Sleep-disordered breathing and upper airway size in pregnancy and post-partum

Abstract

Sleep-disordered breathing and snoring are common in pregnancy. The aim of this study was to determine whether pregnancy was associated with upper airway narrowing.One-hundred females in the third trimester of pregnancy were recruited and 50 agreed to be restudied 3 months after delivery. One-hundred nonpregnant females were also recruited. Upper airway dimensions were measured using acoustic reflection.Snoring was less common in nonpregnant (17%) than pregnant females (41%; odds ratio (OR) 3.34; 95% confidence interval (CI) 1.65-6.74) and returned to nonpregnant levels after delivery (18%; OR 0.15; 95% CI 0.06-0.40). Pregnant females had significantly smaller upper airways than nonpregnant females at the oropharyngeal junction when seated (mean difference 0.12; 95% CI 0.008-0.25), and smaller mean pharyngeal areas in the seated (mean difference 0.14; 95% CI 0.001-0.28), supine (mean difference 0.11; 95% CI 0.01-0.22) and lateral postures (mean difference 0.13; 95% CI 0.02-0.24) compared with the nonpregnant females. Pregnant females had smaller mean pharyngeal areas compared with post-partum in the seated (mean difference 0.18; 95% CI 0.02-0.32), supine (mean difference 0.20; 95% CI 0.06-0.35) and lateral postures (mean difference 0.26; 95% CI 0.12-0.39).In conclusion, this study confirmed increased snoring and showed narrower upper airways during the third trimester of pregnancy.

Sleep Apnea and Cardiovascular Disease

“…In the third trimester of pregnancy, snoring is increased and the upper airway diameter is narrow compared with postpartum. 143 The severity of sleep apnea and the associated BP responses measured in the third trimester improve significantly (Pϭ0.03) after parturition, further supporting the concept that pregnancy may exacerbate sleep apnea. 144 To determine the interaction between OSA in patients with drug-resistant hypertension, defined as a clinic BP of Ն140/ 90 mm Hg while taking a combination of Ն3 antihypertensive drugs titrated to maximally recommended doses, Logan et al 145 noted that the prevalence of OSA, defined as an AHI of Ն10, was 83%.…”

Elevated Body Position Early after Delivery Increased Airway Size during Wakefulness, and Decreased Apnea Hypopnea Index in a Woman with Pregnancy Related Sleep Apnea

“…[1][2][3] During the postpartum period, airway obstructions are a main cause of anesthesia related maternal death in North America, 4 and increased vulnerability to airway obstruction may be successfully treated with adequate body position, as elevated posture has been shown to improve UA size accessed by acoustic pharyngometry 5 and collapsibility during anesthesia 6 and sleep, as well as during wakefulness in pregnant women. 7,8 Nevertheless, the effect of elevated upper body position on airway size and pregnancy associated OSA is currently unknown. We evaluated the effects of elevated upper body position on nocturnal breathing in a woman during her second night after delivery.…”

Kreislaufstillstand in besonderen Situationen

“…[745]. Eine Studie konnte zeigen, dass die oberen Atemwege im dritten Trimester enger sind als postpartal und bei nicht schwangeren Kontrollpatientinnen [746]. Die endotracheale Intubation kann bei schwangeren Patientinnen schwieriger sein [747].…”