Across pooled analyses and large cohort studies, pregnant patients with obstructive sleep apnea had roughly 2- to 3-fold higher odds of preeclampsia and were more likely to require intensive care and prolonged hospitalization in retrospective cohort analyses, according to a narrative review published in The Open Respiratory Medicine Journal.
Although obstructive sleep apnea is well characterized in the general population, pregnancy-related cases are frequently unrecognized, as symptoms such as snoring, fatigue, and daytime sleepiness may be attributed to physiologic changes of pregnancy. The researchers reported that obstructive sleep apnea (OSA) in pregnancy is frequently overlooked and is associated with adverse maternal and fetal outcomes.
OSA during pregnancy was associated with higher odds of preeclampsia, gestational hypertension, gestational diabetes, cardiomyopathy, pulmonary edema, cesarean delivery, intensive care unit admission, and longer hospital stays, across observational studies and meta-analyses. Reported adjusted odds ratios for preeclampsia ranged from approximately 2 to 3 in pooled analyses. These associations were linked to intermittent hypoxia, sympathetic activation, systemic inflammation, and endothelial dysfunction. As lead study author Parth Dhamelia of Maulana Azad Medical College, New Delhi, India, and colleagues noted, symptoms of OSA in pregnancy "are often attributed to normal physiological adaptations, leading to underdiagnosis and negative maternal and fetal outcomes."
Fetal outcomes associated with maternal OSA included increased risks of preterm birth, growth abnormalities, neonatal respiratory complications, and neonatal intensive care admission. Placental studies demonstrated markers of chronic fetoplacental hypoxia, while molecular analyses identified alterations in fetal gene expression and shorter telomere lengths in umbilical cord blood. Several studies reported that treatment with positive airway pressure was associated with reduced fetal growth restriction, although the evidence was largely observational.
The researchers also identified limitations in screening and diagnosis. Common questionnaires used to assess OSA demonstrated modest sensitivity and specificity in pregnant populations. Polysomnography remained the diagnostic reference standard, while home sleep testing was reported as feasible in selected high-risk pregnant patients.
The review consistently described higher OSA prevalence among pregnant patients with obesity, chronic hypertension, preeclampsia, cardiopulmonary complications, and worsening sleep-disordered breathing symptoms. Continuous positive airway pressure therapy was associated with improvements in some cardiometabolic and hypertensive outcomes, although adherence varied and pregnancy-specific randomized data were limited.
The authors reported no conflicts of interest.