Sleep Apnea, Obesity & Pregnancy

Sleep apnea in obese pregnant women leads to higher rate of complications

(RxWiki News) The risks to a woman and her baby if she's obese have been well-established, but having sleep apnea ups the stakes even more. Fortunately, sleep apnea can be treated.

A recent study of obese pregnant women found that those with sleep apnea had higher rates of several pregnancy complications.

"Treat sleep apnea before pregnancy."

The study was led by Judette Louis, MD, MPH, of the Department of Obstetrics and Gynecology and various other departments and divisions at MetroHealth Medical Center-Case Western Reserve University School of Medicine in Cleveland.

It aimed to find out the links between obstructive sleep apnea and mother and newborn health in a group of obese pregnant women.

The study involved 175 obese women who had an overnight sleep study at home using a portable home monitor.

Women were diagnosed as having obstructive sleep apnea if they scored a 5 or higher on the apnea hypopnea index, which measures how many times per hour they stop breathing for at least 10 seconds.

A total of 15 percent of the women were diagnosed with obstructive sleep apnea: 13 had mild apnea, 9 had moderate and 5 had severe.

These women and their newborns were compared to the other women in the group who did not have sleep apnea.

Overall, the women with sleep apnea were considerably more obese and included more women with high blood pressure.

The average body mass index (BMI, a measure of obesity) of the women in the obstructive sleep apnea group was 46.8, compared to 38.1 in the non-sleep apnea group.

While 32 percent of the women without sleep apnea had high blood pressure, 56 percent of the women with sleep apnea were hypertensive.

In terms of pregnancy outcomes, the women with sleep apnea were more likely to have a cesarean section, to have pre-eclampsia and to have their baby admitted to the neonatal intensive care unit (NICU).

While 33 percent of the women without sleep apnea had C sections, 65 percent of those with sleep apnea did.

Further, 42 percent of the women with sleep apnea had pre-eclampsia (a high blood pressure complication) compared to only 17 percent of the women without sleep apnea.

Even after taking into account the women's weight, age and diabetes status, women with obstructive sleep apnea were 3.5 times more likely to have pre-eclampsia.

The NICU was required for 46 percent of the babies born to women with sleep apnea compared to 18 percent of the babies born to women without sleep apnea.

The rates of premature babies born was about the same in both groups.

Throughout the entire study, one woman died in the non-sleep apnea group, and one woman's heart stopped during a C section in the sleep apnea group.

There were also two stillbirths and one baby born too early to survive on its own in the group without sleep apnea.

The researchers concluded that being obese and having obstructive sleep apnea increased a woman's risk of C section, pre-eclampsia and her newborn's admission to NICU.

William Kohler, MD, the director of the Florida Sleep Institute in Spring Hill, Florida, said the findings of this study are important for patients to consider.

"Previous studies have shown a correlation between sleep apnea and pre-eclampsia, which this study confirmed, but what this study added was that there was an increase in neonatal intensive care unit admissions for the children of the patients that had obstructive sleep apnea," he said.

"So not only does obstructive sleep apnea increase the risk of pregnancy for the mother, but it increases morbidity in the children who are delivered to patients that have obstructive sleep apnea and, in this particular report, to those that are obese," Dr. Kohler said.

Sleep apnea can be treated with the use of continuous positive airway pressure, or CPAP.

CPAP machines require a prescription and can cost anywhere from $150 to over $5,500, though most insurance plans will cover some or all of the expense. CPAP masks range from $30 to $200.

The study was published in the journal Obstetrics and Gynecology. The research was funded by the Robert Wood Johnson Foundation Physician Faculty Program, the National Institutes of Health and a Case Western Reserve University Cleveland Clinic grant from the National Center for Research Resources.

One author reported receiving a grant from the ResMed Foundation and research equipment from Resmed Inc. and from Philips Respironics. No other conflicts of interest were noted.

Review Date: 
September 24, 2012