Impact of Obstructive Sleep Apnea on Fetal Heart Rate: A Systematic Review

Area of Science:

• Obstetrics and Gynecology
• Perinatology
• Sleep Medicine

Background:

• Obstructive sleep apnea (OSA) in pregnant individuals is a growing concern.
• Intermittent maternal hypoxia associated with OSA may influence fetal development.
• The impact of maternal OSA on fetal heart rate (FHR) requires further investigation.

Purpose of the Study:

• To systematically review existing evidence on the association between maternal OSA and FHR alterations.
• To synthesize findings regarding the potential effects of OSA on fetal cardiac activity during pregnancy.

Main Methods:

• Systematic literature search of Cochrane Library, PubMed-Medline, EMBASE, Web of Science, and Google Scholar up to June 2024.
• Inclusion of studies involving pregnant women with OSA and assessed FHR via cardiotocography or fetal electrocardiography.
• Exclusion of studies lacking polysomnography, using cross-over designs, or published in non-English languages.

Main Results:

• Six studies met the inclusion criteria, comprising five prospective observational studies and one case report.
• Maternal characteristics varied, with ages ranging from 26.6 to 34.8 years and BMI between 27.5 and 55 kg/m².
• Findings on FHR alterations were discordant; three studies found no association, while three others reported FHR changes linked to maternal respiratory events.

Conclusions:

• The impact of maternal OSA on FHR shows significant variability and contradictory results in the current literature.
• Discrepancies may stem from differences in study designs, sample sizes, and outcome measures.
• Further high-quality research is essential to definitively establish the relationship between maternal OSA and fetal cardiac response.