/ /

  • linkedin
  • Increase Font
  • Sharebar

    Obstructive sleep apnea in pregnancy- what you need to know



    Continuous positive airway pressure (CPAP) is the treatment of choice for mild, moderate, and severe OSA.17 More than 15 randomized clinical trials have demonstrated that treatment of OSA reduces the risks of hypertension, cardiovascular morbidities, and motor vehicle crashes.18-21 Customized oral mandibular repositioning devices are noninvasive and keep the airway open by pulling the lower jaw forward. While they can be an effective treatment for mild to moderate OSA for individuals with good dentition, they are only recommended if a patient cannot tolerate CPAP or desires alternative therapy. However, when it comes to pregnancy, there are few data to direct management. Small studies examined CPAP and used short-term intermediary outcomes, such as maternal blood pressure.22-24 However, with such small sample sizes, they were insufficiently powered to detect an impact of treatment. Therefore, despite the demonstrated increased risk of adverse pregnancy outcomes associated with OSA, we do not have any studies to date that adequately evaluate treatment during pregnancy to show improvement in maternal or neonatal outcome. However, the accepted standard is to offer treatment because there is benefit in the general population.17

    Maternal morbidity

    The Sleep Disordered Breathing Substudy of the Nulliparous Pregnancy Outcomes Study was a multicenter, prospective cohort study designed to estimate whether SDB during pregnancy is a risk factor for development of hypertensive disorders of pregnancy and gestational diabetes mellitus (GDM). In early and mid-pregnancy, the adjusted odds ratio for preeclampsia when SDB was present was 1.94 (95% CI 1.07–3.51) and 1.95 (95% CI 1.18–3.23), and for GDM was 3.47 (95% CI 1.95–6.19) and 2.79 (95% CI 1.63–4.77). These results support findings from prior smaller cross-sectional and observational studies.10,25-28  Even after controlling for obesity, OSA is also associated with an increased risk of cardiomyopathy (OR, 9.0; 95% CI, 7.5-10.9), pulmonary embolism (OR, 4.5; 95% CI, 2.3-8.9) and in-hospital mortality (OR 5.1 95% CI, 2.4-11.5).29

    Neonatal morbidity

    The adverse fetal and neonatal consequences of sleep apnea in pregnancy are less well delineated. Maternal OSA is associated with a 1.5- to 2-fold increased frequency of low birth weight and small-for-gestational-age infants, both in high-risk women and in an otherwise healthy non-obese cohort.10,30,31 These infants are also more likely to have preterm delivery and neonatal intensive care unit admission (despite similar gestational age at delivery).9 One study following 74 mom-baby pairs 24% of which had OSA noted no difference in general motor scores but an increased frequency of low social development scores in neonates of moms with OSA ( 64% vs. 25%, P = .036 ) at age 12 months.32 There are no studies that indicate an increased risk of fetal death or miscarriage in association with sleep apnea.

    Next: Antepartum care

    Judette Louis, MD, MPH
    Dr Louis is Assistant Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Morsani College of ...


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available


    Latest Tweets Follow