Obstructive Sleep Apnoea in Pregnancy
Pregnancy is associated with:
- changes in physiology and sleep
- increased risk of developing OSA
- increased severity of preexisting OSA
OSA in pregnancy is associated with significant maternal and
fetal complications.
OSA in pregnancy is thought to be underdiagnosed.
Diagnostic challenges include:
- common symptoms (snoring, daytime sleepiness) are also common symptoms in normal pregnancy
- commonly used screening questionnaires (ESS, Berlin questionnaire) – poor predictive values in pregnancy1
- clinical picture can change rapidly as pregnancy progresses
1 Tantrakil et al Sleep Med Rev 2016
Diagnosis and monitoring
Whilst there is a lack of evidence-based management guidelines, there is general consensus:
- screen at-risk groups [Obese, hypertension (HTN), preclampsia, gestational diabetes mellitus (GDM)]
- serial monitoring is required
- – Type 1 Polysomnogram (PSG) (overnight in lab study)
- = gold standard in sleep diagnostic testing
- – Consider Type 2 (?home sleep) study if resource issues
CPAP therapy should be recommended for pregnant patients with:
- moderate/severe OSA, mild OSA with significant hypoxia (as per general guidelines)
- query for all pregnant patients with OSA (incl. mild OSA)
- – repeat PSG post-partum)
