What is obstructive sleep apnea during pregnancy?
Obstructive sleep apnea (OSA) is a condition that is part of a spectrum of breathing abnormalities that is common during pregnancy, due to changes that develop in your body. Known as sleep-disordered breathing (SDB), the spectrum includes simple snoring on the mild end and OSA on the severe end. In between are varying amounts of resistance to the flow of air through your upper airways while you sleep. OSA is the severe end of the range because it is characterized by episodes in which your breathing pauses for some moments, impairing the ability to obtain quality sleep.
How common is OSA during pregnancy?
OSA affects more than 10 percent of pre-menopausal women, and one study has reported the condition with a prevalence of 10.5 percent of pregnant women in the first trimester, rising to 26.7 percent by the third trimester. Additionally, OSA has been reported in 15 to 20 percent of obese pregnant women.
How is OSA during pregnancy diagnosed?
The best way to diagnose OSA is with a procedure called polysomnography, conducted in a special sleep laboratory (in-lab PSG) overnight. Many medical centers that care for pregnant women do not have this type of facility, and the testing is expensive and fairly inconvenient for pregnant women. Consequently, home sleep testing with special portable devices has become popular. The capability to diagnose OSA this way is limited so that it probably misses many cases of mild OSA, but the approach can nevertheless detect OSA that is severe, or moderate.
Does OSA cause problems during pregnancy?
OSA causes poor sleep quality and also increases the chances that you will suffer from certain complications, such as preeclampsia and other high-blood pressure syndromes, gestational diabetes, pulmonary edema, cardiomyopathy, and congestive heart failure. OSA also increases your likelihood that you will need a hysterectomy, that youll have a longer-than-normal hospital stay, and that youll be admitted to the intensive care unit.
Does OSA cause problems for the baby?
OSA may slow the growth of the fetus in the womb (intrauterine growth retardation), which in turn is associated with preterm birth, low birth weight, low Apgar score, and various problems with the lungs, brain, eyes, and other organs. The risk of preterm birth is further elevated, because of the association between OSA and preeclampsia, which generally requires the delivery to be performed a few weeks early. Because of its association with gestational diabetes, OSA also puts the fetus at risk of a shoulder injury, if a cesarean section is not performed.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the OSA
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat OSA during pregnancy?
There is no particular medication for OSA, but a drug called modafinil, which promotes wakefulness and concentration, is sometimes given to compensate for poor sleep quality. Since there are very few data available on reproductive safety, however, women are advised to stop modafinil when they become pregnant.
Who should NOT stop taking medication for OSA during pregnancy?
If you are taking modafinil for wakefulness, the consensus supports stopping it for pregnancy.
What should I know about choosing a medication for my OSA during pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my OSA when I am breastfeeding?
It has been recommended that you avoid modafinil if you are nursing since not much is known about its safety for the nursing neonate.
What alternative therapies besides medications can I use to treat my OSA during pregnancy?
The standard treatment for OSA is not medication but continuous positive airway pressure (CPAP) in which you breathe through a special mask, connected to a special ventilator while you sleep. If you are overweight for your stage of pregnancy, it is also helpful to slow, or stop, your weight gain, depending on how much overweight you are.
What can I do for myself and my baby when I have OSA during pregnancy?
Follow the instructions of your physician regarding the appropriate amount of weight gain over the course of pregnancy. If you are given CPAP therapy, use your CPAP machine every night.
Resources for OSA in pregnancy:
For more information about OSA during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:
- Mayo Clinic. Obstructive Sleep Apnea
- Contemporary Ob/Gyn. Obstructive sleep apnea in pregnancy- what you need to know