Management of Obstructive Sleep Apnea in Pregnancy

Abstract

The spectrum of sleep-disordered breathing (SDB) ranges from mild snoring to obstructive sleep apnea, the most severe form of SDB. Current recommendations are to treat these women with continuous positive airway pressure despite limited data. SDB in early and mid-pregnancy is associated with preeclampsia and gestational diabetes. Pregnant women with a diagnosis of obstructive sleep apnea at delivery were at significantly increased risk of having cardiomyopathy, congestive heart failure, pulmonary embolism, and in-hospital death. These effects were exacerbated in the presence of obesity. Postpartum, these women are at risk for respiratory suppression and should be monitored.

Keywords: Anesthesia; Diabetes; Hypoxia; Obesity; Obstructive sleep apnea; Preeclampsia; Pregnancy; Sleep-disordered breathing.

Figure 1

The mechanisms that connect obstructive sleep apnea (OSA) in pregnant women with gestational diabetes and preeclampsia are not well-elucidated, but may share common pathways with cardiovascular and metabolic diseases associated with OSA in non-pregnant adults. OSA is associated with pro-inflammatory states, oxidative stress, and sympathetic activation. This cascade of events is thought to lead to endothelial dysfunction. Some of these same mechanisms have been implicated in the development of gestational diabetes and preeclampsia, but few studies have investigated these pathophysiologic mechanisms in women with OSA in pregnancy.

Figure 2

Untreated sleep disordered breathing (SDB) has a bidirectional association with type II diabetes and cardiovascular disease in non-pregnant adults. SDB has also been associated with gestational diabetes and hypertensive diseases of pregnancy in recent studies. Developing complications such as preeclampsia and gestational diabetes have been shown to increase the future risk of cardiovascular disease and type II diabetes among the affected women.