.
28. Bartra J, Valero AL, Del Cuvillo A, et al. Interactions of the H. J Investig Allergol Clin Immunol. 2006;16(Suppl. 1):29-36.
29. Seto A, Einarson T, Koren G. Pregnancy Outcome Following First Trimester Exposure to Antihistamines: Meta-Analysis. Am J Perinatol. 1997;14(3):119-24.
30. Ito S, Blajchman A, Stephenson M, et al. Prospective Follow-up of Adverse Reactions in Breast-Fed Infants Exposed to Maternal Medication. Am J Obstet Gynecol. 1993;168(5):1393-9.
31. Popescu FD. H1 Antihistamines and Driving. J Med Life. 2008;1(3):262-8.
32. Badhu BP, Bhattarai B, Sangraula HP. Drug-Induced Ocular Hypertension and Angle-Closure Glaucoma. Asia Pac J Ophthalmol (Phila). 2013;2(3):173-6.

Авторы

Д.И. Бурчаков*

НОЧУ ДПО «Высшая медицинская школа», Москва, Россия
*dr.burchakov@yandex.ru

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Denis I. Burchakov*

Higher Medical School, Moscow, Russia
*dr.burchakov@yandex.ru

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