Sleep disordered breathing in pregnant women: maternal and fetal risk, treatment considerations, and future perspectives

ABSTRACT

Introduction: Numerous physiologic and anatomic changes during pregnancy exacerbate or unmask obstructive sleep apnea in women. Left untreated, upper airway flow limitation during pregnancy may lead to dire maternal and fetal health consequences.

Areas covered: This review outlines the relationship between sleep disordered breathing (SDB) and gestational hypertension, preeclampsia, and gestational diabetes. It also discusses the implications of SDB on fetal and maternal health and concludes with a review of the emerging literature of treatment options for SDB in pregnancy and its benefit.

Expert commentary: Providers should screen, recognize, and treat SDB in pregnant women given its implicated risk on maternal and fetal health. This is particularly true in preeclampsia, a leading cause of maternal and fetal morbidity and mortality where SDB has been shown to add risk and severity. It is important to note that repetitive upper airway flow limitations in pregnancy are associated with surges in nocturnal blood pressure and poor maternal and fetal outcomes, and may be just as detrimental as frank apneas/hypopneas. Future large, prospective, randomized controlled studies on the effects of CPAP are still needed. The epidemiology of SDB in pregnant women needs to be further studied, as well as highlighting the need for systematic, long-term follow ups on mother and infant health post-delivery.

KEYWORDS:

• Sleep disordered breathing
• obstructive sleep apnea
• pregnancy
• preeclampsia
• gestational hypertension
• gestational diabetes
• continuous positive airway pressure

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Funding

This manuscript has not been funded.