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)