Obstructive Sleep Apnea In Pregnancy Research Articles

Effect of Obstructive Sleep Apnea during Pregnancy on Fetal Development: Gene Expression Profile of Cord Blood.

Obstructive sleep apnea (OSA) is quite prevalent during pregnancy and is associated with adverse perinatal outcomes, but its potential influence on fetal development remains unclear. This study investigated maternal OSA impact on the fetus by analyzing gene expression profiles in whole cord blood (WCB). Ten women in the third trimester of pregnancy were included, five OSA and five non-OSA cases. WCB RNA expression was analyzed by microarray technology to identify differentially expressed genes (DEGs) under OSA conditions. After data normalization, 3238 genes showed significant differential expression under OSA conditions, with 2690 upregulated genes and 548 downregulated genes. Functional enrichment was conducted using gene set enrichment analysis (GSEA) applied to Gene Ontology annotations. Key biological processes involved in OSA were identified, including response to oxidative stress and hypoxia, apoptosis, insulin response and secretion, and placental development. Moreover, DEGs were confirmed through qPCR analyses in additional WCB samples (7 with OSA and 13 without OSA). This highlighted differential expression of several genes in OSA (EGR1, PFN1 and PRKAR1A), with distinct gene expression profiles observed during rapid eye movement (REM)-OSA in pregnancy (PFN1, UBA52, EGR1, STX4, MYC, JUNB, and MAPKAP). These findings suggest that OSA, particularly during REM sleep, may negatively impact various biological processes during fetal development.

Obstructive Sleep Apnea in Pregnancy: A Comprehensive Review of Maternal and Fetal Implications.

Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition in pregnancy, associated with various maternal and fetal complications. This review synthesizes the current evidence on the epidemiology, pathophysiology, and neurological consequences of OSA in pregnancy, along with the potential management strategies. Articles were sourced from the PubMed, EMBASE, and Cochrane databases until 2023. Our comprehensive review highlights that the incidence of OSA increases during pregnancy due to physiological changes such as weight gain and hormonal fluctuations. OSA in pregnancy is linked with gestational hypertension, pre-eclampsia, gestational diabetes, and potential adverse fetal outcomes such as intrauterine growth restriction and preterm birth. Continuous positive airway pressure (CPAP) therapy remains the most effective management strategy for pregnant women with OSA. However, adherence to CPAP therapy is often suboptimal. This comprehensive review underscores the importance of the early recognition, timely diagnosis, and effective management of OSA in pregnancy to improve both maternal and fetal outcomes. Future research should focus on enhancing screening strategies and improving adherence to CPAP therapy in this population.

The Effectiveness of Continuous Positive Airway Pressure for Treating Obstructive Sleep Apnoea in Pregnancy: A Systematic Review

(Aust N Z J Obstet Gynaecol 2023. 2023;63(3):290–300) Obstructive sleep apnea (OSA) is characterized by recurrent pauses in breathing during sleep due to upper airway collapse, resulting in decreased oxygen levels. OSA affects around 10.5% of parturients during early pregnancy and up to 30% at term. In pregnancy, OSA is associated with an increased risk for gestational hypertension, pre-eclampsia, and gestational diabetes. Infants born to mothers with OSA may have a lower birth weight and are at increased risk for premature delivery and neonatal intensive care unit admission. Baseline obesity increases the risk of OSA during pregnancy, with lifestyle modifications being the standard treatment, though their influence on maternal outcomes is limited. Continuous positive airway pressure (CPAP) is an effective OSA treatment; however, little research exists on the impact of CPAP on either maternal or fetal outcomes. This systematic review sought to investigate if the use of CPAP improved outcomes for pregnant women with or at risk of OSA.

Home monitoring for clinically suspected obstructive sleep apnea in pregnancy

Home monitoring for clinically suspected obstructive sleep apnea in pregnancy

A machine learning-based model to predict obstructive sleep apnea in pregnancy

A machine learning-based model to predict obstructive sleep apnea in pregnancy

A Relation between Obstructive Sleep Apnea in Pregnancy and Delivering Small for Gestational Age Infant-A Systematic Review.

Obstructive sleep apnea (OSA) during pregnancy can negatively affect both the mother and the baby. Our main goal is to show whether there is an association between OSA during pregnancy and delivering small for gestational age (SGA) infants. This systematic review was conducted according to the PRISMA 2020 statement using three databases: MEDLINE via PubMed, Scopus, and Cochrane Library. All databases were last accessed on 1 June 2023. The implemented systematic literature search identified 744 articles. After excluding reviews, meta-analyses, book chapters, case reports, and letters, 47 studies were analyzed, 18 of which finally met the inclusion criteria. The included studies mainly indicate that OSA during pregnancy may not significantly impact SGA, but some of them have shown the existence of this relation. Nevertheless, it is recommended that all pregnant women should be screened for symptoms of OSA and that sleep tests should be performed on those who show signs of it. Detecting and treating OSA early in pregnancy can help reduce the condition's negative effects. However, more extensive studies are still needed to gather clear evidence on the impact of an OSA diagnosis on mothers and babies.

Home monitoring for clinically suspected obstructive sleep apnea in pregnancy.

To determine if a home sleep apnea test (HSAT) using a type III portable monitor (PM), Nox-T3 (Nox Medical, Inc., Reykjavik, Iceland), detects obstructive sleep apnea in pregnant women. Ninety-two pregnant women (34.5 ± 4.3 years; gestational age 25.4 ± 8.9 weeks; body mass index 29.9 ± 4.7 kg/m2) with suspected obstructive sleep apnea underwent HSAT with the Nox-T3 PM followed by overnight polysomnography (PSG) and PM recording simultaneously in the laboratory within 1 week. PMs were scored automatically and manually using a 3% criteria and compared with PSGs scored by following guidelines. Apnea-hypopnea indexes were 8.56 ± 10.42, 8.19 ± 13.79, and 8.71 ± 14.19 events/h on HSAT, in-laboratory PM recording, and PSG (P = .955), respectively. Bland-Altman analysis of the apnea-hypopnea index on PSG vs HSAT showed a mean difference (95% confidence interval) of -0.15 (-1.83, 1.53); limits of agreement (± 2 SD) were -16.26 to 16.56 events/h. Based on a threshold apnea-hypopnea index ≥ 5 events/h, HSAT had 91% sensitivity, 85% specificity, 84% positive-predictive value, and 92% negative-predictive value compared with PSG. When comparing the simultaneous recordings, closer agreement was observed. Automated vs manual analysis of PM showed no significant difference. A type III PM had an acceptable failure rate and high diagnostic performance operating as a reasonable alternative for in-laboratory PSG in pregnant women. Wang J, Zhang C, Xu L, etal. Home monitoring for clinically suspected obstructive sleep apnea in pregnancy. J Clin Sleep Med. 2023;19(11):1951-1960.

Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy.

The Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology tasked an expert group to review existing evidence and to generate recommendations on the screening, diagnosis, and treatment of patients with obstructive sleep apnea during pregnancy. These recommendations are based on a systematic review of the available scientific evidence and expert opinion when scientific evidence is lacking. This guideline may not be appropriate for all clinical situations and patients, and physicians must decide whether these recommendations are appropriate for their patients on an individual basis. We recognize that not all pregnant people may identify as women. However, data on non-cisgendered pregnant patients are lacking, and many published studies use gender-binary terms; therefore, depending on the study referenced, we may refer to pregnant individuals as women. This guideline may inform the creation of clinical protocols by individual institutions that consider the unique considerations of their patient populations and the available resources.

Clinical application of a previously validated pregnancy-specific screening tool for sleep apnea in a cohort with a high prevalence of obesity

ObjectiveThe purpose of this project was to determine the positive predictive value of existing obstructive sleep apnea (OSA) screening tools in clinical use, in a real-world clinical population of gravidae, and to explore the development of a new questionnaire for screening for OSA during pregnancy. MethodsPregnant people were administered sleep screening questionnaires as part of routine clinical care. These included Facco's four variable OSA screening tool, the STOP-BANG, and the Epworth Sleepiness Scale. Those who screened positive were referred for diagnostic sleep testing, typically with a type III home monitoring device. Here we analyzed the screening responses used by those who completed diagnostic testing to determine the positive predictive value of the existing tools. Results159 pregnant people completed diagnostic OSA testing and were included in this analysis. The positive predictive value of Facco's four variable sleep screening tool was 74.3%, STOP-BANG was 75.3%, and the Epworth Sleepiness Scale was 69.8%. Our sample size was insufficient to create a new screening tool. ConclusionsHere we calculated the positive predictive value of Facco's 4 variable screening tool for screening for OSA in pregnancy in a real-world pregnant population. While we were not able to generate a new screening tool for screening for OSA during pregnancy, both STOP-BANG and Facco's four variable tool had positive predictive values over 70% in our population which was characterized by high BMI and advanced maternal age. Increased clinical use of the pregnancy-specific tool may be warranted.

Sleep-disordered breathing and obstructive sleep apnea in pregnancy: the burden of patient BMI and risk of poor outcome

Sleep-disordered breathing and obstructive sleep apnea in pregnancy: the burden of patient BMI and risk of poor outcome

A trial of positive airway pressure for the treatment of sleep apnea in pregnancy

The pathophysiology of obstructive sleep apnea in pregnancy remains poorly understood and studies examining the effect of treatment with positive airway pressure on pregnancy have been limited. This study aimed to perform a randomized controlled trial of positive airway pressure treatment for obstructive sleep apnea in pregnancy. Participants with a body mass index ≥30 kg/m2 underwent polysomnography at 14 to 20 weeks' gestation (visit 1) and those with obstructive sleep apnea (apnea-hypopnea index ≥5 but <50) were enrolled. In phase 1, participants were randomized to autotitrating positive airway pressure vs sham positive airway pressure; in phase 2, the sham arm was replaced with a sleep hygiene control. Participants returned at 28 to 31 weeks' gestation (visit 2). The mean arterial blood pressure, uterine artery Doppler pulsatility index, endoglin, soluble FMS-like tyrosine kinase 1 levels, and placental growth factor levels were measured, as well as fasting glucose and insulin to calculate insulin resistance (homeostatic model assessment for insulin resistance). The primary outcome was a composite of the uterine artery Doppler pulsatility index, soluble FMS-like tyrosine kinase 1 to placental growth factor ratio, and the homeostatic model assessment for insulin resistance. For secondary analyses, each outcome variable was analyzed independently. Adherence to treatment was examined. A total of 241 participants completed visit 1, and 89 (37%) had an apnea-hypopnea index between 5 and 50. Of the those, 51 participants were randomized in phase 1 and 38 in phase 2. There was no significant difference in our primary outcome by treatment group. In secondary analyses, the uterine artery Doppler pulsatility index was lower in participants on autotitrating positive airway pressure when compared with sleep hygiene controls. Otherwise, there were no differences in the mean arterial blood pressure, angiogenic markers, or metabolic markers in phase 1, phase 2, or across the entire study. The overall adherence to autotitrating positive airway pressure therapy was low, but the mean use was greater in phase 2 (0.3±0.6 hours/night vs 1.3±2.3 hours/night; P=.10). For those on active therapy, fasting glucose values decreased as adherence increased. This randomized controlled trial of autotitrating positive airway pressure in pregnancy did not find any differences in a composite primary cardiometabolic risk profile between the treatment groups. Higher autotitrating positive airway pressure adherence was associated with lower fasting glucose levels. The use of a sham positive airway pressure control arm in phase1 may have negatively impacted adherence to active treatment.

Obstructive Sleep Apnea in Pregnancy: A Narrative Review.

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that remains underdiagnosed in pregnancy and can cause severe maternal and fetal complications. The prevalence of OSA in pregnancy had a wide variation and increases with increasing gestation. At-risk women are those with increased body mass index (BMI), increasing age, and chronic hypertension. Screening can be done by polysomnography but as it is expensive and necessitate overnight hospital stay, makes it even harder to diagnose and leads to delay in treatment. Once diagnosed, continuous positive airway pressure (CPAP) is the gold standard treatment. Early diagnosis and effective treatment can considerably improve the outcome. This review aims to discuss the diagnosis, treatment, and prognosis of OSA in pregnancy.

0697 Improving Detection of Obstructive Sleep Apnea in Pregnant Women Using a Six-Point Screening Tool

Abstract Introduction Pregnant patients with obstructive sleep apnea (OSA) are at higher risk for adverse outcomes. There are currently no established screening tools for pregnant women. OSA in pregnancy continues to be underdiagnosed resulting in missed opportunities to prevent possible adverse outcomes. Methods A screening pilot program was implemented at our general obstetrics and maternal fetal medicine (MFM) clinic to improve diagnosis of OSA among pregnant women. Patients were screened by a nurse for snoring/apneas, BMI &amp;gt; 35, essential hypertension, glucose disorders, neck size &amp;gt; 36 cm, and symptoms of excessive daytime sleepiness. If a patient scored 3/6 or greater, a home sleep apnea test (HSAT), and in some cases an in-lab sleep study (PSG), was recommended to test for OSA after discussion of risks and benefits with an obstetrician. Results Since the initiation of the screening program, 302 women screened positive for OSA based on our 6-point screening tool. Average gestational age at the time of screening was 14.34 +/- 7.97 weeks. Of the women who scored ≥3 on the 6-point screening tool, 92 (30.46%) were referred directly to a sleep study and 31 (10.3%) received a referral to see a sleep medicine provider. A total of 78 underwent sleep testing and 58 (74.4%) were diagnosed with OSA with an apnea-hypopnea index (AHI) ≥ 5. Most patient were African American (67.9%) with an average age of 31.49 +/-5.74. The diagnosis of OSA correlated moderately well with the total score of the 6-point screening tool (p&amp;lt;.001), BMI (p=.005), essential hypertension (p=.01), glucose disorders (p=.07), and neck size (p=.039). Only a BMI of &amp;gt;35 was independently associated with a 3.7 increase in odds for OSA (95%CI=1.17, 11.76, p=.026). Conclusion A significant increase in screening for obstructive sleep apnea was achieved with implementation of the new screening protocol. Ease of use makes the six-point screening protocol a useful tool in clinic. More research is needed to test the accuracy of the six-point screening as a testing tool in this population. Additional barriers to screening and testing for OSA in pregnancy, including social and lifestyle factors should be explored in more depth. Support (If Any)

Obstructive Sleep Apnea in Pregnancy

The incidence of obstructive sleep apnea (OSA) is higher in pregnancy than in non-pregnancy,and obesity is a major risk factor.OSA in pregnancy can lead to multiple organ dysfunction and is associated with hypertensive disorders in pregnancy,gestational diabetes mellitus,premature birth,and fetal growth restriction. Therefore,early screening and diagnosis are essential for the prevention and treatment of OSA in pregnancy.

A randomized controlled trial of sleep study surveillance with targeted autoregulated positive airway pressure therapy for obstructive sleep apnea in pregnancy

Obstructive sleep apnea is associated with adverse pregnancy outcomes. The impact therapy for obstructive sleep apnea has on these pregnancy outcomes remains under investigated. This study aimed to determine the effects of targeted autoregulated positive airway pressure in women at risk of obstructive sleep apnea on adverse pregnancy outcomes, cost, and natural history of obstructive sleep apnea. Pregnant women at high risk of obstructive sleep apnea were randomized to either a sleep study screening group receiving autoregulated positive airway therapy or a group not screened for obstructive sleep apnea receiving standard obstetrical care (control). Women in the sleep study-screened group received a sleep study at 2 periods during pregnancy, early (6-16 weeks of gestation) and late (27-33 weeks of gestation), with initiation of autoregulated positive airway therapy if their Apnea Hypopnea Index indicated ≥5 events per hour. Women of both groups had a sleep study 3 months after delivery. The primary outcome was effect on adverse pregnancy outcomes, a composite of hypertension, preterm birth, low birthweight, stillbirth, and diabetes mellitus. The secondary outcomes included obstructive sleep apnea severity and hospital costs. Among 193 women randomized (100 in the sleep study-screened group and 93 in the control group; 6 lost to follow-up), there was no significant difference in composite adverse pregnancy outcomes (46.4% screened vs 43.3% control; P=.77), hypertension (23.7% screened vs 32.0% control; P=.25), preterm birth (13.4% screened vs 10.0% control; P=.5), low birthweight (5.2% screened vs 6.7% control; P=.76), stillbirth (1% screened vs 0% control; P=1), gestational diabetes (19.6% screened vs 13.3% control; P=.33), or mean cost ($12,185 screened vs $12,607 control). The Apnea Hypopnea Index increased throughout pregnancy, peaking at 3 months after delivery (P<.001). There were 24 subjects (25.8%) who had a new diagnosis of obstructive sleep apnea, with 6 in whom autoregulated positive airway was prescribed. The autoregulated positive airway compliance rates were poor with usage rates ranging from 2% (1 of 64 days) to 43% (6 of 14 days). Targeted autoregulated positive airway therapy for obstructive sleep apnea did not decrease composite adverse pregnancy outcomes or hospital costs in the sleep study-screened high-risk pregnancy group compared with the group that received no obstructive sleep apnea screening. However, a small sample size, low autoregulated positive airway prescription rates, and poor compliance resulted in difficulty in drawing a definitive conclusion. The prevalence and severity of obstructive sleep apnea worsened throughout pregnancy, with the highest rates detected in the postpartum period. Large, multicenter clinical trials that are adequately powered are needed.

The Challenges of the Diagnosis and Treatment of Obstructive Sleep Apnoea in Pregnancy

With the increased prevalence of obesity worldwide, the incidence of obstructive sleep apnoea (OSA) has risen substantially. OSA is now also more commonly recognized within the pregnant population. The diagnosis of OSA during pregnancy is logistically difficult for many reasons. The symptoms of an uncomplicated pregnancy are traditionally believed to include sleep disruption and daytime sleepiness, without many specific data differentiating ‘normal’ from ‘pathological’, thus complicating the screening process for a true sleep disorder based on symptoms alone. Untreated OSA during pregnancy is associated with a variety of gestational health disorders, along with increased complications during delivery. Although screening protocols and increased healthcare provider awareness have led to earlier diagnosis and treatment of OSA in the general population, their implementation in the pregnant population is lacking. Studies on the use of continuous positive airway pressure in pregnancy have demonstrated its safety, but further research is needed to determine its benefits in this cohort.

Timing is everything: snoring onset and blood pressure trajectories in pregnancy.

Timing is everything: snoring onset and blood pressure trajectories in pregnancy.

Prediction Models of Obstructive Sleep Apnea in Pregnancy: A Systematic Review and Meta-Analysis of Model Performance.

Background: Gestational obstructive sleep apnea (OSA) is associated with adverse maternal and fetal outcomes. Timely diagnosis and treatment are crucial to improve pregnancy outcomes. Conventional OSA screening questionnaires are less accurate, and various prediction models have been studied specifically during pregnancy. Methods: A systematic review and meta-analysis were performed for multivariable prediction models of both development and validation involving diagnosis of OSA during pregnancy. Results: Of 1262 articles, only 6 studies (3713 participants) met the inclusion criteria and were included for review. All studies showed high risk of bias for the construct of models. The pooled C-statistics (95%CI) for development prediction models was 0.817 (0.783, 0850), I2 = 97.81 and 0.855 (0.822, 0.887), I2 = 98.06 for the first and second–third trimesters, respectively. Only multivariable apnea prediction (MVAP), and Facco models were externally validated with pooled C-statistics (95%CI) of 0.743 (0.688, 0.798), I2 = 95.84, and 0.791 (0.767, 0.815), I2 = 77.34, respectively. The most common predictors in the models were body mass index, age, and snoring, none included hypersomnolence. Conclusions: Prediction models for gestational OSA showed good performance during early and late trimesters. A high level of heterogeneity and few external validations were found indicating limitation for generalizability and the need for further studies.

Progress in diagnosis and treatment of obstructive sleep apnea in pregnancy

Progress in diagnosis and treatment of obstructive sleep apnea in pregnancy

102 The efficacy of a pilot program for obstructive sleep apnea screening in pregnancy

Pregnant patients with Obstructive Sleep Apnea (OSA) are at higher risk for eclampsia, gestational diabetes, cardiomyopathy, congestive heart failure and higher in-hospital mortality than pregnant patients without OSA. Unfortunately, OSA in pregnancy is under-diagnosed and opportunities for interventions are missed. A screening pilot program was developed at an obstetrics clinic in an urban teaching facility to improve diagnosis of OSA among pregnant patients. Every new obstetric patient was screened by a nurse for snoring/apneas, body mass index (BMI) > 35, essential hypertension, glucose disorders, neck size > 36 cm, and sleepiness. If a patient scored 2/6 or greater, a home sleep apnea test (HSAT) was ordered to diagnose OSA after discussion of risks and benefits with an obstetrician. In the 6 months prior to implementation of the screening program, zero patients were referred to the sleep medicine clinic. After the initiation of the screening program, 571 women were screened and 124 met criteria to be at high risk for OSA. The rate of tests ordered for patients who screened positive was 35%. Of the tests that were ordered 57% of patients performed the test. Out of the 26 patients who performed portable sleep testing, 16 were diagnosed with OSA with an apnea-hypopnea index (AHI) ≥ 5, which is 61% of those tested. Only 4 patients followed up in the sleep clinic after diagnosis, and only 3 patients met initial compliance with CPAP therapy as measured by percent usage over 30 days greater than 4 hours. A significant increase in screening for obstructive sleep apnea was achieved with implementation of screening protocol. High rate of diagnosis of OSA via HSAT does point to adequacy of six-question screening protocol. There were several patients who screened positive; however, few underwent testing for OSA, and even fewer still started CPAP and were compliant with therapy. This quality initiative program increased detection rates, however there is room for improvement in educating and maintaining patient compliance with therapy.