Obstructive sleep apnea significantly increases risk for pregnancy complications

Researchers found that the risk for some pregnancy complications was significantly increased among pregnant women with obstructive sleep apnea.

The findings, recently presented at the American Thoracic Society International Conference, suggested a 174% increased risk for ICU admission and a significantly longer hospital stay. Increased risk for rare but severe complications, such as hysterectomy (126%), cardiomyopathy (259%), congestive heart failure (263%) and pulmonary edema (406%), was also associated with a diagnosis of obstructive sleep apnea (OSA).

Researchers suggested their findings should have primary care physicians consider screening female patients that are obese for sleep disordered breathing.

“Pregnancy appears to be predispose to the development of OSA due to dynamic physiologic changes,” Ghada Bourjeily, MD, associate professor of medicine, Brown University and The Miriam Hospital, and colleagues wrote. “The goal of this study was to examine the association of a diagnosis of OSA with adverse maternal outcomes.”

Bourjeily and colleagues analyzed the medical records of 1,577,632 pregnant women in the National Perinatal Information Center database from 2010 to 2014, and found that 0.12% had been formally diagnosed with OSA. Researchers used the ICD-9 codes for OSA diagnosis and other outcomes. Descriptive statistics were used to analyze demographic data. Multivariable logistic regression analysis was used to calculate adjusted ORs.

Bourjeily and colleagues found that after adjusting for maternal obesity, women with OSA were older (32.3 vs. 29.6 years, P < .001) and more likely to be black (aOR = 1.9; 95% CI, 1.72-2.11) or smokers (aOR = 1.72; 95% CI, 1.51-2.06). There was a significant association between OSA and prepregnancy hypertension (aOR = 5.2; 95% CI, 4.69-5.77), diabetes (aOR = 4.37; 95% CI, 3.81-5.01) coronary artery disease (aOR = 7.74; 95% CI, 4.18-14.3) and chronic renal disease (aOR = 2.49; 95% CI, 1.67-3.71).

There was also a significant association between OSA and gestational hypertensive disease and its complications after adjusting for maternal obesity, notably pulmonary edema (aOR = 9.92; 95% CI, 4.56-21.6), stroke (aOR = 8.25; 95% CI, 1.1-62), acute renal failure (aOR = 5.24; 95% CI, 3.33-8.33), ecclampsia (aOR = 2.5; 95% CI, 1.75-3.56), preeclampsia (aOR = 2.07; 95% CI, 1.09-1.5) and gestational hypertension (aOR = 1.28; 95% CI, 1.09-1.5). The risk for gestational diabetes was also significantly elevated (aOR = 1.78; 95% CI, 1.59-2). In addition, length of stay was significantly longer in women with OSA (5.1 vs. 3 days,) and odds of an admission to the intensive care unit were higher (aOR = 4.64; 95% CI, 4.03-5.35).

Bourjeily suggested how to put study’s findings into practice.

“Primary care physicians can screen young women with obesity for symptoms of sleep disordered breathing to help identify those at risk and evaluate them with a sleep study,” Bourjeily told Healio Family Medicine. “We do know that treatment for sleep apnea improves BP and quality of life in the general population. However, we do not know yet whether treating sleep apnea in pregnancy would positively impact pregnancy outcomes and that remains to be determined.”

The researchers are now looking at the connection between OSA and birth outcomes, as well as neonatal health and examining biological mechanisms underlying the association of OSA in pregnancy with adverse outcomes, as well as physiologic mechanisms that lead to the development of OSA in pregnancy, according to a press release. - by Janel Miller

Reference: Bourjeily, G. et al. Abstract 5163. Presented at: American Thoracic Society 2017 International Congress; May 19-24, 2017; Washington, DC.

Disclosure: Healio Family Medicine was unable to determine researchers’ relevant financial disclosures prior to publication.