Sleep-Disordered Breathing And Sleep Apnea Can Affect Pregnancy

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Bringing a child into the world is a beautiful, amazing experience to be part of and no easy task, placing great physical demand on the mother. Difficulties or complications can occur at any point from conception to delivery of a baby. Unfortunately, it can also be tragic as the most common type of pregnancy loss is miscarriage, approximately 10% according to the American College of Obstetricians and Gynecologists (ACOG). The reasons for loss are varied but most commonly caused by abnormal chromosomes, and increased risks include “increased age, increased weight, and a history of polycystic ovarian syndrome (PCOS), all of which are also risk factors” for sleep disordered breathing.

PCOS is believed to be one of the most common causes of female infertility and two key studies demonstrate the association between sleep disordered breathing and PCOS. Because sleep apnea is considered to be a condition predominantly affecting overweight or obese men, women are less likely to be diagnosed. Women with OSA or insomnia are often misdiagnosed, and female patients are treated for other disorders.

The University of South Florida performed a study that analyzed data of approximately 55 million pregnant women in the United States, showing a strong association of pregnancy-related death for women suffering from sleep apnea at five times higher than pregnant women who did not have sleep apnea.

OSA in pregnancy was associated with a number of adverse complications, including:

- greater risk for preeclampsia;

- gestational hypertension;

- gestational diabetes;

- pulmonary embolism;

- preterm birth;

- unplanned cesarean delivery;

- increased risk for fetal heart rate deceleration with maternal desaturations (blood oxygen levels <90%);

- lower Apgar scores;

- low birth weight;

- stillbirth; and

- increased neonatal ICU admissions.

Dr. Mahesh Nagappa, assistant professor of anesthesia and perioperative medicine at Western University, in London, Ontario has investigated and found that OSA patients “with preeclampsia, hypertension, diabetes, asthma and BMI [body mass index] greater than 40 [kg/m2] ended up in preterm labor … OSA was not a static process in pregnancy. Rather, it’s a dynamic process: The severity of OSA increases as the pregnancy reaches the third trimester.”

Various OSA screening tools analyzed showed they are less accurate for women than non-pregnant women and that further work is needed to detect and treat OSA in pregnancy to improve both maternal and fetal outcomes. It is important for healthcare providers and patients to understand the signs, risks, and try to diagnose sleep disordered breathing.

Co-authored with Lily Mai.

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