Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management

Among obese pregnant women, 15%–20% have obstructive sleep apnea (OSA) and this prevalence increases along with body mass index and in the presence of other comorbidities. Prepregnancy obesity and pregnancy-related weight gain are certainly risk factors for sleep-disordered breathing in pregnancy, but certain physiologic changes of pregnancy may also increase a woman's risk of developing or worsening OSA. While it has been shown that untreated OSA in postmenopausal women is associated with a range of cardiovascular, pulmonary, and metabolic comorbidities, a body of literature is emerging that suggests OSA may also have serious implications for the health of mothers and fetuses during and after pregnancy. In this review, we discuss the following: pregnancy as a vulnerable period for the development or worsening of OSA; the associations between OSA and maternal and fetal outcomes; the current screening modalities for OSA in pregnancy; and current recommendations regarding peripartum management of OSA. Accepted for publication February 14, 2018. Funding: This research was supported in part by NIH 5T32GM008600-20. Devices used in Dr Dominguez's and Dr Habib's research have been loaned by ResMed and Itamar Medical. Dr Habib is a Senior Editor for Anesthesia & Analgesia. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Jennifer E. Dominguez, MD, MHS, Department of Anesthesiology, Duke University Medical Center, Box 3094, Mail Sort #9, Durham, NC 27710. Address e-mail to Jennifer.dominguez@dm.duke.edu. © 2018 International Anesthesia Research Society

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