There are no specific guidelines for managing OSA in pregnancy. Treatments would be similar to treating the general population: CPAP therapy, oral appliance therapy, upper airway surgery, and positional therapy.
CPAP therapy would typically be considered first-line therapy during pregnancy. It should be noted that the pressure requirements could change as the pregnancy progresses, needing higher pressure over time. Because of this, an auto-adjusting machine (Auto-CPAP) might be of good use. There have been no reported adverse effects of CPAP therapy during pregnancy.
Mandibular advancement device (MAD) therapy, or oral appliance therapy, could also be used. These devices help keep the lower jaw in the forward position during sleep. Simply put, you sleep with an underbite all night. However, this may not be as effective as CPAP therapy.
In some cases, surgery has been used to treat OSA. However, this would not be recommended during pregnancy due to the risks of surgery and anesthesia. General anesthesia has been shown to increase morbidity and mortality in pregnancy, which is exacerbated in patients with OSA.
Weight loss is typically recommended to help improve/treatment OSA in the general population. However, this would not be recommended during pregnancy. Expectant mothers should follow the weight gain recommendations by their obstetrician.
There is no medication on the market used to treat OSA. Medication therapy can be used to help treat daytime sleepiness. However, discussing medication safety with a doctor before starting any medication during pregnancy is highly recommended. Furthermore, some medicines can be passed on to the baby after delivery through breastfeeding.
When To See Your Doctor
A patient with pre-existing OSA who becomes pregnant and has not seen her sleep doctor within six months should follow up to make sure treatment is optimal. If there are any symptom changes during pregnancy, she should follow up sooner.
In fact, a patient could be asked to be evaluated during each trimester. Furthermore, if a patient is recently diagnosed with OSA, it should be made sure that the treatment is optimal. Low oxygen desaturations could be detrimental to the fetus and should be corrected as soon as possible.
Maternal/Fetal Risks
Women who have OSA and are pregnant should be considered a “high risk” pregnancy. This is due to the risk of having or developing any health issues after being diagnosed with OSA.
If anesthesia needs to be used during delivery due to an emergency c-section, regional anesthesia should be given if possible.
If a CPAP machine or oral appliance is currently being used at home, it should also be brought to the hospital during delivery. To determine if the treatment is effective or needs to be adjusted, the medical staff should constantly monitor the patient’s oxygen levels.
Pain medication, such as opioids, is often used after pregnancy. However, pain medication can suppress the CNS system and respiratory system – worsening OSA and low oxygen levels.
If possible, they should avoid the use of opioids. If not, then using the lowest dose possible or choosing alternative pain medications such as nonsteroidal anti-inflammatory drugs is recommended.
OSA is worse in the supine position. Sleeping in an incline position or even on one’s side could help lessen the severity of OSA, especially if opioids are used.
Conclusion
Putting it all together, the treatment of OSA in pregnancy is very similar to the general population – CPAP therapy and oral appliance therapy. There should be close follow-up with a sleep doctor during this time, including maintaining treatment before, during, and after pregnancy.
The primary goal is to prevent low oxygen episodes that occur with OSA. As a result, oxygen levels should be monitored closely before and after delivery. Opioids should only be used with caution. Sleeping on an incline or one’s side can also be helpful.
I hope you found this article helpful. Feel free to comment or leave a question below. I wish you a good night’s sleep!