Obesity has increased in women who are of reproductive age. Furthermore, health conditions related to obesity have also increased, including OSA. Diagnosing and managing OSA in pregnancy is similar to OSA management in women who are not pregnant. However, some facets are exclusive to women who are pregnant.
Body Changes in Pregnancy
The body goes through some amazing changes during pregnancy. However, certain physiological changes occur that could potentially increase the risk of developing OSA. For instance, the upper airway opening narrows. As a result, the airflow decreases when sleeping. Furthermore, the nasal passages also have a reduced opening.
This occurs because there is increased blood flow and fluid to the nasal passages. This causes an increase in nasal congestion. As a result, this could lead to more airway resistance in the upper airway causing it to collapse during breathing when asleep. Snoring is also increased in women who are pregnant due to rising levels of pregnancy hormones.
During pregnancy, there is often edema in the legs. This is due to either sitting or laying down. This fluid can shift from the legs to the neck area, causing the upper airway to narrow, making it easier to collapse during sleep. Other causes point towards an increase in blood supply causing these events to occur.
Snoring and Pregnancy
The prevalence of snoring in pregnancy is reported as high as 50% and increases with gestational age. However, only a small number of women will progress to developing OSA. The studies regarding snoring and health issues in pregnancy are conflicting.
Some studies show an increased risk of gestational hypertension, preeclampsia, and delivery of small-for-gestational-age infants. However, more studies need to be performed.
OSA and Pregnancy
One study has shown that OSA in pregnancy is associated with the development of preeclampsia/eclampsia (gestational hypertension), cardiomyopathy, pulmonary embolism, and in-hospital mortality. This is possibly due to the episodes of low oxygen during sleep caused by the apneas.
This will activate the sympathetic nervous system. These frequent episodes of decreasing and increasing oxygen can lead to blood vessels injuries. Studies have shown that treatment with CPAP therapy helped reduce blood pressure.
It is possible that OSA can increase the risk of gestational diabetes. OSA can cause insulin resistance, increasing the risk of developing diabetes type II, elevated insulin levels in the blood, and metabolic syndrome. Other studies have shown that blood sugar levels are higher in patients with OSA.
Women who had gestational diabetes and severe OSA had higher blood sugars than women with mild OSA or no OSA. There is also an increased number of preterm delivery in women with OSA.
OSA and the Fetus
Studies on OSA and how it affects the fetus are minimal. However, some studies show that OSA has been linked to increased risk for congenital disorders, such as musculoskeletal issues. These cases are more likely to be admitted to the ICU after delivery. There is also an association between OSA and impaired growth of the fetus/low birth weight.
Conclusion
There is an increased risk of developing OSA in women who are pregnant. During pregnancy, the body goes through physical changes – weight gain, narrowing of the upper airway, hormonal changes, and fluid shift in the body. Snoring can be a sign of OSA, and it can develop in pregnancy. OSA in pregnancy has been related to various health conditions such as gestational hypertension, gestational diabetes, and preterm delivery. OSA also affects the fetus.
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