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Sleep-Disordered Breathing During Pregnancy

Pregnancy is associated with many physiologic and hormonal changes along with changes in sleep architecture, placing pregnant women at risk for the development of sleep-disordered breathing or worsening of preexisting sleep apnea. Snoring, the most common symptom of sleep-disordered breathing, is markedly increased during pregnancy. The exact prevalence of obstructive sleep apnea in pregnant women is unknown. Because the apneic episodes are commonly associated with oxyhemoglobin desaturations, the combination of obstructive sleep apnea and pregnancy can be potentially harmful to the fetus given the low oxygen reserves during pregnancy. Obstructive sleep apnea has been associated with an increased risk of hypertension among the general population, and this raises the possibility of its association with gestational hypertension and preeclampsia. In this clinical review, we discuss the physiologic changes of pregnancy that predispose pregnant women to the development of obstructive sleep apnea and the effects of sleep-disordered breathing on pregnancy outcomes. We also review the recommendations regarding evaluation for sleep apnea and treatment options during pregnancy and postpartum.