The majority of expectant women report experiencing more sleep disorders during pregnancy than usual, and many of these are considered normal. Sleep apnea, on the other hand, is a more serious condition in which the airway collapses during sleep, giving rise to moments of breathlessness or shallow breathing and, often, a reduction in blood oxygen levels. Obstructive sleep apnea has been linked to a number of health concerns including increased risk of high blood pressure, heart disease, heart attack, stroke, diabetes, obesity, and depression. Moreover, this condition can also lead to a number of dangerous and costly complications during pregnancy and childbirth.
A staggering one in two pregnant women who both suffer from hypertension (high blood pressure) and snore habitually may unknowingly have obstructive sleep apnea. Additionally, one in four pregnant women with hypertension who do not snore also have unrecognized obstructive sleep apnea. These findings are part of a recent University of Michigan-led research study that appears in the British Journal of Obstetrics and Gynaecology.
Lead study author Louise O’Brien. Ph.D., M.S., notes that habitual snoring has been linked to increased risk of pregnancy complications such as caesarean sections, smaller newborns, preeclampsia, and high blood pressure. The present study suggests that these and other risks associated with obstructive sleep apnea can be mitigated if the condition—which is treatable during pregnancy—is properly diagnosed based on common warning signs such as a combination of hypertension and snoring three or more nights a week.
One approach to treating obstructive sleep apnea involves making lifestyle changes, including avoiding alcohol or medications that induce sleepiness, avoiding sleeping on one’s back, and losing excess weight. Apnea related to sinus congestion is not uncommon. Some pregnant women turn to breathing strips, nasal rinses, humidifiers, and/or an over-the-counter or prescription decongestants to solve the issue, but few of these remedies actually work. Side sleeping is a good idea, particularly during the latter stages of pregnancy, with the increased abdominal girth and increased pressure resisting movement of the diaphragm, particularly during REM sleep. Persistent and severe cases of sleep apnea are often treated through the use of a CPAP (continuous positive airway pressure) device, which pumps air gently through the nose in order to keep the airway open throughout the night. Overall, pregnant women with sleep apnea should consult a doctor before beginning any new regimen or medication.
A member of the Institute for Healthcare Policy and Innovation, Dr. O’Brien sees early intervention in cases of obstructive sleep apnea as beneficial not only in terms of the individual mother and her child’s health, but also in terms of societal healthcare costs. The expense of operative deliveries, neonatal intensive care, and management of the variety of health problems linked to obstructive sleep apnea can be extraordinarily high. By evaluating for and treating obstructive sleep apnea—which affects up to one-third of pregnant women by the third trimester—as soon as symptoms begin to manifest, we may be able to reduce the overall costs associated with high-risk pregnancies and deliveries, and in turn lessen the burdens placed upon an already taxed health care system.
In the end, sleep in pregnancy needs much more study by the sleep medicine community. We’ve just scratched the surface. Very little is known about sleep medicine and pregnancy, except for the fact that restless legs is more common in pregnancy. At Rowe Neurology Institute, we have the most current diagnostic tools for the diagnosis of sleep disorders, and a staff of neurologists and integrated caregivers who specialize in sleep disorders. We perform 1,500 in lab sleep studies annually in our nationally accredited sleep disorders center. We believe it’s extremely important for patients to see their sleep studies in detail. So they can be their best selves and have a full understanding of their sleep disorders. We show them how.