Sleep apnea in pregnancy

Abstract

Snoring occurs in about one-third of women by third trimester of pregnancy and prevalence of obstructive sleep apnea (OSA) in pregnancy is estimated between 10% and 20%. The prevalence of sleep apnea among pregnant women in the USA may be increasing, paralleling higher rates of obesity and older maternal age. Changes in respiratory physiology, anatomy, and endocrine physiology have both predisposing and protective effects on sleep-disordered breathing in pregnancy. Diagnosing OSA in pregnancy can be challenging; respiratory physiology is different during pregnancy, and home sleep testing can underestimate sleep apnea due to sleep disturbances that frequently occur in pregnant women. Furthermore, common sleep apnea screening questionnaires are not valid in perinatal women. Sleep apnea in pregnancy poses a risk of developing gestational hypertensive disorders and gestational diabetes, as well as more severe outcomes including cardiomyopathy, congestive heart failure, need for postpartum hysterectomy, and even death. Infants of women with sleep apnea have a higher risk of low birthweight, preterm delivery, and small for gestational age. Positive airway pressure therapy (e.g., CPAP) is the gold standard treatment for OSA in pregnancy, though more research is needed to improve access to and compliance with CPAP in the perinatal period and to determine whether CPAP mitigates the risks of sleep apnea in expectant and new mothers and their offspring.