An assessment of risks associated with obstructive sleep apnea and its relationship with adverse health outcomes among pregnant women. A multi-hospital based study.

Nitin Joseph,Shreeshaina Shreeshaina,Vinod Kumar Gundi,Mrudula Bhargav Herambapura Subramanya,Shivani Bhat Loliem,Shreyashree Belthur Shashidhar

doi:10.5603/arm.a2020.0104

Abstract

Physiological changes in pregnancy increase the vulnerability of antenatal women to develop obstructive sleep apnoea (OSA). It is a known cause of several adverse health outcomes in pregnancy. To assess the risk status of OSA in pregnant women and to study its association with adverse maternal outcomes, fatigability, and daytime sleepiness. Pregnant women were interviewed to assess for the risk of OSA, fatigability, and daytime sleepiness. STOP BANG, the fatigue severity scale, and the Epworth sleepiness scale were used to assess these parameters. The mean age of the 214 participants was 27.2 ± 4.7 years. 7 (3.3%) participants had a history of snoring louder than the volume of normal talking, or of being loud enough to be heard past closed doors. A moderate risk status of OSA was present among 3 (1.4%) participants. 45 (21.0%) pregnancies were high risk in nature. The risk status of OSA was associated with a high risk status of pregnancies among the participants (p = 0.0088). 41 (19.2%) participants had a history of significant fatigue over the previous week of the study. 7 (3.3%) participants reported mild to severe excessive daytime sleepiness. A history of snoring loudly (p = 0.0179) and a OSA risk status (p = 0.0027) was associated with excessive daytime sleepiness. A risk status for OSA was associated with a high risk pregnancy status and excessive daytime sleepiness among pregnant women in the current setting. Therefore, pregnant women with these conditions need to be evaluated for OSA. They also need to be suitably managed to ensure the healthy well-being of the mother and the baby.

Highlights

Physiological changes in pregnancy increase the vulnerability of antenatal women to develop obstructive sleep apnoea (OSA)
The majority of pregnant women were in the third trimester [144 (67.3%)]
1.4% of the participants were found to have a greater risk for developing OSA which was again less than 13.4% [14], 18.4% [15], 26.4% [9], 26.7% [16] and 30.9% [17] reported in previous studies

Summary

Introduction

Physiological changes in pregnancy increase the vulnerability of antenatal women to develop obstructive sleep apnoea (OSA). Objectives: To assess the risk status of OSA in pregnant women and to study its association with adverse maternal outcomes, fatigability, and daytime sleepiness. A history of snoring loudly (p = 0.0179) and OSA risk status (p = 0.0027) was associated with excessive daytime sleepiness. Conclusions: A risk status for OSA was associated with a high risk pregnancy status and excessive daytime sleepiness among pregnant women in the current setting. High levels of progesterone and estrogen during pregnancy cause fluid retention leading to swelling around the neck, mucus membranes, and nasal passages These changes result in narrowing of the oropharyngeal diameter and increased upper airway resistance leading to the occurrence of snoring [1]. Prior studies have observed OSA complicating pregnancy and resulting in an increased risk of intensive care admission as well as an increased duration of time spent in the hospital [3]

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