Women with obstructive sleep apnea (OSA) appear to be at greater risk of serious pregnancy complications, longer hospital stays, and even admission to the intensive care unit (ICU) than mothers without OSA, according to a study conducted by Brown University.
The researchers analyzed the medical records of 1,577,636 pregnant women in the US National Perinatal Information Center database from 2010 and 2014. Of those women, 0.12% had been formally diagnosed with OSA. Those who were diagnosed were typically older and more likely to be smokers and African American. Also, they were more likely to have pre-pregnancy hypertension, diabetes, and coronary artery disease.
After adjusting for obesity and many other potential confounders, the researchers found that the risk of ICU admission was 174% higher in pregnant women with OSA compared to those without OSA. Additionally, total hospital length of stay was 5 days, compared to 3 days for women without OSA.
There also was an increased risk of rare but severe complications such as hysterectomy (126%), cardiomyopathy (259%), congestive heart failure (263%), and pulmonary edema (406%) associated with an OSA diagnosis. Increased risks of pregnancy-related complications included preeclampsia (122%), eclampsia (195%), and gestational diabetes (52%).
“Given that pregnancy is a window into future cardiovascular and metabolic health, OSA is a diagnosis worthy of investigation in pregnancy,” said lead study author Ghada Bourjeily, MD, associate professor of medicine at Brown University. “Early intervention in these women, as well as in their children, may represent a great opportunity to offer treatment strategies that may offer long-term health benefits.”
In addition to the large sample size, Bourjeily said, the study’s strengths included the diversity of its population and participating hospitals that enabled the researchers to identify a sample that is representative of the United States population.
“This allowed us to demonstrate associations with rare medical outcomes, including hysterectomy and ICU admission, pulmonary edema, cardiomyopathy, and congestive heart failure that would have been more difficult to prove with prospective studies,” said Bourjeily.
According to the researchers, no other study has reported on the association of OSA in pregnancy with hysterectomy and ICU admission. The study’s limitations included a lack of information about whether the OSA was being treated. This missing data, along with the general under-diagnosis of OSA, likely led to an underestimation of the association between OSA and other health problems, Bourjeily said.
The researchers now are analyzing the association between OSA and birth outcomes and neonatal health. Also, they are examining the biological mechanisms underlying the association of OSA in pregnancy with adverse outcomes, as well as the physiologic mechanisms that lead to the development of OSA in pregnancy.
The study, “Obstructive Sleep Apnea in Pregnancy Is Associated with Adverse Maternal Outcomes: A National Cohort,” was presented at the American Thoracic Society 2017 International Conference in Washington, DC.