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Positive Airway Pressure Therapy for Obstructive Sleep Apnea in High-Risk Pregnancy: A Meta-Analysis
Thamiris D D Cabral1, Renata M Knoll2,3, Jaime Plane4
1Federal Hospital of Bonsucesso, Rio de Janeiro, Brazil.
The Laryngoscope
|August 15, 2025
Summary
Positive airway pressure (PAP) therapy may improve glucose metabolism in high-risk pregnant women with obstructive sleep apnea (OSA). However, PAP therapy showed limited effects on other maternal and neonatal outcomes in this patient group.
Area of Science:
- Obstetrics and Gynecology
- Sleep Medicine
- Perinatology
Background:
- Obstructive sleep apnea (OSA) is increasingly recognized as a comorbidity in high-risk pregnancies.
- OSA in pregnancy is associated with adverse maternal and fetal outcomes, including gestational diabetes and hypertensive disorders.
- Positive airway pressure (PAP) therapy is a common treatment for OSA, but its efficacy in high-risk pregnancies requires further investigation.
Purpose of the Study:
- To systematically review and synthesize the evidence on the effects of PAP therapy in high-risk pregnancy patients with OSA.
- To assess the impact of PAP therapy on maternal metabolic parameters, blood pressure, and pregnancy outcomes.
- To evaluate the effects of PAP therapy on neonatal outcomes.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, Web of Science, Cochrane Library).
- Included studies compared PAP therapy to no treatment or non-PAP modalities in high-risk pregnant women with OSA.
- Outcomes analyzed included glucose metabolism, insulin resistance, blood pressure, hypertensive disorders, cesarean section, birth weight, and neonatal outcomes.
Main Results:
- Seven studies with 696 patients were included; 328 received PAP therapy.
- PAP therapy was associated with significantly lower fasting plasma glucose (FPG) and improved insulin resistance (HOMA-IR).
- No significant differences were found for other maternal or neonatal outcomes, including hypertensive disorders, cesarean section, or birth weight.
Conclusions:
- PAP therapy may offer benefits for high-risk pregnant women with OSA, particularly in improving glucose metabolism and insulin resistance.
- Current evidence suggests limited impact of PAP therapy on other maternal and neonatal complications.
- Further research is warranted to fully elucidate the role of PAP therapy in managing OSA during high-risk pregnancies.
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