Maternal obstructive sleep apnea and neonatal birth outcomes in a population based sample

Bourjeily, Ghada; Danilack, Valery A.; Bublitz, Margaret H.; Muri, Janet H.; Rosene‐Montella, Karen; Lipkind, Heather S.

doi:10.1016/j.sleep.2019.01.019

Cited by 33 publications

(20 citation statements)

References 44 publications

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“…This agrees with data from a large retrospective database study and a meta-analysis. 11,38,39 The mechanisms that may connect maternal OSA with adverse neonatal outcomes are largely unknown but may relate to the greater burden of comorbidities in this patient population, namely preeclampsia, which is a risk factor for preterm birth and gestational diabetes. This is an area that warrants further investigation.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea Among Gravidas With Chronic Hypertension Compared to Matched Controls: A Prospective Cohort Study

Dominguez¹,

Grotegut

Wright³

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Previous studies of obstructive sleep apnea (OSA) risk in gravidas with chronic hypertension (cHTN) did not control for obesity as a risk factor for OSA. We therefore performed this study to evaluate whether OSA is more prevalent among gravidas with cHTN compared to normotensive gravidas matched for body mass index (BMI) and gestational age (primary outcome). We also assessed whether OSA is more severe when comorbid with cHTN in pregnancy (secondary outcome). METHODS: This was a single-center, prospective cohort study. Adult gravidas at 10-20 weeks of gestation, with and without cHTN, were enrolled and BMI matched. All subjects answered OSA screening questionnaires and underwent a home sleep test when they were between 10 and 20 weeks of gestation. Pregnancy outcomes were followed for all subjects. We performed univariable and multivariable logistic regression to model the relationship between cHTN status and OSA. RESULTS: A total of 100 pregnant subjects (50 with cHTN and 50 normotensive) completed a home sleep test of 2 hours or more. There were no differences in demographic variables between the 2 groups, except that gravidas with cHTN were significantly older than normotensive subjects (mean ± standard deviation [SD] 34 ± 4 vs 30 ± 6 years; P < .001). OSA was more prevalent (64% vs 38%; P = .009; odds ratio [95% confidence interval (CI)] 2.90 [1.30-6.65]; P = .01) and more severe in gravidas with cHTN (moderate or severe OSA 59% vs 21%; P = .009). After controlling for age, we found no overall association between cHTN on OSA risk (adjusted odds ratio [95% CI] 2.22 [0.92-5.40]; P = .076). However, among gravidas older than 25 years of age, cHTN was associated with higher odds of OSA (adjusted odds ratio [95% CI], 2.64 [1.06-6.71], P = .038). CONCLUSIONS: cHTN and age are important risk factors for OSA in gravidas. Gravidas with cHTN should be screened for OSA in early pregnancy. Future studies may validate screening tools that include cHTN and age, and investigate the role of OSA therapy in blood pressure control. (Anesth Analg 2023;136:205-14) KEY POINTS• Question: Is obstructive sleep apnea (OSA) more prevalent among gravidas with chronic hypertension (cHTN) compared to normotensive controls matched for body mass index (BMI) and gestational age, and is OSA more severe in gravidas with cHTN compared to controls? • Findings: OSA is nearly twice as prevalent and more severe among gravidas with cHTN in early gestation compared to BMI-matched controls; age appears to be an important variable in this relationship. • Meaning: cHTN and age are important risk factors for OSA in gravidas after controlling for BMI.

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Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea Among Gravidas With Chronic Hypertension Compared to Matched Controls: A Prospective Cohort Study

Dominguez¹,

Grotegut

Wright³

et al. 2022

Anesthesia &Amp; Analgesia

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“…SDB can lead to some fetal side-effects, including intrauterine growth retardation (IUGR), preterm labor, LBW, admission to neonatal intensive care unit, and Apgar score less than seven in the first minute of birth [47,54]. Li et al [55] showed that prenatal SDB didn't significantly relate to Apgar score and birth weight but it was associated with GDM, pregnancy-induced hypertension, and PEC.…”

Section: Fetal Outcomementioning

confidence: 99%

Sleep Disorders During Pregnancy and Postpartum: A Systematic Review

2021

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This study aimed to asses previous research results about bio-physiological alterations during pregnancy and postpartum, and make clear outlook about prevalence and related factors of sleep disorders during pregnancy and postpartum. In this review, the articles that published from 2000 to 2019 were reviewed. Related articles were searched from databases in English language. After evaluation of inclusion and exclusion criteria, articles were chosen and reviewed based on the University of York strategies. Sleep disorders in present study were classified according to the International Classification of Sleep Disorders-3. The search revealed 4449 articles, after evaluating and assessing qualified articles, finally 56 article selected to review. According to the results of this review, The prevalence of sleep disorders was almost 76%–97% in whole pregnancy. The most common sleep disorders included central disorders of hyper somnolence (waking up in the middle of the night, daytime sleepiness, sleeplessness) or insomnia, sleep-related movement disorders (restless legs syndrome), sleep related breathing disorders (obstructive sleep apnea), and parasomnia. In addition, sleep disorder may continue 3–12 months postpartum (33.2%). Sleep disorders induced by physiological processes (fetal movement, excessive weight gain, male sex of the fetus, and multiparty), health-related risks (metabolism disorders, cardiovascular diseases, and mood disorders), and physical or sexual abuse in childhood. In addition, these disorders could have maternal outcomes that can be greatest trigger to postpartum psychiatric disorders and fetal outcomes that have harmful sequences during childhood (sexual, fertility, emotional, and cognitive problems). Health care providers should evaluate the mothers’ sleep quality because sleep disorder leads to harmful consequences in fetuses and children.

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“…This may be related to the definition of exposure or outcome, differences in adjusting for confounders, or the methodology used. Emerging data link OSA or high risk for OSA with adverse fetal outcomes such as congenital anomalies, 8 large for gestational age, 3 and shortened telomere length, 18 but these have not been reproduced in other studies. There appears to be an increased risk for admission to the neonatal intensive care unit (NICU) 3,8,9,11,17 among the neonates of people with OSA, but the drivers of the association are unknown.…”

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confidence: 98%

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confidence: 99%

“…The increased morbidity associated with OSA during pregnancy, particularly for hypertensive disorders of pregnancy and gestational diabetes mellitus, has been demonstrated in several small prospective studies, metaanalyses, and large retrospective database studies and bring urgency to the purpose of this guideline. [1][2][3][4][5][6][7][8][9][10] Obstructive sleep apnea has also been associated with severe cardiovascular morbidity in national and population-based samples. 7,11 Despite considerable interest in the potential implications of maternal OSA on fetal and neonatal outcomes, the results of the few retrospective and prospective studies and meta-analyses that have examined these associations have been inconsistent.…”

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confidence: 99%

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Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy

Dominguez¹,

Cantrell²,

Habib³

et al. 2023

Obstetrics &Amp; Gynecology

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The Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology tasked an expert group to review existing evidence and to generate recommendations on the screening, diagnosis, and treatment of patients with obstructive sleep apnea during pregnancy. These recommendations are based on a systematic review of the available scientific evidence and expert opinion when scientific evidence is lacking. This guideline may not be appropriate for all clinical situations and patients, and physicians must decide whether these recommendations are appropriate for their patients on an individual basis. We recognize that not all pregnant people may identify as women. However, data on non–cisgendered pregnant patients are lacking, and many published studies use gender-binary terms; therefore, depending on the study referenced, we may refer to pregnant individuals as women. This guideline may inform the creation of clinical protocols by individual institutions that consider the unique considerations of their patient populations and the available resources.

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Maternal obstructive sleep apnea and neonatal birth outcomes in a population based sample

Cited by 33 publications

References 44 publications

Obstructive Sleep Apnea Among Gravidas With Chronic Hypertension Compared to Matched Controls: A Prospective Cohort Study

Obstructive Sleep Apnea Among Gravidas With Chronic Hypertension Compared to Matched Controls: A Prospective Cohort Study

Sleep Disorders During Pregnancy and Postpartum: A Systematic Review

Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy

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