Original articlePregnancy, sleep disordered breathing and treatment with nasal continuous positive airway pressure
Introduction
We previously reported on 267 pregnant women who were polygraphically monitored during sleep [1]. Snoring was observed at least intermittently in 52% of the women in their sixth month of pregnancy. Airflow limitation and increased respiratory effort were documented in a subgroup of these women. Bourne et al. [2] have also noted small drops in oxygen saturation (SaO2) during otherwise normal pregnancies. Although none of the women required treatment, our studies demonstrate that pregnancy affects breathing patterns during sleep.
We now report on a small group of women who presented with clinical complaints prior to or during early pregnancy and were diagnosed with either obstructive sleep apnea syndrome (OSAS) or upper airway resistance syndrome (UARS) [3]. We will consider both of these conditions as ‘sleep disordered breathing’ (SDB). The selected treatment—nasal continuous positive airway pressure (CPAP) during sleep—was initiated based on symptomatology and the clinical evaluation. This report details patient course, indicated intervention, and pregnancy outcome with nasal CPAP as the treatment modality during pregnancy.
Section snippets
Subjects
Of the 12 women (mean age 28.4 years) included in the report, seven were diagnosed with SDB prior to pregnancy and the others were diagnosed early in their first trimester. Two were pregnant for the second time. The mean body mass index (BMI) of the total group just prior to or close to conception was 24.03 kg/m2 (range 22.4–26.2) (Table 1). None of the women was taking prescription medications at initial visit.
On gynecologic history, menarche was reported between age 10.5 and 12.5 years. All
Results
Data concerning the 12 women included in the report are presented in Table 1.
Comments
Nasal CPAP is a well-documented treatment of SDB. Placebo controlled studies have demonstrated the efficacy of CPAP in improving various measures of sleepiness, including the multiple sleep latency test (MSLT) and cognitive functioning [15]. Treatment of OSA with tracheostomy has had a benefit on hypertension [16], [17]. Studies with nasal CPAP have demonstrated similar blood pressure improvements [18]. When women with SDB become pregnant, the question of nasal CPAP tolerance during pregnancy
Acknowledgements
Christian Guilleminault was supported by an Academic Award from the Sleep Research Center from NHLBI from NIH. Martina Kreutzer was the recipient of an unrestrictive educational grant from Respironics, Inc.
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