Elsevier

Sleep Medicine

Volume 5, Issue 1, January 2004, Pages 43-51
Sleep Medicine

Original article
Pregnancy, sleep disordered breathing and treatment with nasal continuous positive airway pressure

https://doi.org/10.1016/j.sleep.2003.07.001Get rights and content

Abstract

Objective: To investigate the tolerance, compliance and problems associated with usage of nasal continuous positive airway pressure (CPAP) by pregnant women with sleep disordered breathing (SDB).

Patients and method: Twelve pregnant women diagnosed with SDB received polysomnography (PSG) at entry, CPAP titration, repeat PSG at 6 months gestation (GA) and home monitoring of cardio-respiratory variables at 8 months GA. Compliance was verified by the pressure at the mask. Results from the Epworth sleepiness scale, fatigue scale and visual analogue scales (VAS) for sleepiness, fatigue, and snoring were compared over time.

Results: All of the subjects had full term pregnancies and healthy infants. Nightly compliance was at least 4 h initially and 6.5 h at 6 months GA. Nasal CPAP significantly improved all scales compared to entry. VAS scores remained lower at 6 months GA compared to entry. Re-adjustment of CPAP pressure was needed in six subjects at 6 months GA.

Conclusion: Nasal CPAP is a safe and effective treatment of SDB during pregnancy.

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.

References (19)

There are more references available in the full text version of this article.

Cited by (107)

  • A trial of positive airway pressure for the treatment of sleep apnea in pregnancy

    2023, American Journal of Obstetrics and Gynecology MFM
  • Sleep Disturbance in Pregnancy

    2022, Sleep Medicine Clinics
  • Sleep Disorders and Gestational Diabetes Mellitus

    2020, Neurological Modulation of Sleep: Mechanisms and Function of Sleep Health
View all citing articles on Scopus
View full text