Preliminary Evidence Linking Maternal Sleep-Disordered Breathing During Pregnancy to Early Childhood Development: A 3-Year Pilot Cohort Study in Japan

Abstract

Highlights: What are the main findings? Obstructive sleep apnea (OSA) during pregnancy may be associated with lower cognitive and language development in 3-year-old children. No clear associations were found with children’s physical growth or occlusal status. Early screening for maternal sleep-disordered breathing using home sleep tests may help identify high-risk pregnancies. What are the implications of the main findings? Raising awareness on maternal sleep health may help prevent developmental differences during early childhood. Feasible prenatal screening tools, such as home sleep apnea testing, could enable early identification and management of maternal OSA. Integrating sleep health assessments into routine prenatal care may improve long-term outcomes for both mothers and children. Background/Objectives: Obstructive sleep apnea (OSA) during pregnancy may reduce maternal oxygenation, cause sleep fragmentation, and influence offspring development. This pilot study explored potential associations between OSA during pregnancy and child outcomes at age 3. Methods: Pregnant women aged 23–48 years who underwent home sleep apnea testing (HSAT) at 28–32 weeks of gestation between June 2021 and July 2025 were enrolled. OSA was defined as an apnea–hypopnea index (AHI) ≥ 5. Mothers and children were prospectively followed until the child reached 3 years of age. Children’s developmental levels (motor, cognitive/adaptive, language/social, and total) were evaluated using the New K-Type Developmental Test. Anthropometric measures (height, weight, and head circumference) and dental occlusion were also assessed. Correlations between the maternal AHI and developmental indices were examined. Results: Thirty-four women, including six with OSA, completed the follow-up assessment. No significant differences were observed in children’s physical growth or occlusion between the OSA and non-OSA groups. The maternal AHI showed a negative tendency with the total developmental index and the cognitive/adaptive and language/social domains. One participant with severe OSA (AHI = 69.3) showed markedly lower developmental scores, suggesting a possible dose-dependent trend rather than a definitive threshold. Given the small number of OSA cases and the influence of a single severe case, these findings should be interpreted cautiously as preliminary and descriptive. Conclusions: OSA during pregnancy may be associated with differences in early childhood development. The findings highlight the importance of maternal sleep health awareness and feasible screening approaches, such as HSAT, during pregnancy.