Nocturnal oxygen desaturation in the late third trimester of uncomplicated pregnancy for prediction of late‐onset gestational hypertension

Abstract

Aim This study aimed to determine whether 1‐night screening of oxygen desaturation in women with uncomplicated pregnancy about 1 month before the due date is useful to predict late‐onset gestational hypertension (GH) after 37 weeks of gestation. Methods We recruited 102 women with uncomplicated pregnancy between 34 and 36 weeks of gestation. These women then completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Berlin Questionnaire for obstructive sleep apnea, and recorded their oxygen saturation (SpO2) and physical acceleration profiles during nocturnal sleep for 1 night at home using a portable pulse oximeter and actigraph, respectively. Thereafter, their blood pressure was monitored weekly until delivery. Results Pulse oximetry data between 34 and 36 weeks of gestation revealed that three women had an oxygen desaturation index (ODI) ≥5.0 and seven had a minimum SpO2 < 90%. During follow‐up until delivery, two women with an ODI ≥5.0 and a minimum SaO2 <90% developed GH at 37 weeks of gestation. Among clinical measures at recruitment, body mass index (BMI) and pulse oximetry measures appeared available for the prediction of GH. The positive predictive values (95% confidence intervals) of the criteria using these measures were 0.67 (0.26–0.67) for ODI ≥5.0, 0.29 (0.10–0.35) for minimum SpO2 <90%, and 0.07 (0.02–0.07) for BMI ≥25.0. Conclusion For the prediction of late‐onset GH after 37 weeks of gestation, pulse oximetry measures about 1 month before the due date are particularly useful because of their high positive predictive values.

Obstructive Sleep Apnea-Associated Intermittent Hypoxia-Induced Immune Responses in Males, Pregnancies, and Offspring

“…These data are consistent with findings that hypoxia-inducible factor 1 alpha (HIF-1α) mRNA and its target genes are not altered in placentas or fetal brain at E19 during gestational IH exposure, despite a decline in arterial oxygen saturation in the dam to ~80-85% with each hypoxic episode [165]. Typical oxygen saturation levels in pregnant women with sleep apnea range from 80 to 90% [166][167][168]. Further, the injection of dams with an oxygensensing probe (hydroxyprobe) that forms protein thiol adducts in hypoxic cells showed no change in gestational IH-exposed fetal brains relative to controls [165].…”

Intermittent Hypoxia Upregulates the Renin and Cd38 mRNAs in Renin-Producing Cells via the Downregulation of miR-203

“…Recent epidemiological research has demonstrated that SAS may be associated with various metabolic dysfunctions, including dyslipidemia, cardiovascular diseases, insulin resistance, and hypertension. Additionally, in pregnant women, SAS may be a risk factor of gestational hypertension [ 19 , 20 ] and preeclampsia [ 21 , 22 , 23 ]. The pathophysiology of hypertension in relation to SAS is dependent on various factors, for example, the sympathetic tone, peripheral vasoconstriction, altered baroreceptor reflexes, and increased RAS activity [ 1 ].…”

Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy

“…73,74 Several studies show that very few pregnant people have oxygen desaturation events during sleep. 66,[75][76][77] Moreover, the prevalence of the oxygen desaturation index of five or more events per hour in pregnant people varied greatly, depending on desaturation criteria. Because of the lack of evidence in pregnant people, great variance in prevalence with changing desaturation criteria, and poor correlation with symptoms and clinical outcomes, we do not recommend that overnight pulse oximetry be used as a diagnostic tool for OSA in pregnant people (Class of Recommendation III [no benefit]; Level of Evidence C-EO).…”