Gestational Obstructive Sleep Apnea: From Pathophysiological Mechanisms to Maternal-Fetal Outcomes

Obstructive sleep apnea (OSA) during pregnancy is increasingly recognized as a clinically significant condition associated with maternal cardiovascular and metabolic complications, as well as adverse fetal outcomes. Physiological changes in pregnancy, including weight gain, airway edema, reduced functional residual capacity, and altered ventilatory control, can exacerbate or unmask sleep-disordered breathing. Emerging evidence suggests associations between gestational OSA and hypertensive disorders of pregnancy, gestational diabetes mellitus, cesarean delivery, and preterm birth. Continuous positive airway pressure (CPAP) remains the primary therapy for moderate to severe disease, while noninvasive ventilation may be required in selected ventilatory failure phenotypes, such as obesity hypoventilation syndrome. Mandibular advancement devices (MADs) may offer an alternative in carefully selected patients with mild disease or CPAP intolerance. This review synthesizes current evidence regarding the epidemiology, pathophysiology, maternal-fetal implications, diagnostic strategies, and evolving treatment approaches for OSA in pregnancy. Particular emphasis is placed on risk-stratified screening, phenotype-guided therapy, and the importance of multidisciplinary management throughout the antenatal and postpartum periods.