Sleep apnea in pregnancy may raise future risk for hypertension, metabolic syndrome

Women with persistent sleep-disordered breathing during and after pregnancy had an increased risk for hypertension and metabolic syndrome, according to data published in the American Journal of Respiratory Critical Care Medicine.

“While epidemiologic data from cohorts of middle-aged and older adults indicate that sleep-disordered breathing is associated with adverse cardiometabolic outcomes, less is known about how sleep-disordered breathing in pregnancy and in the post-delivery period impacts maternal health,” Francesca L. Facco, MD, associate professor in the department of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine and the division of maternal fetal medicine at UPMC Magee-Womens Hospital, and colleagues wrote. “In pregnancy, increases in inflammation, oxidative stress and sympathetic nervous system activity, all of which can be exacerbated by sleep-disordered breathing, can lead to adverse maternal health events.”

This study evaluated a subgroup of 1,964 participants who underwent sleep-disordered breathing assessments during their first pregnancy and 1,222 participants who underwent a repeat sleep-disordered breathing assessment 2 to 7 years after delivery in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be Heart Health Study.

The adjusted RR for metabolic syndrome in those with an apnea-hypopnea index of 5 or more during pregnancy was 1.44 (95% CI, 1.08-1.93); the researchers reported no association with hypertension.

However, researchers observed an increased risk for hypertension (aRR = 2.02; 95% CI, 1.3-3.14) and metabolic syndrome (aRR = 1.53; 95% CI, 1.19-1.97) in those with an oxygen desaturation index of 5 or greater during pregnancy.

Participants with a persistent apnea-hypopnea index of five or more after delivery had higher risk for hypertension (aRR = 3.77; 95% CI, 1.84-7.73) and metabolic syndrome (aRR = 2.46; 95% CI, 1.59-3.76). These results were similar for oxygen desaturation index after delivery for hypertension (aRR = 1.75; 95% CI, 1.05-2.92) and metabolic syndrome (aRR = 1.60; 95% CI, 1.21-2.12).

“Further longitudinal studies are needed to examine the temporal or causal relationships between sleep-disordered breathing and cardiometabolic risk, to determine if simple oximetry monitoring can reliably be used to identify individuals at risk, and to study if treatment with CPAP during or after pregnancy can modify these risks,” Facco said.