Positive Airway Pressure Therapy for Obstructive Sleep Apnea in High-Risk Pregnancy: A Meta-Analysis

We aimed to assess the effects of positive airway pressure (PAP) therapy in high-risk pregnancy patients with OSA.

Studies were systematically searched on PubMed, Embase, Web of Science, and Cochrane Library.

Articles comparing PAP therapy to no treatment or non-PAP treatment modalities, such as waitlist, sham PAP, and nasal dilator strips in high-risk pregnancy patients with OSA were included. Outcomes of interest included fasting plasma glucose (FPG), estimated insulin resistance, gestational diabetes, blood pressure measurements, hypertensive disorders of pregnancy, cesarean section, Epworth Sleepiness Scale, birth weight, Apgar at 1 and 5 min, preterm delivery, fetal growth abnormalities, and neonatal intensive care unit admission. Mean difference (MD) was used for continuous outcomes and risk ratio for binary endpoints, with 95% confidence intervals (CI).

Seven studies involving 696 patients were included, of which 328 patients were treated with PAP therapy. PAP therapy was associated with lower FPG (MD -6.50, 95% CI -10.64 to -2.36, p = 0.002, I ² = 3.2%) and improved insulin resistance, as indicated by reduced HOMA-IR levels (MD -0.90, 95% CI -1.15 to -0.65, p < 0.01; I ² = 0%). No significant differences were observed in other maternal or neonatal outcomes.

Our findings suggest PAP therapy may benefit high-risk pregnant women with OSA by improving certain maternal outcomes related to glucose metabolism, while effects on other maternal and neonatal outcomes are limited.