Obese Pregnant Women Who Have Sleep Apnea May Have Delivery Complications

This article looks at the relationship between obese pregnant women with sleep apnea and delivery complications resulting in the infant staying in the ICU.

The newborns of obese pregnant women with obstructive sleep apnea, a disorder that causes disrupted sleep and pauses in breathing during the night, are more likely to be admitted to a neonatal intensive care unit, according to new research.

The study, published online in the journal Obstetrics & Gynecology, also found that sleep apnea was linked to higher rates of preeclampsia among very overweight women.

"Our findings show that obstructive sleep apnea can contribute to poor outcomes for both obese mothers and their babies," study lead author Dr. Judette Louis, a maternal-fetal medicine specialist and assistant professor of obstetrics and gynecology at the University of South Florida, said in a school news release.

"Its role as a risk factor for adverse pregnancy outcomes independent of obesity should be examined more closely," added Louis, who conducted the study while a faculty member at Case Western Reserve University's School of Medicine.

The researchers examined 175 obese pregnant women enrolled in a study that had screened them for sleep-related breathing disorders. The women were provided with a portable device to use at home to test for obstructive sleep apnea.

The study also analyzed more than 150 live births to track admissions to neonatal intensive care units, prematurity, congenital defects and respiratory problems among the newborns.

Roughly 15 percent of the women had sleep apnea. These women were more overweight and had more chronic high blood pressure than the women without the sleep disorder. Pregnant women with sleep apnea were more likely to have a Cesarean delivery and develop preeclampsia, a serious condition that results in high blood pressure and protein in the urine.

Although there was no difference among rates of preterm births among the women, the newborns of women with sleep apnea were more likely to be sent to the neonatal intensive care unit. Most often, these babies were admitted due to respiratory distress. The researchers pointed out that the greater number of C-section deliveries could also play a role in the higher neonatal intensive care unit admission rates.

Screening for sleep-disordered breathing among pregnant women should be improved, the researchers concluded.

Although the study found an association between obesity, sleep apnea and pregnancy complications, it did not prove a cause-and-effect relationship.

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ICU Might Not Be Necessary After Sleep Apnea Surgery

After undergoing surgery for obstructive sleep apnea, patients require close monitoring but may not need to be in an intensive care unit, according to a new study.

Obstructive sleep apnea is a disorder in which a person experiences abnormal pauses in breathing while they sleep. Sleep apnea can put people at risk of high blood pressure, stroke and heart problems.

Treatments include losing weight and continuous positive airway pressure (CPAP) devices, although some people may need surgery.

The surgery itself carries risks, however, the experts note. These include post-operative breathing difficulties, so patients are often placed in ICUs afterward.

But is that always necessary? To find out, researchers at the Pacific Sleep Centre in Singapore reviewed the cases of nearly 500 sleep apnea patients who had surgery between early 2007 and mid-2010. The surgeries included nasal, palate and tongue procedures.

The overall complication rate was 7 percent, according to the study, which appears online March 19 in the Archives of Otolaryngology -- Head & Neck Surgery.

Patients who undergo surgery for sleep apnea will end up with small lower jaws, making airway access difficult for anesthesiologists, the researchers noted. Another risk is dangerously slowed breathing due to anesthetics such as muscle relaxants and narcotics.

While routine admission to the ICU may not be necessary for all patients who've just had sleep apnea surgery, all patients should be closely monitored in the recovery or high-dependency area (one step below intensive care) for at least 3 hours after surgery, the researchers suggested.

"In conclusion, we strongly recommended that the clinician manage the patient with OSA [obstructive sleep apnea] with caution and prudence, with the understanding that these patients have a higher risk of airway compromise and respiratory depression intraoperatively and postoperatively," they wrote.

Dr. Lisa Liberatore, an ear, nose and throat specialist at Lenox Hill Hospital in New York City, said sleep apnea patients often have other medical issues that may raise surgical risks.

Because of the risks, surgeons should proceed with caution and patients should first try other, non-surgical treatments, she said.

"I recommend that the patient use CPAP first and lose at least 20 to 30 pounds before doing any surgery," Liberatore said.

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