Obstructive Sleep Apnea in Pregnancy: An Underrecognized Syndrome with Maternal and Fetal Consequences?

Abstract

Background: Sleep Obstructive Apnea (OSA) is becoming increasingly recognized as a serious comorbidity in pregnancy but remains underdiagnosed. Physiological changes and anatomical alterations of pregnancy can predispose women to or worsen underlying OSA, which has been a cause for concern regarding its potential to represent a unique obstetric syndrome. Objective: To determine the prevalence of OSA in pregnant patients, evaluate its relationship to maternal and perinatal outcomes, and determine whether OSA manifests as a unique clinical syndrome in obstetric care. Methodology: This prospective observational study was conducted over 18 months at Lady Reading Hospital, Peshawar, in collaboration with the Sleep Medicine and Pulmonology Units. A total of 160 pregnant women between 20–32 weeks gestation was screened using the STOP-BANG questionnaire; those with scores ≥3 underwent confirmatory sleep studies. Results: OSA was diagnosed in 48 women (30%). The OSA group experienced significantly higher rates of maternal problems, including preeclampsia (27.1% vs. 8.9%, p = 0.003), gestational diabetes (29.2% vs. 12.5%, p = 0.009), gestational hypertension (33.3% vs. 11.6%, p = 0.002), and cesarean birth (64.6% vs. 38.4%, p = 0.004). Multivariate regression also established that OSA was an independent predictor of maternal adverse outcomes (Adjusted OR 3.6, 95% CI: 1.8–7.1, p = 0.001), joined by BMI >30 and STOP-BANG score ≥3. Conclusion: OSA is common in pregnancy and significantly linked with complications in both maternal and neonatal outcomes. Its independent effect, even after age and obesity have been adjusted for, adds strength to the argument that OSA should be considered a new obstetric clinical syndrome.