Snoring In Pregnancy Linked To Higher Health Risks

November 8, 2013

There’s been lots of studies in the past showing that obstructive sleep apnea during pregnancy can be potentially dangerous to the mother and baby’s health, but unfortunately, these finding haven’t made their way into being used in clinical practice. Here’s another study that supports the need to screen for OSA on a regular basis: Snoring before or during pregnancy was found to be associated with significantly higher rates of  pre-term delivery and c-section rates. Women who snored were 2/3 more likely to have smaller babies and about 2 times more likely to undergo a c-section. Knowing that weight gain is a major risk factor for sleep apnea, it’s important to make sure you do or don’t have this condition if you’re pregnant. Lack of sleep and repeated oxygen deprivation is not very healthy for the mother or the baby.

Sleep Apnea May Increase The Risk Of Adverse Pregnancy Outcomes

October 15, 2013

Guest post

Obstructive sleep apnea (OSA) is a common condition among Americans. This is well evident as one in 15 Americans suffers from this condition these days. A new study states that women who have OSA are highly prone to high risk health conditions during pregnancy, which is fatal to their babies and the mothers. The study said that those babies that were born to women with OSA condition are more likely to be admitted to the neonatal intensive care unit than those babies that are delivered by healthy mothers.

Details of the study

The study was conducted on obese women who were pregnant. The study revealed that the women with Sleep Apnea were more prone to develop preeclampsia, which is a serious condition of high blood pressure during pregnancy, where an emergency caesarean section may be required. The complications during pregnancy of obese women were also linked to high blood pressure and gestational diabetes. These two medical conditions are always understudied and under-diagnosed in women who are pregnant, according to the researchers. The study researcher and Assistant Professor of Obstetrics and Gynecology at the University of South Florida, Dr. Judette Louis, said that there is a need for better methods to test for and treat sleep apnea among women during their pregnancy.

Nature of Sleep Apnea

Usually, people who experience this condition gasp for air while sleeping. Women who are overweight face a higher risk of experiencing this condition, as fat in the throat can narrow the airway and can cause difficulty breathing at night.

Findings of the study

In this new study, researchers analyzed the condition of over 175 obese women who were pregnant and were screened for OSA in their homes by offering them a small portable device. About 15% of participants were found to have OSA. These participants were a bit heavier and had higher blood pressure levels than those who did not have OSA. Among those pregnant women who had OSA, about 65% needed a caesarean section while 33% of those without this condition needed a C-section to deliver their baby.

In addition, the study revealed that 42% of those with sleep apnea had preeclampsia when compared to 17% of those who did not have this condition. However, the premature birth rate was similar between the groups involved in the study. The percentage of newborn babies that required admission to NICU was 46% of the mothers who had OSA. This is much higher when compared to the 18% of those mothers who did not have sleep apnea. Researchers feel this might be because of the high rate of the caesarean births among the group of women who have sleep apnea. However, it is not clear on the effects of sleep apnea among women who are not obese as this study focuses on obese women.

 

Rania Paula, Author of this article writes for  http://www.sleepwellblog.com. A weblog providing information about various sleep disorders such as insomnia, sleep apnea, restless leg syndrome, sleep deprivation, etc and there by helping you to have good night sleep.

 

 

 

 

Women with Gestational Diabetes Have 7X Increased Risk of Sleep Apnea

August 21, 2013

Here’s another not too surprising study revealing that women with gestational diabetes during pregnancy have 7 times increased risk of having obstructive sleep apnea compared to women without gestational diabetes. There are also many other studies linking preeclampsia (dangerous high blood pressure during pregnancy) with obstructive sleep apnea. Gaining significant weight during pregnancy can tip you over the edge for sleep apnea, especially if you’re already at risk. I predict that there will be studies in the future that show that screening for and treating obstructive sleep apnea routinely during pregnancy can significantly lower pregnancy related complications. CPAP is already being used in Australia successfully to treat preeclampsia. It’s only a matter of time before we start doing the same here in the United States.

If you are a woman that had either gestational diabetes or preeclampsia during pregnancy, how many of you now have a diagnosis of obstructive sleep apnea?

Can CPAP Prevent Pregnancy Complications?

January 2, 2013

Preeclampsia is a potentially dangerous condition during pregnancy that can lead to life-threatening high blood pressure, kidney failure, and fetal growth delay. Dr. Colin Sullivan (the inventor of the CPAP machine) has published a series of studies on the beneficial effects of using CPAP to control preeclampsia. In his latest study, he and his colleagues showed that fetal movements were significantly lower in mothers with preeclampsia compares to controls. Using CPAP at relatively low pressures significantly increased the number of fetal movements. Over the course of the night, women not on CPAP had progressively lower fetal movements, whereas those on CPAP had progressively increased fetal movements. 

Just like in their previous studies, many of these women had only mild obstructive sleep apnea. Some did not have sleep apnea at all. However, the vast majority had what’s called inspiratory flow limitation, where there is partial obstruction to inhalation, but not meeting the criteria for an apneas (10 second pauses and/or lowered oxygen levels). 

It’s likely that they are treating is upper airway resistance syndrome, with multiple partial obstructions and arousals that don’t present as classic obstructive sleep apnea. 

It’s disappointing that despite this important information about pre-eclampsia, there’s been no significant movement to look for sleep-related breathing disorders in preeclamptic women.

If you ever had preeclampsia during pregnancy, did your doctor ever ask about your snoring or sleep quality?

High Blood Pressure In Pregnancy Raises Child’s Heart Risk

May 28, 2012

Having high blood pressure during pregnancy (also called preeclampsia) was found to increase the offspring’s risk of having high blood pressure in childhood and young adulthood. This study published in Pediatrics analyzed 18 studies and looked at cardiovascular risk factors in people exposed to high blood pressure during pregnancy. Those that were exposed had a systolic blood pressure that was 2.39 mm Hg higher compared to those whose mothers had healthy pregnancies. The diastolic pressure was 1.35 mm Hg higher. They calculated  that over time, these figures would increase one’s risk for dying from heart disease by 8% and from stroke by 12%.

What’s my take on this study? It’s not surprising, since many women with preeclampsia have sleep-breathing problems such as obstructive sleep apnea and upper airway resistance syndrome. It’s been shown that treating with CPAP can lower blood pressure in women with preeclampsia. Despite this knowledge , sleep apnea is almost never considered when treating preeclamptic women in the US. Having hypoxia and physiologic stress from the mother’s poor sleep quality can be detrimental to the developing fetus. Since the offspring will also inherit the mother’s upper airway anatomy, it’s not surprising that the child will be predisposed to the consequences of obstructive sleep apnea, such as high blood pressure, diabetes, heart attack and stroke. It’s also likely that environmental and dietary factors during pregnancy  may carry over into the household which can also affect the child’s diet.

Obese Women More Likely to Have Children with Autism

May 7, 2012

Here’s a not-to-surprising study showing that obese women are at higher risk of having children with autism. Obese women were 67% more likely to have an autistic child, and about 2x as likely to have an child with another developmental disorder. Having gestational diabetes also raised by 2x a mother’s risk of having a baby with developmental disorders.

They also note that nearly 60% of women of childbearing age in the US is overweight and about 1/3 are obese. Obesity rates are rapidly climbing. Autism rates are also climbing, with the latest report showing 1/88 children having one of the autism spectrum disorders.

The authors mentioned every possible explanation (diabetes, high blood pressure, fluctuating glucose levels, lack of oxygen) expect for obstructive sleep apnea. I’ve written numerous times in the past about complications of obstructive sleep apnea during pregnancy. If you’re overweight or obese, you’re much more likely to have obstructive sleep apnea. One of the hallmarks of sleep apnea is hypoxia and major physiologic stress on the mother’s body. I wonder what the effect is on the developing baby’s brain? It would make sense to routinely screen for sleep apnea in all women, especially if you’re overweight or heavier.

If you were overweight during pregnancy, did your doctor screen you for obstructive sleep apnea? 

Is Nocturnal Asthma Really Sleep Apnea?

August 21, 2011

Having an asthma attack in the middle of the night can be a frightening and terrifying experience. Typically, these attacks happen in the early morning hours, just before awakening. 

Now there’s research showing that poorly controlled asthma during pregnancy can increase a woman’s chances of developing preeclampsia (50%) and premature births (25%). Furthermore, infants born to mothers with poorly controlled asthma delivered babies that were about 0.2 pounds less than those born to mothers without asthma.

We typically think of asthma being a separate, distinct condition from obstructive sleep apnea, and it’s treated in completely different ways. However, it’s not just coincidence that nocturnal awakenings from asthma and the most intense periods of apnea occur at the same time in the middle of the night—the early morning hours. The early morning hours are when REM sleep is most prominent, and this is the time when throat muscles are most relaxed. Having an apnea also is known to cause reflex, which is known to reach the throat as well as the nose and the lungs. In one small study in people with sleep apnea and asthma, treating sleep apnea with CPAP significantly improved nocturnal asthma symptoms. 

We know that any degree of stress on the mother’s body can lead to a higher rate of pregnancy-related complications and low birth rates. Even snoring by the mother alone was found to result in lower Apgar scores in newborn infants. Apneas are also known to raise blood pressure and promote insulin resistance. Stress hormones are also known to increase when you have apneas.

In light of all these findings, it’s not surprising that pregnant women with poorly controlled asthma have higher complications rates. This is another great example of “connecting the dots” between two seemingly unrelated conditions, which only adds to support my sleep-breathing paradigm.

 

 

Pregnant Women More Likely To Stop Breathing At Night

August 3, 2011

As a follow-up to my post last week on why pregnant women may have an increased risk of stroke, here’s a study published this month in the journal Sleep. Researchers compared 34 women with gestational hypertension vs. 26 healthy women with uncomplicated pregnancies. Significant sleep-disordered breathing was defined as a respiratory disturbance index (RDI) of 5. Pregnant women with high blood pressure had significant sleep-disordered breathing in 53%, whereas 12% of healthy pregnant women had sleep-disordered breathing. Hypertension is a known risk factor for preeclampsia and stroke.

This study is in line with my suspicion that pregnant women, while at risk for obstructive sleep apnea, probably have shorter obstructions and RERAs (respiratory-effort related arousals), rather than frank apneas. Increased progesterone and various other physiologic changes seen in pregnancy can increase your respiratory drive and lower arousal thresholds, leading to more frequent arousals from deep sleep.

Notice how commonly pregnant women snore, and they’re extremely tired. If they weren’t pregnant, doctors would suspect obstructive sleep apnea. Then why do we have this double standard? Why can’t women who suddenly gain weight and snore be routinely screened for obstructive sleep apnea?

Why Pregnant Women Have More Strokes

July 28, 2011

Rates of stroke went up 47% for expectant mothers and climbed to 83% in the first three months after delivery. This was the finding that was published in the journal Stroke: Journal of the American Heart Association. They cite rising rates of additional risk factors such as high blood pressure, obesity, and gestational diabetes, but didn’t give a plausible explanation. Here’s a story about this study published in the Wall Street Journal.

Here’s a simple explanation: Sleep-breathing problems. Whether it’s obstructive sleep apnea or more likely upper airway resistance syndrome, pregnant women tend to have more frequent breathing pauses, especially as they gain weight. One protective mechanism is through progesterone, which acts as a tongue muscle stimulant, but the forces of upper airway collapse is likely to overwhelm these protective effects. What’s even more striking is that the rate almost doubles immediately postpartum. Remember that progesterone drops soon after delivery, but you’re still left with all that additional weight. We know that obstructive sleep apnea can significantly increase your chances of stroke and heart attacks. There are even reports that suggest that preeclampsia can be successfully treated with CPAP.

Overall, the numbers are still very low, but the sudden rise in the rate of stroke in new mothers leaves researchers scratching their heads.

How Sleep Position Can Affect Stillbirth Risk

June 19, 2011

Researchers from New Zealand discovered that women who did not sleep on their left side the last night before delivering their babies had twice the rate of stillbirth compared with those that slept on their left side. It’s commonly recommended for pregnant women to sleep on their left side, especially later in pregnancy. There are various explanations for why this is preferred, from placing less pressure on the mother’s major blood vessels to worsening the mother’s snoring.

I’ve mentioned before that a woman’s risk of developing obstructive sleep apnea increases as she gains weight during pregnancy, but progesterone counteracts this effect neuromuscularly, by tensing the throat muscles and increasing the drive to breathe. However, back sleeping is a known aggravator of breathing pauses during sleep due to gravity’s effects on the tongue. Whether or not this leads to apneas (10 seconds or longer pauses), the mother will still stop breathing and wake up more often during the night. This can place a major stress not only on the mother’s body, but on the baby as well.

This study was an observational study, so more prospective studies are needed. But it only goes to show that any additional situation that can aggravate sleep-breathing problems during pregnancy can raise your risk of complications, which also includes gestational diabetes and preeclampsia.

I wonder if the researchers asked the women what their preferred pre-pregnancy sleep position was. I suspect that women who can’t sleep on their backs may have more complications during pregnancy due to narrowed upper airway anatomy.



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