Obstructive sleep apnea in pregnancy: emerging insights into maternal and fetal outcomes

Sleep disordered breathing (SDB) encompasses a spectrum of disorders ranging from snoring to complete upper airway collapse and cessation of respiration leading to oxygen desaturation and sleep fragmentation. SDB is highly prevalent in the pregnant population, particularly predisposed to SDB because of physiological changes such as hormonal changes, changes to body habitus, and respiratory mechanics due to the gravid uterus.

The disorder has been associated with adverse maternal outcomes in pregnancy such as gestational hypertension, preeclampsia, impaired glucose metabolism, severe maternal cardiovascular morbidity, and long-term morbidity, as well as maternal mental health conditions with potential societal consequences. There is also mounting evidence on the impact of SDB with regards to the fetal and neonatal outcomes, including preterm birth, altered growth trajectories, and congenital anomalies, as well as evidence of epigenetic changes in the offspring exposed to disordered breathing during sleep.

This review focuses on SDB in pregnancy and recent data demonstrating its impact on maternal morbidity and fetal and neonatal outcomes, and recent guidelines and data on treatment modalities and their impact on pregnancy health.