828: Perinatal outcomes associated with obstructive sleep apnea in pregnancy: a prospective study

Abstract

sleep apnea in pregnancy: a prospective study Judette Louis, Susan Redline, Dennis Auckley, Anna Shepherd, Patricia Mencin, Brian Mercer MetroHealth Medical Center-Case Western Reserve University, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland, OH, Harvard Medical School, Division of Sleep Medicine, Department of Internal Medicine, Boston, MA, MetroHealth Medical Center-Case Western Reserve University, Division of Pulmonary, Critical Care and Sleep Medicine, Cleveland, OH, MetroHealth Medical CenterCase Western Reserve University, Obstetrics G Carlsbad, CA) that recorded nasal pressure, oxygen saturation, snoring, and head movements. All studies were manually scored by a central masked Sleep Reading Center using American Academy of Sleep Medicine diagnostic criteria. An apnea hypopnea index (AHI) 5 was considered to be diagnostic of OSA, [Mild (AHI: 5-15), Moderate (AHI: 15-30) and Severe (AHI: 30]. Perinatal outcomes were compared between women with and without OSA (p5 days, and readmission. Evaluated neonatal outcomes were: NICU admission, RDS, transient tachypnea (TTN), sepsis, and death. RESULTS: Among 170 evaluated obese women, the prevalence of OSA was 12.4% (12 mild, 7 moderate, 2 severe). Women with OSA had a mean AHI of 20 / 6 events per hour of sleep and spent 6.5 / 2.5% of the night with an SpO2 90%. Compared with controls, the OSA group had higher BMIs (49 / 11 vs. 39 / 6 k/m2, p 0.001) but similar rates of chronic hypertension (58 vs. 33%, p 0.07) and pregestational diabetes (15 vs. 20%, p 0.76). Severe maternal complications included: Maternal death (N 1, amniotic fluid embolus, control group) and cardiac arrest (N 1, intraoperative at cesarean delivery, OSA group). One previable birth and 2 stillbirths occurred in the control group. Among livebirths, OSA was associated with more frequent PET, NICU admission and TTN. (Table). After controlling for BMI, OSA was not associated with PET [OR .4(.11-1.4, p 0.15). After controlling for diabetes, gestational age and cesarean, neonates of women with OSA were more likely to have TTN (OR 4.7 (1.1-19.1, p 0.02) CONCLUSION: Untreated OSA among obese women in pregnancy is associated with more frequent neonatal respiratory complications 829 Nocturnal hypoxemia and neonatal body composition Judette Louis, Dennis Auckley, Susan Redline, Anna Shepherd, Patricia Mencin, Brian Mercer, Patrick Catalano MetroHealth Medical Center-Case Western Reserve University, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland, OH, MetroHealth Medical Center-Case Western Reserve University, Division of Pulmonary, Critical Care and Sleep Medicine, Cleveland, OH, Harvard Medical School, Division of Sleep Medicine, Department of Internal Medicine, Boston, MA, MetroHealth Medical Center-Case Western Reserve University, Obstetrics G Carlsbad, CA) that recorded nasal pressure, oxygen saturation, snoring, and head movements. Sleep studies were manually scored by an independent masked Sleep Reading Center using American Academy of Sleep Medicine diagnostic criteria. Any SpO2 90% was considered an episode of hypoxemia. Maternal and neonatal body composition was measured by air displacement plethysmography (BodPod, PeaPod). Neonatal morphometry was evaluated using a standardized protocol within 72 hours of birth. The primary outcome was neonatal lean body composition (%lean body mass, NLBM %). This analysis was restricted to neonates delivered 37 weeks. RESULTS: The cohort included 78 maternal/neonatal pairs. On average women were screened for OSA at mean [S.D.] gestational age of 22 [5] weeks, were age 27 [6] years, BMI 40.1 [8] kg/m2, % body fat (MBF %) 44 [6] %. And delivered at 38.6[1.3] weeks. Chronic hypertension (33%), pregestational (18%) and gestational diabetes (14%) were common. Eleven percent of these mothers had OSA who spent 2.5[1.1] % of the total sleep time with hypoxemia, and had a mean lowest SpO2 of 85 [5] %. Mean birth weight for the cohort was 3284 [507] gm, and NLBM% 86 [4] %. NLBM% was associated with maternal BMI (r 0.23, p 0.04), but not MBF% ( .15, p 0.06), degree of nocturnal hypoxemia (r .07, p 0.58) or lowest SpO2 (r .266, p 0.1). Neonates of OSA mothers were similar to neonates of non-OSA mothers regarding ponderal index (2.8 vs. 2.9, p 0.45) and NLBM% (85.1 vs. 87.7%, p 0.05). CONCLUSION: In obese pregnant women, using standardized methodology and criteria, neither prospectively diagnosed maternal OSA nor nocturnal hypoxia were associated with increased neonatal adiposity