Population-Based Study of Sleep Apnea in Pregnancy and Maternal and Infant Outcomes

Apr 13, 2016Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

Sleep Apnea During Pregnancy and Its Links to Health Outcomes for Mothers and Babies

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Abstract

Sleep apnea is associated with higher rates of pregnancy hypertension and preterm birth in a cohort of 636,227 women.

Pregnancy hypertension is significantly more likely in women with sleep apnea, with an adjusted risk ratio (RR) of 1.43.
The likelihood of planned delivery increases with sleep apnea, showing an adjusted RR of 1.15.
Women with sleep apnea have a 1.50 times higher risk of experiencing preterm birth.
A 5-minute Apgar score of less than 7 is associated with sleep apnea, with an adjusted RR of 1.60.
Admission to neonatal intensive care or special care nursery is 1.26 times more likely for infants of mothers with sleep apnea.
Infants born to mothers with sleep apnea are 1.27 times more likely to be classified as large for their gestational age.

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STUDY OBJECTIVES: To examine the association between sleep apnea and pregnancy outcomes in a large population-based cohort.

METHODS: Population-based cohort study using linked birth and hospital records was conducted in New South Wales, Australia. Participants were all women who gave birth from 2002 to 2012 (n = 636,227). Sleep apnea in the year before pregnancy or during pregnancy was identified from hospital records. Outcomes of interest were gestational diabetes, pregnancy hypertension, planned delivery, caesarean section, preterm birth, perinatal death, 5-minute Apgar score, admission to neonatal intensive care or special care nursery, and infant size for gestational age. Maternal outcomes were identified using a combination of hospital and birth records. Infant outcomes came from the birth record. Modified Poisson regression models were used to examine associations between sleep apnea and each outcome taking into account maternal age, country of birth, socioeconomic disadvantage, smoking, obesity, parity, pre-existing diabetes and hypertension.

RESULTS: Sleep apnea was significantly associated with pregnancy hypertension (adjusted RR 1.43; 95% CI 1.18-1.73), planned delivery (1.15; 1.07-1.23), preterm birth (1.50; 1.21-1.84), 5-minute Apgar < 7 (1.60; 1.07-2.38), admission to neonatal intensive care/special care nursery (1.26; 1.11-1.44), large-for-gestational-age infants (1.27; 1.04-1.55) but not with gestational diabetes (1.09; 0.82-1.46), caesarean section (1.06; 0.96-1.17), perinatal death (1.73; 0.92-3.25), or small-for-gestational-age infants (0.81; 0.61-1.08).

CONCLUSIONS: Sleep apnea is associated with higher rates of obstetric complications and intervention, as well as preterm delivery. Future research should examine if these are independent of obstetric history.

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Population-Based Study of Sleep Apnea in Pregnancy and Maternal and Infant Outcomes

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