10 Sep Pregnancy and obstructive sleep apnoea an underrecognized condition
Prevalence:
Studies suggest that obstructive sleep apnoea affects 3.6% – 27% of pregnant women.
Sleep apnoea during pregnancy can be categorised into two classes:
- Pre-existing obstructive sleep apnoea diagnosed during pregnancy
- Gestational obstructive sleep apnoea, where obstructive sleep apnoea is brought on by pregnancy
Physical factors causing Gestational sleep apnoea:
- Weight gain
- Oedema – increased blood volume and fluid retention that can accumulate in the tissue of the neck
- Fat deposits – especially in the tissue of the neck
- Increased breast size
These factors increase mechanical pressure on the upper airway. Additionally, the growing foetus elevates the diaphragm, which reduces lung capacity and increases the effort required to breathe.
Hormonal factors causing Gestational sleep apnoea:
- Progesterone – relaxes bronchial smooth muscle, increasing airway collapsibility. However, it also acts as a respiratory stimulant, enhancing the brain’s sensitivity to carbon dioxide and triggering more forceful breathing efforts.
- Estrogen – promotes swelling of mucous membranes in the nose and oropharynx, narrowing the airway and increasing airflow resistance.
Impact on maternal and foetal health:
- Gestational diabetes
- Pre-eclampsia
- Preterm birth
- Neonatal intensive care unit (NICU) admission
- Cardiovascular disease
- Impaired placental function and restricted foetal growth
These complications are linked to intermittent hypoxia, which causes surges in peripheral vasoconstriction, blood pressure, and heart rate. This in turn leads to endothelial dysfunction.
Treatment:
CPAP Therapy has been shown to significantly reduce the risks and health impacts associated with OSA during pregnancy. Although more research is needed regarding its impact on foetal outcomes, CPAP is considered safe for use during pregnancy.
References
Dominguez, J. E., Street, L., & Louis, J. (2018). Management of obstructive sleep apnea in pregnancy. Obstetrics and Gynecology Clinics of North America, 45(2), 233–247. https://doi.org/10.1016/j.ogc.2018.01.001
Gabryelska, A., Łukasik, Z. M., Makowska, J. S., & Białasiewicz, P. (2018). Obstructive sleep apnea: from intermittent hypoxia to cardiovascular complications via blood platelets. Frontiers in Neurology, 9. https://doi.org/10.3389/fneur.2018.00635
Gottlieb, J. D., Schwartz, A. R., Marshall, J., Ouyang, P., Kern, L., Shetty, V., Trois, M., Punjabi, N. M., Brown, C., Najjar, S. S., & Gottlieb, S. S. (2009). Hypoxia, not the frequency of sleep apnea, induces acute hemodynamic stress in patients with chronic heart failure. Journal of the American College of Cardiology, 54(18), 1706–1712. https://doi.org/10.1016/j.jacc.2009.08.016
Maniaci, A., La Via, L., Pecorino, B., Chiofalo, B., Scibilia, G., Lavalle, S., & Scollo, P. (2024). Obstructive Sleep Apnea in Pregnancy: A Comprehensive review of Maternal and Fetal implications. Neurology International, 16(3), 522–532. https://doi.org/10.3390/neurolint16030039
Pelizzo, G., Calcaterra, V., Baldassarre, P., Marinaro, M., Taranto, S., Ceresola, M., Capelo, G., Gazzola, C., & Zuccotti, G. (2024). The impact of hormones on lung development and function: an overlooked aspect to consider from early childhood. Frontiers in Endocrinology, 15. https://doi.org/10.3389/fendo.2024.1425149