Airflow limitations in pregnant women suspected of sleep-disordered breathing

Pregnancy physiology may predispose women to the development of airflow limitations during sleep. The goal of this study was to evaluate whether pregnant women suspected of sleep-disordered breathing (SDB) are more likely to have airflow limitations compared to non-pregnant controls.

We recruited pregnant women referred for polysomnography for a diagnosis of SDB. Non-pregnant female controls matched for age, body mass index (BMI), and apnoea-hypopnoea index (AHI) were identified from a database. We examined airflow tracings for changes in amplitude and shape. We classified airflow limitation by (a) amplitude criteria defined as decreased airflow of > or =10 s without desaturation or arousal (FL 10), or decreased airflow of any duration combined with either 1-2% desaturation or arousal, (FL 1-2%); and (b) shape criteria defined as the presence of flattening or oscillations of the inspiratory flow curve.

We identified 25 case-control pairs. Mean BMI was 44.0±6.9 in cases and 44.1±7.3 in controls. Using shape criteria, pregnant women had significantly more flow-limited breaths throughout total sleep time (32.4±35.8 vs. 9.4±17.9, p<0.0001) and in each stage of sleep (p<0.0001) than non-pregnant controls. In a subgroup analysis, pregnant women without a diagnosis of obstructive sleep apnoea (OSA) who had an AHI <5 had similar findings (p<0.0001). There was no difference in airflow limitation by amplitude criteria between pregnant women and controls (p=0.22).

Pregnant women suspected of OSA have more frequent shape-defined airflow limitations than non-pregnant controls, even when they do not meet polysomnographic OSA criteria.