High risk for obstructive sleep apnea and other sleep disorders among overweight and obese pregnant women

Abstract

BackgroundObstructive sleep apnea (OSA), a common and serious disorder in which breathing repeatedly stops during sleep, is associated with excess weight and obesity. Little is known about the co-occurrence of OSA among pregnant women from low and middle-income countries.MethodsWe examined the extent to which maternal pre-pregnancy overweight or obesity status are associated with high risk for OSA, poor sleep quality, and excessive daytime sleepiness in 1032 pregnant women in Lima, Peru. The Berlin questionnaire was used to identify women at high risk for OSA. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to examine sleep quality and excessive daytime sleepiness, respectively. Multinomial logistic regression procedures were employed to estimate odds ratios (aOR) and 95 % confidence intervals (CI) adjusted for putative confounding factors.ResultsCompared with lean women (<25 kg/m2), overweight women (25–29.9 kg/m2) had 3.69-fold higher odds of high risk for OSA (95 % CI 1.82–7.50). The corresponding aOR for obese women (≥30 kg/m2) was 13.23 (95 % CI: 6.25–28.01). Obese women, as compared with their lean counterparts had a 1.61-fold higher odds of poor sleep quality (95 % CI: 1.00–2.63).ConclusionOverweight or obese pregnant women have increased odds of sleep disorders, particularly OSA. OSA screening and risk management may be indicated among pregnant women in low and middle income countries, particularly those undergoing rapid epidemiologic transitions characterized by increased prevalence of excessive adult weight gain.

Sleep disruption and duration in late pregnancy is associated with excess gestational weight gain among overweight and obese women

“…One possible mechanism underlying the observed association involves sleep disordered breathing. As pregnancy progresses, high fluid volume and engorged capillaries cause nasal congestion, and high BMI and excess gestational weight gain may further increase the likelihood of snoring, sleep disordered breathing, and obstructive sleep apnea . These conditions would also increase sleep disruption and result in shorter total sleep duration .…”

“…Pre‐pregnancy sleep disruption and duration were not assessed, and it is possible that poor sleep before pregnancy contributed to being overweight and that this pattern continued through pregnancy and contributed to excess gestational weight gain. Given prior studies documenting the influence of poor sleep on metabolic function as well as studies documenting the influence of high BMI on sleep quality, it is also possible that sleep and metabolism are part of a positive feedback loop that can be exacerbated during pregnancy.…”

“…Numerous studies have documented an association between high body mass index (BMI) and both shorter sleep duration and more severe sleep disruption in both pregnant and nonpregnant adults . Furthermore, poor sleep has been associated with several health risks, including metabolic disorder, cardiovascular disease, and mood disorders, and with poorer birth outcomes among pregnant women .…”

Sex differences in sympathetic activity in obesity and its related hypertension

“…79 Obesity is a major risk factor for obstructive sleep apnea. [80][81][82] During apneic episodes, blood oxygenation level decreases and carbon dioxide level increases; these changes stimulate peripheral and central chemoreceptors, leading to a profound increase in sympathetic outflow. 83,84 In addition, afferent vagal signals from pulmonary stretch receptors are diminished, resulting in augmented sympathetic activity.…”

Sleep-Disordered Breathing in Pregnancy

“…It is strongly associated with obesity; compared with lean women (<25 kg/m 2 ), overweight women (25-29.9 kg/m 2 ) are reported to have a 3.69-fold higher odds of obstructive sleep apnea (OSA) risk (95%CI 1.82-7.50) [4]. The corresponding adjusted odds ratio (OR) for obese women (≥30 kg/m 2 ) was 13.23 (95%CI 6.25-28.01) [4]. Furthermore, weight gain of only 10 % has been associated with a 6-fold increase in the development of significant SDB [5].…”