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    Obstructive sleep apnea in pregnancy- what you need to know

     

    Antepartum care

    Management of OSA in pregnant women should continue through the postpartum period and should be multidisciplinary (Table 1). Women with known OSA who become pregnant should be evaluated by a sleep medicine specialist. Goals of the visit should include optimization of CPAP settings to help a patient achieve a normalized AHI and oxygenation. Obstetric providers should be acutely aware of the risk of hypertensive disorders and diabetes. Management should focus on early detection or prevention of
    these conditions.

    Women who are undiagnosed but suspected of having OSA should be referred to a sleep medicine specialist for evaluation. Situations where a suspicion of sleep apnea may arise include, but are not limited to, maternal symptoms of excessive daytime sleepiness, witnessed apneas, or observed maternal hypoxia in the absence of cardiorespiratory pathology. A sleep medicine provider can evaluate the patient and make recommendations regarding diagnosis and management throughout pregnancy and in the postpartum period. In the absence of pregnancy-specific data to direct treatment, we suggest treatment for all women with OSA. An individualized plan can be developed with the sleep medicine provider.

    Intrapartum management

    Women with OSA are also more likely to have comorbid conditions that predispose them to cesarean deliveries.9  The described perioperative risks include the need for conversion to general anesthesia and difficult airway intubation. A preoperative airway assessment and early evaluation by anesthesiology for placement of regional anesthesia and pain algorithms that maximize the use of nonopioid medications may be beneficial for these women.33,34 There are no clear guidelines for postpartum management. Because of risk of postoperative respiratory suppression, it is recommended that patients at increased risk of respiratory compromise from OSA have continuous pulse oximetry monitoring after discharge from the recovery room and that it be maintained as long as the patients remain at increased risk.35 If frequent or severe airway obstruction or hypoxemia develop during the monitoring period, CPAP or noninvasive positive pressure ventilation should be considered.35

    During the postpartum period, all women diagnosed with or suspected of having OSA should be managed in a way similar to the general population.17 The American Academy of Sleep Medicine suggests that they be evaluated by a sleep medicine provider to allow for reassessment of OSA severity and overall management/treatment strategy.17 Weight loss and bariatric surgery are important tools for treatment of sleep apnea in obese women.

    Conclusion

    In conclusion, obstructive sleep apnea in pregnancy is a prevalent and under-recognized disorder that carries implications for both mother and fetus. Increased awareness with appropriate diagnosis, treatment, and perioperative management could improve outcomes in these pregnancies. <

     

    Disclosures The authors report no potential conflicts of interest with regard to this article.

     

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

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