Obstructive sleep apnea in pregnancy is associated with adverse maternal outcomes: a national cohort

Abstract

Objective Pregnancy and the obesity epidemic impacting women of reproductive age appear to predispose women to obstructive sleep apnea (OSA) in pregnancy. The aim of this study is to examine the association between OSA and adverse maternal outcomes in a national cohort. Methods The National Perinatal Information Center in the US was used to identify women with a delivery discharge diagnosis of OSA from 2010 to 2014. We used the International Classification of Diseases, 9th Revision to classify OSA diagnosis and maternal outcomes. Results The sample consisted of 1,577,632 gravidas with a rate of OSA of 0.12% (N=1963). There was a significant association between OSA and preeclampsia (adjusted odds ratio (aOR) 2.22, 95% confidence interval (CI) 1.94–2.54), eclampsia (aOR 2.95, 1.08–8.02) and gestational diabetes (aOR 1.51, 1.34–1.72) after adjusting for a comprehensive list of covariates which includes maternal obesity. OSA status was also associated with a 2.5- to 3.5-fold increase in risk of severe complications such as cardiomyopathy, congestive heart failure and hysterectomy. Length of hospital stay was significantly longer (5.1 ± 5.6 vs 3.0 ± 3.0 days, p<0.001) and odds of an admission to an intensive care unit higher (aOR 2.74, 2.36–3.18) in women with OSA. Conclusions Compared to pregnant women without OSA, pregnant women with OSA have a significantly higher risk of pregnancy-specific complications such as gestational hypertensive conditions and gestational diabetes, and rare medical and surgical complications such as cardiomyopathy, pulmonary edema, congestive heart failure and hysterectomy. OSA diagnosis was also associated with a longer hospital stay and significantly increased odds for admission to the intensive care unit.

Pathophysiological changes associated with sleep disordered breathing and supine sleep position in pregnancy

“…[27,29,30] SDB is associated with a plethora of negative maternal, obstetric and perinatal outcomes including cardiovascular and metabolic disease, fetal growth restriction, preterm birth, low birth weight, operative delivery, low 5-minute Apgar score, stillbirth and perinatal death, longer hospital stay, as well as maternal and neonatal admission to intensive care. [8,9] More recent evidence also suggests that offspring of women with high levels of daytime sleepiness have poorer executive function and increased neuropsychiatric problems in early childhood.…”

“…[1,4] Perturbations in sleep are common in pregnancy, with women often describing increased frequency of awakenings, lower overall sleep duration and higher levels of daytime sleepiness compared with pre-pregnancy patterns. Indeed there is mounting evidence showing that sleep abnormalities negatively impact obstetric and perinatal outcomes [5][6][7][8][9][10][11] and treatment, particularly those related to obstructive airway symptoms, ameliorates some of these complications. [12][13][14] Maternal sleep position has also been linked with adverse outcomes particularly stillbirth.…”

Waking up too early – the consequences of preterm birth on sleep development

“…; Bourjeily et al . ). It has been suggested that the incidence of OSA in pregnancy is dramatically under‐reported (Pien et al .…”

“…), and in industrialised countries OSA during pregnancy is increasing due to the obesity epidemic, particularly in younger women, and is associated with a number of pregnancy complications (Bourjeily et al . ).…”

The presence of coexisting sleep-disordered breathing among women with hypertensive disorders of pregnancy does not worsen perinatal outcome

“…The degree of OSA appears to be linearly related to cardiovascular risk. [8] Accumulating evidence suggests this relationship may also exist in pregnancy with several studies reporting an association between SDB and gestational hypertensive disorders, [3,9,10] although obesity can act as a confounder to this relationship. [11] Hypertensive disorders of pregnancy (HDP), particularly preeclampsia, are associated with placental dysfunction resulting in impaired fetal growth and increased risks of acute compromise.…”