Sleep apnea and pregnancy: What’s the relationship?

Sleep apnea and pregnancy: What are the risks? Are pregnant women more susceptible to sleep apnea or other sleep-related conditions?

Unfortunately, the answer to that last question seems to be yes. A 1998 poll by the National Sleep Foundation (NSF) found that 78 percent of women reported “more disturbed sleep during pregnancy than at other times” — and that includes women who’d never before experienced significant sleep problems.¹

Keeping in mind the physical (not to mention emotional) changes pregnancy causes, this isn’t a big surprise. The NSF goes on to describe the relationship between pregnancy and sleep:

• Hormonal changes can cause daytime sleepiness and may affect muscles in a way that could lead to snoring — a key symptom and cause of obstructive sleep apnea (OSA)
• Physical changes frequently lead to more frequent bathroom trips during the night, disrupting healthy sleep
• Emotional changes can lead to anxiety and loss of sleep

That means lack of sleep is a legitimate risk for pregnant women — but does it mean that sleep apnea and pregnancy are clinically connected? Citing a 2009 study by the Mayo Clinic’s Division of Critical Care Medicine, the Journal of the American Board of Family Medicine concludes that, although the “exact prevalence of obstructive sleep apnea in pregnant women is unknown,” pregnant women are more at risk “for the development of sleep-disordered breathing or worsening of preexisting sleep apnea.”²

How sleep apnea and pregnancy can affect labor and delivery

That same study goes on to warn that the combination of sleep apnea and pregnancy can potentially harm the fetus because of the mother-to-be’s reduced oxygen reserves.

These birth risks are even more pronounced among pregnant women considered obese. “Obstructive sleep apnea among obese pregnant women is associated with more frequent preeclampsia, neonatal intensive care unit admissions, and cesarean delivery,” the American College of Obstetricians and Gynecologists concluded in a 2012 study.³

In an analysis of that study, MyHealthNewsDaily offers some additional conclusions.⁴ Among the obese women who experienced both sleep apnea and pregnancy, “about 65 percent required a C-section, while 33 percent of those without the condition required the surgery.”

On top of that, 46 percent of those pregnancies resulted in admission to the NICU (versus 18 percent for those without sleep apnea).

“The higher rate of NICU admissions for infants born to mothers with sleep apnea may be due to the higher rate of C-sections in this group,” the article added, offering the qualification that, because the study “only included obese women, it’s not clear whether sleep apnea could have the same effects in women who are not obese.”

The delivery itself can also be affected by lack of sleep. According to a study conducted by the University of California at San Francisco and published in 2004 by the American Journal of Obstetrics & Gynecology, women who slept fewer than six hours experienced longer periods of labor and “were 4.5 times more likely to have cesarean deliveries.”⁵

“This serves as an important reminder to healthcare providers to discuss the importance of adequate sleep with expectant mothers,” said lead author Kathryn Lee, RN, PhD, FAAN in the UC Newsroom.⁶ “Similar to advice that women should ‘eat for two’ when pregnant, healthcare providers should consider recommending that women also sleep for two.”

Of course, getting that optimal eight hours of sleep means making sure your sleep isn’t disrupted by sleep apnea. Especially for those women anticipating pregnancy in the coming months and who feel they may experience some of the signs of sleep apnea, a sleep test is recommended to ensure proper treatment for sleep apnea prior to the pregnancy.

“Sleep apnea may also be associated with complications during pregnancy such as gestational hypertension, preeclampsia, or low birth weight,” the National Sleep Foundation concludes. “If you are pregnant and feel you may suffer from sleep apnea, it is very important that you talk to your doctor.”