Obstructive sleep apnea and pregnancy: the effect on perinatal outcomes

Abstract

Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper airway obstruction, resulting in hypoxemia, hypercapnia and sleep fragmentation. Pathophysiological sequelae include sympathetic activation, increased oxidative stress and a generalized inflammatory response, culminating in endothelial dysfunction. These are the proposed mechanisms that mediate the increased risk of hypertension and cardiovascular disease among patients with OSA outside of pregnancy. It is intriguing to consider the consequences of these events on pregnancy outcomes. There is a growing literature on the impact of maternal OSA on hypertensive disorders of pregnancy, gestational diabetes and impaired fetal growth. The data, while promising, require confirmation with larger numbers to verify the findings. OSA may be an important mediator of the poor perinatal outcomes associated with maternal obesity; moreover, one which may be amenable to treatment. This review discusses OSA and summarizes the current literature linking OSA with adverse perinatal outcomes.

Obstructive Sleep Apnea and the Risk of Perinatal Outcomes: A Meta-Analysis of Cohort Studies

“…One possible explanation for such different findings is confounding by BMI, as increasing BMI will generally be associated with excessive fetal size. Thus, the number of women with SGA infant will thus be small34.…”

Inclusion of Body Mass Index in the History of Present Illness

“…15,[23][24][25][26][27] As shown in Table 3, BMI had the strongest association (32 [94%]) with adverse pregnancy outcomes or conditions. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Most importantly, there was a dose-response relationship between increasing maternal BMI categories and outcomes with morbid obesity (BMI higher than 40) associated with increased rates of multiple adverse pregnancy outcomes such as fetuses large for gestational age (odds ratio [OR] 3.82), preeclampsia (OR 4.82), cesarean delivery (OR 2.69), antepartum stillbirth (OR 2.79), shoulder dystocia (OR 3.14), instrumental delivery (OR 1.34), meconium aspiration (OR 2.85), fetal distress (OR 2.52), and early neonatal death (OR 3.41), as compared with mothers with normal weights; the associations were similar for women with BMI between 35.1 and 40, but to a lesser degree. 41 Table 2 shows the association of the descriptors with gynecologic outcomes or conditions.…”

Managing anesthesia  for cesarean section in obese patients: current perspectives

“…OSA is associated with increased risk for hypertension, myocardial infarction, stroke, diabetes, and metabolic syndrome 18,19. Louis et al20 found a fivefold increase of in-hospital death in parturients with OSA compared with those without OSA, even when adjusting for serious cardiovascular, renal, and metabolic conditions.…”