Obstructive Sleep Apnea Is Associated With Late-Onset Preeclampsia in Overweight Pregnant Women in Korea

Abstract

Background Obstructive sleep apnea (OSA) is closely related to maternal obesity in pregnant women, and the association increases with later pregnancy. Obesity and OSA are risk factors of pregnancy-related complications, including gestational hypertension, gestational diabetes mellitus (GDM), and fetal morbidities. We aimed to determine the prevalence of OSA and to assess the impact of OSA on pregnancy-related disorders in overweight pregnant women. Methods Eligible participants who were overweight [body mass index (BMI) ≥ 23 kg/m 2 ] in gestational age 30 weeks or more, assessed OSA using a portable polysomnography at home. Clinical data were collected from pregnant women and their babies. Results The average age of 51 participants was 34.5 years (27–44 years). The number of primipara was 25 (49%) and that of multipara was 26 (51%). Eight cases of GDM (15.7%) and five cases of preeclampsia (9.8%) were reported, and six patients (11.8%) experienced preterm delivery. In results of polysomnography, 14 patients (27.5%) were diagnosed as OSA. Apnea-hypopnea index moderately correlated with BMI ( r = 0.515, P < 0.001). The BMI ( P < 0.005) and preeclampsia rate ( P < 0.017) were higher in the OSA group compared to the control group. Odds ratios (ORs) adjusting age, BMI, parity, and abortion history were calculated. The presence of OSA increased OR of preeclampsia (OR, 13.1; 95% confidence interval, 1.1–171.3). The majority of preeclampsia patients (4/5, 80%) underwent preterm delivery. Conclusion OSA is an important risk factor for preeclampsia, resulting in preterm delivery. For overweight pregnant women, an OSA evaluation should be mandatory.

Application of portable sleep monitoring devices in pregnancy: a comprehensive review

“…In some studies (Louis et al 2012), it has been reported that SDB increases the frequency of caesarean delivery and chronic hypertension and delivery of small for gestational age while one work reported that they found no relationship between SDB exposure such perinatal outcomes (Facco et al 2014b). A few studies examined the association between SDB and preeclampsia reporting that SDB is an important risk factor for preeclampsia that may significantly influence the perinatal outcomes such as preterm delivery (Yinon et al 2006, Facco et al 2013, Ryu et al 2023. However, obesity seems, once again, plays a critical role in defining the association between SDB and maternal and fetal outcomes.…”

“…They have reported that preeclamptic subjects (20 preeclamptic patients) experience more SDB events and higher degree of nocturnal hypoxemia compared to normotensive controls (20 normotensive control patients). Ryu et al (2023) studied the prevalence of OSA in 51 pregnant Korean women with BMI >23 kg m −2 in gestational age of 30 weeks or more using WatchPAT. They reported that OSA is an important risk factor for preeclampsia resulting in preterm delivery in overweight pregnant women.…”

Prevalence and factors associated with restless legs syndrome among pregnant women in middle-income countries: a systematic review and meta-analysis

“…This could be due to vascular changes and reduced blood flow associated with preeclampsia, which may contribute to the development or worsening of RLS symptoms (78-80). On the other hand, RLS, which is associated with obstructive sleep apnea, can result in the occurrence of preeclampsia by causing apneas or hypopneas, inducing sympathetic activation, endothelial dysfunction, and abnormal placental physiology (50,(81)(82)(83)(84)(85). This can be decreased by increasing ventilation and ensuring an open airway through lifestyle modifications, constant positive airway pressure, or other mechanisms based on individual needs (86, 87).…”

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 ].…”