What is the morbidity associated with sleep apnea during pregnancy?

Updated: Nov 08, 2018
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Although elderly men have the risk of obstructive sleep apnea, sleep-disordered breathing may also occur in pregnant women. [31] The prevalence of loud snoring is reported to increase during the late months of pregnancy. Women who gain excessive weight or develop fluid retention may be at particular risk for reduced airflow (ie, apneic and hypopneic events). Such irregularities in breathing degrade the quality of nighttime sleep and may lead to daytime sleepiness.

Possible nocturnal oxygen desaturation is another issue for pregnant women, especially during rapid eye movement (REM) sleep. REM sleep typically produces a generalized loss of muscle tone (except in the diaphragm). Consequently, patients with restrictive lung disease may breathe at abnormally low lung volumes during REM sleep. When lung volumes are low, blood may be shunted through underventilated lung tissue, and oxygen desaturation may result. The abdominal distention caused by a gravid uterus may produce or add to a preexisting restriction.

Sleep apnea is a recognized risk factor for hypertension. It may cause recurrent activation of the sympathetic nervous system in response to airway obstruction and hypoxemia. Women with preeclampsia are most likely to have narrow upper airways and to be snorers; this observation suggests that increased upper airway resistance or the resultant snoring or apneas may contribute to pregnancy-induced hypertension. A greater degree of sleep-disordered breathing is seen in in preeclamptic women than in nonpreeclamptic women. [32]

Pregnant women who have an elevated apnea-hypopnea index can be successfully treated with nasal continuous positive airway pressure (NCPAP) therapy, and their blood pressure can be decreased.


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