Obstructive sleep apnea in pregnancy

Obstructive sleep apnea (OSA), while commonly diagnosed in obese men and women, is often underdiagnosed in pregnant women. Snoring, witnessed apneas, excessive daytime sleepiness, and fatigue are common symptoms of OSA. These symptoms overlap with normal physiologic changes in pregnancy. Many women experience reduced quality of sleep, reduced sleep efficiency, increasing arousals due to acid reflux, fetal movements, nocturia, and pressure on the urinary bladder as the pregnancy progresses. Complications of untreated OSA in pregnancy include gestational diabetes, gestational hypertension, pre-eclampsia, intrauterine growth retardation, and increased rates of cesarean sections (Bourjeily et al, Sleep Med 38:50-57, 2017). Treatment of OSA with continuous positive airway pressure (CPAP) is recommended for pregnant women with moderate to severe OSA, and conservative management may be considered for women with mild disease.