Sleep Apnea: Complications During Pregnancy

Sleep Apnea Pregnancy Complications

Summary

  • Overweight or obese women are at a significantly greater risk of developing sleep apnea than non-obese women.
  • The complications of OSA in pregnant women include gestational diabetes, hypertensive disorders, maternal morbidity, miscarriage, and preterm delivery.
  • Babies born to mothers with diagnosed OSA were more likely to need NICU admission after birth due to breathing problems
  • Conclusively, it is critical to consult a doctor for a proper checkup and timely diagnosis of OSA in pregnancy to avoid complications.

Sleep apnea is a condition characterized by episodic lapses in breathing while sleeping at night. Generally, there are 5 to 14 breath suspensions in an hour during mild apnea, while in moderate and severe apnea, there are about 15 to 29 and over 30 episodes an hour, respectively. [1]

The symptoms of sleep apnea include:

  • Heavy snoring
  • Shortness of breath during sleep
  • Sleep disruption due to choking
  • Disproportionate daytime sleepiness. [2]

Risk of Sleep Apnea in Pregnancy Due to Obesity

All pregnant women are at a higher risk of obstructive sleep apnea (OSA) due to elevated estrogen levels and already low oxygen levels during pregnancy. There is a greater chance of inflammation of the mucus membranes of your nose that leads to nasal congestion. However, overweight or obese women are at a significantly greater risk of developing sleep apnea than non-obese women. The additional weight in the neck puts extra pressure on the upper airway. According to a study on more than 3000 pregnant women, it was reported that about 8.3 percent developed symptoms of sleep apnea at mid-pregnancy. [3]

Complications Of Sleep Apnea In Pregnancy

  1. Gestational Diabetes

    There is growing evidence that shows a connection between sleep-disordered breathing (SDB) and gestational diabetes. A cohort study found the rates of gestational diabetes to be 25% with no SDB, 43% with mild SDB, and 63% with moderate to severe SDB [4] with a two-fold increased risk of OSA in 791 pregnant women. [5]

  2. Hypertensive Disorders

    Recent research also shows that hypertensive disorders such as chronic hypertension, pre-eclampsia, and gestational hypertension, along with recurrent snoring, are connected to OSA in pregnancy. [6] Another cohort study of 791 women with diagnosed OSA found a higher risk of pre-eclampsia in women with pre-existing OSA before pregnancy compared to women without the sleep disorder. [5]

  3. Maternal Morbidity

    Louis et al. evaluated more than 55 million women from the database of delivery-related hospital discharges in the U.S. It was found that there was a higher risk of severe maternal morbidities such as cardiomyopathy, pulmonary embolism, eclampsia, and hospital death, in women with OSA. [7]

  4. Adverse Outcomes in the Fetus and Newborns

    A study conducted on obese mothers found that babies born to women with OSA were highly likely to need neonatal intensive care units compared to babies born to non-OSA mothers.
    Another clinical trial conducted on obese pregnant women suggested that 46% of newborns from women with sleep apnea needed admission to the NICU compared to 18% born to mothers without sleep apnea. Most of these NICU admissions were reported to occur because of breathing issues in the neonates. [8]

  5. Miscarriage And Preterm Delivery

    Recent studies have shown that many pregnant women with obesity and confirmed OSA had a substantial tendency to have a miscarriage or preterm delivery than the normal-weight control group. [9] Furthermore, evidence shows that there were three times greater risk of pregnant women with OSA to need a cesarean delivery with a higher likelihood of NICU requirement for their babies.

Final Thought

The identification or diagnosis of sleep apnea is critical in pregnancy, particularly in obese women. Consult with us to discuss your condition to get a proper diagnosis. So, if you are suffering from sleep apnea, you can promptly start treatment and prevent any complications for yourself and the newborn.

References:

  1. Anonymous. Obstructive Sleep Apnea During Pregnancy. What to expect. Nov 2018. https://www.whattoexpect.com/pregnancy/obstructive-sleep-apnea
  2. Peters B. Obstructive Sleep Apnea in Pregnancy. Verywellhealth. Aug 2020. https://www.verywellhealth.com/sleep-apnea-and-pregnancy
  3. Gooley JJ, Mohapatra L, Twan DCK. The role of sleep duration and sleep-disordered breathing in gestational diabetes mellitus. Neurobiol Sleep Circadian Rhythms. 2017;4:34-43. Published 2017 Nov 28. DOI:10.1016/j.nbscr.2017.11.001. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584491/
  4. Facco FL, Ouyang DW, Zee PC, et al. . Implications of sleep-disordered breathing in pregnancy. Am J Obstet Gynecol 2014; 210: 559.e1–559.e6.
  5. Chen YH, Kang JH, Lin CC, et al. . Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J Obstet Gynecol 2012; 206: 136.e1–136.e5.
  6. O’Brien LM, Bullough AS, Chames MC, et al. . Hypertension, snoring, and obstructive sleep apnoea during pregnancy: a cohort study. BJOG 2014; 121: 1685–1693
  7. Louis JM, Mogos MF, Salemi JL, et al. . Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998–2009. Sleep 2014; 37: 843–849
  8. Live science staff. Sleep Apnea in Pregnancy May Harm Mom and Baby. Live Science. Sept 2012. https://www.livescience.com/23358-sleep-apnea-pregnancy
  9. Izci Balserak B. Sleep-disordered breathing in pregnancy. Breathe (Sheff). 2015;11(4):268-277. DOI:10.1183/20734735.009215.
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