167. Can obstructive sleep apnea worsen hypertension during gestation? Case report

Abstract

Several studies have demonstrated the association between obstructive sleep apnea syndrome (OSAS), characterized by airflow limitation, chronic intermittent hypoxia and apnea, and hypertensive disorders, but few report such events to gestation Objective Show the significant improvement of the clinical parameters of an hypertensive pregnant woman with the treatment of OSAS. A 26 years old, afro-descendant, obese, G3P2 with chronic arterial hypertension, was hospitalized at 32 weeks of gestation with progressive dyspnea, associated with tachycardia, orthopnea and nocturnal paroxysmal dyspnea. She was medicated with nifedipine 40 mg and alfametildopa 2 g (progressively escalated doses since the beggning of pregnancy). At physical exam: BMC 60, HR 125bpm, RR 22irpm, BP 140 × 100 mmHg, O2 Saturation (SatO2) 98%, bilateral pulmonary crackling in the middle third, lower limbs with good perfusion and no edema and fetal heart rate of 150 bpm. Chest radiograph showed pulmonary congestion, sinus tachycardia at electrocardiogram, echocardiogram with ejection fraction(EF) 56%. Measures were taken to treat pulmonary congestion, with noninvasive ventilation, furosemide and propranolol, with general clinical improvement. Arterial blood gas analysis without evidence of CO2 retention discarded the hypothesis of hypoexpansibility by obesity (PCO2 31,7). The polysomnography of type IV without the use of CPAP showed a SatO2 mean of 94% and a minimum of 84%, diagnosing moderate OSAS. During CPAP, there was an improvement in SatO2 standards. She underwent CPAP treatment with improved sleep and blood pressure levels, and discontinued the use of antihypertensive drugs, remaining normotensive. Fetal well being has always remained normal. A new echocardiogram after treatment showed increased EF (62%). Significant improvement in the clinical parameters of the pregnant woman after the use of CPAP. With the increased incidence of obesity, obstructive sleep apnea may become more frequent, but the literature is still scarce in relation to studies of this comorbidity in pregnancy.