Dealing with Sleep Apnea During Pregnancy

Dealing with sleep apnea during pregnancy can be a challenging and concerning experience for both the expectant mother and the baby, as it can lead to various health complications if left untreated.

If you suspect that you may have developed sleep apnea during pregnancy, it is important to speak to your doctor for a proper diagnosis. This ensures you can be properly treated with the many treatment options available to reduce associated health risks for both you and your baby.

In this article, we’ll dive into how untreated obstructive sleep apnea (OSA) affects the health of both the mother and the baby, and take a look at sleep apnea symptoms during pregnancy. We’ll also examine how women can test for sleep apnea while pregnant and discuss the various sleep apnea treatment options.

Sleep apnea is a common sleep disorder characterized by interruptions in breathing, such as pauses or shallow breaths during sleep. These breathing events can lower oxygen levels in the body and disrupt sleep. Pauses in breathing during sleep are called “apnea” or “apneic events” and each event lasts at least 10 seconds, often repeating numerous times throughout the night. In addition to apneas, people with sleep apnea also have hypopneas, which is reduced airflow during sleep.

There are three main types of sleep apnea: obstructive sleep apnea (OSA), central sleep apnea (CSA), and complex sleep apnea. In this article, we’ll focus on the most common type— obstructive sleep apnea.

Obstructive sleep apnea is a type of sleep apnea where the muscles at the back of the throat fail to keep the airway open during sleep. This leads to interruptions in breathing that can range from seconds to minutes. Common symptoms of OSA include loud snoring, gasping and choking during sleep and frequent awakenings throughout the night.

There are several factors that contribute to the development of sleep apnea during pregnancy. One of the most common is a high BMI greater than 35 kg/m². In a study comparing the odds of OSA in obese vs normal weight pregnant woman, Rice et al. found that obese pregnant women are 13.29 times more likely to have OSA.¹

OSA not only affects the mother’s health during pregnancy, but it can also have a significant negative effect on the baby. Women who have sleep apnea while pregnant are more likely to develop gestational diabetes and preeclampsia. Preeclampsia can lead to serious maternal complications such as kidney and liver failure, pulmonary edema, placental abruption and even issues with blood clotting. Gestational diabetes increases the risk of preeclampsia, as well as the odds of the baby developing type 2 diabetes and obesity later in life, in addition to increasing the chance of a preterm birth.

When it comes to the health of the baby, sleep apnea is associated with fetal growth restriction, low birth weight, increased risk of preterm birth and admission to the neonatal intensive care unit.³ The exact mechanism for how sleep apnea affects the baby is still unclear, however, studies suggest that repeated drops in oxygen levels, chronic inflammation of the blood vessels and oxidative stress on vessel endothelium may be responsible.^2,4 It’s believed that these factors affect the availability of blood flow to the placenta, which then results in problems such as low birth weight.

Women who developed sleep apnea while pregnant have a greater risk of preterm births and are more likely to require obstetric intervention during delivery.⁵ These interventions can include anything from induced labor to emergency C-sections and are most likely due to the comorbidities that occur alongside sleep apnea.

Pregnant women with OSA have a greater chance of requiring C-sections and like all individuals with OSA, they have a greater risk of anesthesia-related complications post surgery. Individuals with OSA need to be closely monitored after surgery because they are prone to respiratory depression and are also harder to ventilate, should they need to be intubated.

The symptoms of sleep apnea during pregnancy can vary from person to person. Every expecting mother may exhibit different symptoms, which is why it is best to get a professional diagnosis.

Here are some sleep apnea symptoms to look out for during pregnancy:

• Frequent awakenings during the night.
• Loud snoring
• Pauses in breathing during sleep
• Gasping or choking during sleep
• Morning headache.
• Daytime sleepiness
• Irritability and mood swings
• Heartburn
• Dry mouth

There are several diagnostic tests that pregnant women can undergo to determine if they have sleep apnea. One of the most common tests is polysomnography or PSG, a comprehensive overnight sleep study conducted in a sleep lab.

The test involves monitoring your brain waves, eye movements, heart rate, oxygen levels, breathing patterns, and other vital signs to detect possible obstructive sleep apnea symptoms. If an in-lab sleep study is inconvenient, another option is a home sleep apnea test. This at-home sleep study is a more comfortable and cost-effective alternative that allows you to undergo sleep apnea testing in the comfort of home.

 An at-home sleep test involves wearing a portable device that records snoring, heart rate, oxygen level and breathing effort. The results are then analyzed by a sleep specialist who will diagnose sleep apnea and recommend appropriate treatment options.

When deciding between a PSG or a home sleep test for obstructive sleep apnea symptoms during pregnancy, there are a few factors to consider:

Pros: In-lab sleep study

• PSG is the gold standard for diagnosing sleep apnea. It provides a comprehensive evaluation of various physiological parameters during sleep, including neurological activity.
• PSG is conducted in a sleep lab under the supervision of trained technicians, so there is less chance of user error affecting results.
• PSG can diagnose sleep disorders other than sleep apnea.

Cons: In-lab sleep study

• Since you need to go to a sleep clinic or hospital for testing, there may be a wait. 
• It can be difficult to sleep in an unfamiliar place, especially when you’re pregnant.
• More expensive than a home sleep study.

Pros: At-home sleep study

• A home sleep test is convenient. There are no wait times and you can do the test whenever it works best for you.
• Pregnant women may sometimes experience severe morning sickness or be too tired to go out, making a home sleep test the best option because it does not require a trip to the sleep lab.
• While home sleep tests don’t provide as much information, they are still a valid test for sleep apnea.

Cons: At-home sleep study

• Results are more prone to be affected by user error since there is no technician monitoring you.
• At-home sleep tests do not measure brain activity and therefore cannot diagnose sleep disorders with neurological causes. These disorders include insomnia, central sleep apnea, Cheyne-Stokes respiration, and others.

Treating sleep apnea can be challenging, but luckily, there are many options available. The most common and the gold standard of treatment is continuous positive airway pressure (CPAP) therapy. This therapy involves wearing a CPAP mask over the nose or mouth while you sleep. The mask is connected to a CPAP machine that delivers pressurized air to keep your airway open and prevent apneas and hypopneas.

Another treatment option to consider is mandibular advancement devices (MADs). These are custom-made oral appliances that help to reposition the lower jaw and tongue forward, thereby opening up the airway. MADs are suitable for treating mild to moderate sleep apnea and are a great CPAP alternative for people who cannot tolerate CPAP therapy.

Another good sleep apnea treatment option for pregnant women is positional therapy. This approach involves changing the sleeping position to improve airflow during sleep. Sleeping positions can be a challenge during pregnancy, but positional therapy can help pregnant women maintain certain sleeping positions, such as sleeping on the side instead of the back, using specialized pillows or devices.

It’s worth noting that positional therapy is more effective for those with positional OSA, where the airway becomes obstructed only in certain sleeping positions. No matter what your obstructive sleep apnea symptoms are, it is important to consult with a healthcare professional to determine the most suitable treatment, rather than attempt a self-diagnosis.

Does sleep apnea go away after I give birth? 

Not entirely. Sleep apnea may improve after giving birth, but it does not always go away completely. Some women enter pregnancy with existing sleep apnea, while others develop the disorder during pregnancy. So, if you have untreated sleep apnea before pregnancy, it’s unlikely that your sleep apnea symptoms will improve after you give birth without treatment.

Can I reduce sleep apnea symptoms naturally?

While there are natural remedies that may help alleviate sleep apnea symptoms, such as maintaining a healthy weight, sleeping on your side, and avoiding alcohol and sedatives, it is important to consult with a healthcare professional for a comprehensive treatment plan.

Each person’s case of sleep apnea is different, so it’s important to talk with your doctor. They can provide personalized recommendations and discuss potential interventions, such as using CPAP during pregnancy or oral appliances, depending on what’s best for you.

Is it safe to do a sleep study while pregnant?

Yes. Doing a sleep study while pregnant is generally safe as the test is non-invasive and low-risk. However, your doctor will decide the best course of action for diagnosing your sleep apnea symptoms, based on your medical history and whether you have any pregnancy complications.

Sleep apnea during pregnancy is a serious condition that requires attention and management. By understanding the causes and recognizing the symptoms, expectant mothers can better manage sleep apnea and have a healthier and happier pregnancy.

Seeking timely medical advice and diagnosis, using CPAP therapy, and maintaining a healthy lifestyle are all steps that help ensure the well-being of both the mother and the baby. After all, a well-rested mother is better equipped to handle the challenges of pregnancy.

1. Ghesquière, L., Deruelle, P., Ramdane, Y., Garabédian, C., Charley-Monaca, C., & Dalmas, A. (2020). Obstructive sleep apnea in obese pregnant women: A prospective study. PLOS ONE, 15(9), e0238733. https://doi.org/10.1371/journal.pone.0238733

2. Dominguez, J. E., Krystal, A. D., & Habib, A. S. (2018). Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management. Anesthesia and analgesia, 127(5), 1167–1177. https://doi.org/10.1213/ANE.0000000000003335

3. Mph, J. L. M., & Street, L., MD. (2020, November 13). Obstructive sleep apnea in pregnancy- what you need to know. Contemporary OB/GYN. https://www.contemporaryobgyn.net/view/obstructive-sleep-apnea-pregnancy-what-you-need-know-0

4. Sun, J.-C., Lin, C.-L., Wu, F.-L., Chung, C.-H., Sun, C.-A., & Chien, W.-C. (2022). The association between obstructive sleep apnea and the risk of poor delivery events in women: A population-based nested case–control study. Journal of Nursing Scholarship, 54, 31–37. https://doi.org/10.1111/jnu.12708

5. Bin, Y. S., Cistulli, P. A., & Ford, J. B. (2016). Population-Based Study of sleep apnea in pregnancy and maternal and infant outcomes. Journal of Clinical Sleep Medicine, 12(06), 871–877. https://doi.org/10.5664/jcsm.5890