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

Abstract

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.

Referral practices and treatment of obstructive sleep apnea in pregnancies with obesity

“…This is likely between 12 and 18 weeks to allow enough time for meaningful treatment, 22 but later screening should still be performed, especially for women at high risk or with significant related comorbidities for example, signs of right heart failure. Early gestational screening for OSA in individuals with chronic hypertension is also beneficial 23 . Unfortunately, gestation of OSA screening was also not recorded in our study.…”

“…Early gestational screening for OSA in individuals with chronic hypertension is also beneficial. 23 Unfortunately, gestation of OSA screening was also not recorded in our study.…”

A Relation between Obstructive Sleep Apnea in Pregnancy and Delivering Small for Gestational Age Infant—A Systematic Review

“…Some investigators suggest that OSA during pregnancy can lead to unfavorable maternal and fetal outcomes, which may be even more relevant in multiple pregnancies [ 62 ]. Therefore, screening all pregnant women for OSA symptoms and offering PSG to suspected cases and those with high-risk pregnancies, excessive daytime sleepiness, chronic hypertension, or obesity is recommended [ 14 , 63 , 64 , 65 , 66 , 67 , 68 ]. Additionally, BMI, age, and the presence of tongue enlargement can be used to predict the risk of OSA in pregnancy [ 69 ].…”