High blood pressure, snoring, and sleep apnea during pregnancy

This article examines how high blood pressure and snoring during pregnancy can indicate sleep apnea in pregnant women.

Half of hypertensive pregnant women who snore and one quarter of those who do not snore have unrecognized obstructive sleep apnea (OSA), suggesting such women should be tested for this condition. Findings from this cohort study were published online May 29 in BJOG.

OSA is a sleep disorder associated with reduced nocturnal blood oxygen levels and other morbidity. The prevalence of OSA increases during pregnancy, affecting up to one third of women by the third trimester.

"We know that habitual snoring is linked with poor pregnancy outcomes for both mother and child, including increased risk of C-sections and smaller babies," lead author Louise O'Brien, PhD, associate professor, Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, said in a news release. "Our findings show that a substantial proportion of hypertensive pregnant women have [OSA] and that habitual snoring may be one of the most telling signs to identify this risk early in order to improve health outcomes."

The study goal was to examine the prevalence of OSA among women with and without hypertensive disorders of pregnancy followed-up at obstetric clinics at an academic medical center. Pregnant women who were normotensive and those with hypertensive disorders (chronic hypertension, gestational hypertension, or preeclampsia) completed a questionnaire regarding habitual snoring. They also underwent overnight ambulatory polysomnography to determine the presence and severity of OSA.

Snoring and Hypertension Linked to OSA

Of 51 women with hypertensive disorders, 31 (61%) had OSA compared with 3 (19%) of 16 normotensive women (P = .008 by chi-square). Although nonsnoring women with hypertensive disorders generally had mild OSA, more than 25% of snoring women with hypertensive disorders had moderate to severe OSA.

Among women with hypertensive disorders, those who snored had a substantially greater apnea/hypopnea index than did nonsnorers (19.9 ± 34.1 vs 3.4 ± 3.1; P = .013), as well as a significantly lower oxyhemoglobin saturation nadir (86.4 ± 6.6 vs 90.2 ± 3.5; P = .021).

After stratification by obesity, the pooled relative risk for OSA in snoring versus nonsnoring women with hypertension was 2.0 (95% confidence interval, 1.4 - 2.8), or double the risk.

Women with chronic snoring were most likely to have chronic hypertension, whereas women with gestational hypertension were more likely to have the onset of snoring during pregnancy.

Limitations of this study include an inability to determine causality. In addition, only about one third of women who were invited to take participate actually did so.

"Hypertensive pregnant women who report snoring should be evaluated for [OSA,] since sleep apnea can be treated during pregnancy," Dr. O'Brien said. "Prompt recognition, evaluation, and management will not only improve health benefits for both moms and babies but may also help cut the high healthcare expenses of operative deliveries, taking care of babies who are admitted to the [neonatal intensive care unit] and other associated health risks."

In an accompanying commentary, F. Facco, MD, from the Department of Obstetrics and Gynecology, University of Pittsburgh, Pennsylvania, reviews current knowledge of sleep-disordered breathing (SDB) in pregnancy.

"[W]ell-designed clinical trials of CPAP use in pregnancy are needed to determine whether treatment of SDB during pregnancy can improve pregnancy outcomes; however, in the meantime we have to recognise that as our obstetrical patient population is becoming more obese, we will encounter more women with symptomatic SDB in pregnancy," Dr. Facco writes. "It is well documented that patients with symptomatic SDB, typically those who snore and report persistent complaints of significant sleep disruption and excessive daytime sleepiness, can benefit from CPAP in terms of sleep quality and daytime function. Therefore, in addition to encouraging women already prescribed CPAP to continue their therapy during pregnancy, obstetricians who suspect a patient may suffer from symptomatic SDB should refer her to a sleep specialist for diagnosis and possible treatment."

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Pregnant women with hypertension and who snore may have a sleep disorder

A study shows that nearly half of pregnant women with hypertension and who snore may also have an undiagnosed sleep disorder.

One in two hypertensive pregnant women who habitually snore may have unrecognized obstructive sleep apnea, a sleeping disorder that can reduce blood oxygen levels during the night and that has been linked to serious health conditions, new University of Michigan-led research shows.

One in four hypertensive pregnant women who don't snore also unknowingly suffer from the sleeping disorder, according to the study that appears in the British Journal of Obstetrics and Gynecology.

"We know that habitual snoring is linked with poor pregnancy outcomes for both mother and child, including increased risk of C-sections and smaller babies," says lead author Louise O'Brien, Ph.D., M.S., associate professor at U-M's Sleep Disorders Center in the Department of Neurology and adjunct associate professor in the Department of Obstetrics & Gynecology at the U-M Medical School.

"Our findings show that a substantial proportion of hypertensive pregnant women have obstructive sleep apnea and that habitual snoring may be one of the most telling signs to identify this risk early in order to improve health outcomes."

Habitual snoring – snoring three or more nights a week – is the hallmark symptom of obstructive sleep apnea, which has been shown to increase in frequency during pregnancy. and affects up to one-third of women by the third trimester.

O'Brien's previous studies have found that snoring during pregnancy may influence delivery and baby's health, with a higher risk for C-sections and delivering smaller babies. Women who begin snoring during pregnancy are also at a strong risk for high blood pressure and preeclampsia, O'Brien's research has shown.

"Hypertensive pregnant women who report snoring should be evaluated for obstructive sleep apnea since sleep apnea can be treated during pregnancy," says O'Brien, who is also a member of the Institute for Healthcare Policy and Innovation.

"Prompt recognition, evaluation, and management will not only improve health benefits for both moms and babies but may also help cut the high healthcare expenses of operative deliveries, taking care of babies who are admitted to the NICU and other associated health risks."

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A baby's health may be hurt by a mother's sleep apnea

This article explains how sleep apnea during pregnancy may hurt a baby's health

For a lot of us, snoring is simply a part of life.  But while millions deal with and have learned to live with snoring, it could have a significant impact on expectant mothers. Scientists have looked into how snoring can affect a woman during pregnancy, but a recent study showed that snoring can also affect an unborn child.

Snoring can sometimes be attributed to a sleep disorder known  as sleep apnea, which causes one to momentarily stop breathing while asleep. This can happen a few times a night or, in more severe cases, up to hundreds of times, causing the amount of oxygen in the blood to decrease. Untreated sleep apnea can lead to other health problems, and in pregnant women, can increase the risk of pre-eclampsia or high blood pressure.

With this in mind, it’s easy to see why doctors would be concerned about an infant’s health if its mother was snoring during pregnancy and had a sleep disorder. To find out just what these snoring risks were, the scientists who conducted the new study followed more than 1,600 mothers during their pregnancies; one-third of the pregnant women studied were regular snorers. Among the snorers, quite a number had cesarean deliveries; not only that, many were emergency C-sections. Another trend noticed among the mothers who snored was that their newborns weighed less than average. This isn’t necessarily a bad thing, but smaller infants have been found to be more prone to certain medical conditions.

Now that this new information has come to light, doctors can prepare accordingly. Screening expectant mothers for disorders such as sleep apnea is clearly essential. Checking breathing and oxygen levels are steps that can be taken early on in a woman’s pregnancy to find the cause of her snoring and perhaps even eliminate it. In the case of sleep apnea, there are treatments that can also help patients rest better and maintain proper oxygen levels, leading to better quality of life for mom and baby.

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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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Snoring during pregnancy could mean greater risk of high blood pressure

A new study discusses how snoring during pregnancy may indicate a risk of high-blood pressure and preeclampsia.

Objective

This study aimed to prospectively examine the impact of chronic vs pregnancy-onset habitual snoring on gestational hypertension, preeclampsia, and gestational diabetes.

Study design

Third-trimester pregnant women were recruited from a large, tertiary medical center from March 2007 through December 2010 and screened for the presence and duration of habitual snoring, as a known marker for sleep-disordered breathing. Clinical diagnoses of gestational hypertension, preeclampsia, and gestational diabetes were obtained.

Results

Of 1719 pregnant women, 34% reported snoring, with 25% reporting pregnancy-onset snoring. After adjusting for confounders, pregnancy-onset, but not chronic, snoring was independently associated with gestational hypertension (odds ratio, 2.36; 95% confidence interval, 1.48–3.77; P < .001) and preeclampsia (odds ratio, 1.59; 95% confidence interval, 1.06–2.37; P = .024) but not gestational diabetes.

Conclusion

New-onset snoring during pregnancy is a strong risk factor for gestational hypertension and preeclampsia. In view of the significant morbidity and health care costs associated with hypertensive diseases of pregnancy, simple screening of pregnant women may have clinical utility.

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Perinatal Outcomes Associated With Obstructive Sleep Apnea in Obese Pregnant Women

In obese women, sleep apnea increases risk of NICU admission from 17% to 46%, cesarean  33 to 65% and preeclampsia 17 to 42%! JR

Perinatal Outcomes Associated With Obstructive Sleep Apnea in Obese Pregnant Women

Louis, Judette MD, MPH; Auckley, Dennis MD; Miladinovic, Branko PhD; Shepherd, Anna BSN; Mencin, Patricia BBA; Kumar, Deepak MD; Mercer, Brian MD; Redline, Susan MD, MPH

Published Ahead-of-Print

Abstract

OBJECTIVE: To investigate the associations between obstructive sleep apnea (OSA) and maternal and neonatal morbidities in a cohort of obese gravid women.

METHODS: Participants were enrolled in a prospective observational study designed to screen for OSA and describe the possible risk factors for and outcomes of OSA among obese (body mass index [BMI, calculated as weight (kg)/[height (m)]2] 30 or higher) pregnant women. Women underwent an overnight sleep study using a portable home monitor. Studies were manually scored by a central masked sleep reading center using American Academy ofSleep Medicine diagnostic criteria. An apnea hypopnea index of 5 or more was considered diagnostic of OSA. Perinatal outcomes were compared between women with and without OSA.

RESULTS: Among 175 women, OSA prevalence was 15.4% (13 mild, nine moderate, five severe). Compared with no OSA (apnea hypopnea index less than 5), the OSA group had a higher BMI (46.8+/-12.2 compared with 38.1+/-7.5; P=.002) and more chronic hypertension (55.6 compared with 32.4%, P=.02). Maternal complications included maternal death (n=1, amniotic fluid embolus [no OSA group]) and cardiac arrest (n=1, intraoperative at cesarean delivery [OSA group]). One previable birth and two stillbirths occurred in the no OSA group. Among live births, OSA was associated with more frequent cesarean delivery (65.4 compared with 32.8%; P=.003), preeclampsia (42.3 compared with 16.9; P=.005), and neonatal intensive care unit admission (46.1 compared with 17.8; P=.002). After controlling for BMI, maternal age, and diabetes, OSA (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.1-11.3), previous preeclampsia (OR 2.79, 95% CI 1.09-7.19), and hypertension (OR 4.25, 95% CI 1.67-10.77) were associated with development of preeclampsia.

CONCLUSION: Obstructive sleep apnea among obese pregnant women is associated with more frequent preeclampsia, neonatal intensive care unit admissions, and cesarean delivery.

LEVEL OF EVIDENCE: II

Abstract here