Skip to main content
SpringerLink
Log in

Sleepiness and sleep-disordered breathing during pregnancy

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to examine if there is a difference in the prevalence of obstructive sleep apnea (OSA) and sleepiness between pregnant and non-pregnant women. It also aimed to evaluate if obstetric outcomes were associated to sleep-disordered breathing among the pregnant women.

Methods

One hundred pregnant women (gestational weeks 24–34) and 80 age- and body mass index-matched non-pregnant women underwent whole-night respiratory recordings (airflow, snoring, respiratory movements, body position, pulse oximetry). The women also answered a questionnaire including the Epworth sleepiness scale.

Results

Eighty-nine percent of the pregnant women had normal body mass index (BMI). Objectively, recorded snoring was more common among the pregnant women (median 9 % of total estimated sleep time) than among the controls (4 % of total sleep time, p = 0.005). Three of the pregnant women had OSA (apnea/hypopnea index (AHI) >5), but in two cases, this was mainly due to central hypopneas. None had AHI >10. Two controls were diagnosed as OSA. Respiratory parameters including snoring showed no impact on obstetric outcomes. Total Epworth sleepiness scale (ESS) score was higher among pregnant women than among controls (median 9 vs 7, p < 0.001). There was no difference concerning the separate items. There were no significant associations between either subjectively reported or objectively recorded snoring and ESS scores.

Conclusion

There was no increased prevalence of obstructive sleep apnea among pregnant women. One reason for this could be that the majority of the women in this study were non-obese. Neither OSA nor snoring was likely an explanation for the increased daytime sleepiness seen in the pregnant women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342(19):1378–1384. doi:10.1056/nejm200005113421901

    Article  CAS  PubMed  Google Scholar 

  2. Loube DI, Poceta JS, Morales MC, Peacock MD, Mitler MM (1996) Self-reported snoring in pregnancy: association with fetal outcome. Chest 109(4):885–889

    Article  CAS  PubMed  Google Scholar 

  3. Sarberg M, Svanborg E, Wirehn AB, Josefsson A (2014) Snoring during pregnancy and its relation to sleepiness and pregnancy outcome—a prospective study. BMC Pregnancy Childbirth 14(1):15. doi:10.1186/1471-2393-14-15

    Article  PubMed  PubMed Central  Google Scholar 

  4. Pien GW, Pack AI, Jackson N, Maislin G, Macones GA, Schwab RJ (2014) Risk factors for sleep-disordered breathing in pregnancy. Thorax 69(4):371–377. doi:10.1136/thoraxjnl-2012-202718

    Article  PubMed  Google Scholar 

  5. Izci Balserak B, Jackson N, Ratcliffe SA, Pack AI, Pien GW (2013) Sleep-disordered breathing and daytime napping are associated with maternal hyperglycemia. Sleep & breathing = Schlaf & Atmung 17(3):1093–1102. doi:10.1007/s11325-013-0809-4

    Article  Google Scholar 

  6. Tantrakul V, Park CS, Guilleminault C (2012) Sleep-disordered breathing in premenopausal women: differences between younger (less than 30 years old) and older women. Sleep Med 13(6):656–662. doi:10.1016/j.sleep.2012.02.008

    Article  PubMed  Google Scholar 

  7. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545

    Article  CAS  PubMed  Google Scholar 

  8. Baumgartel KL, Terhorst L, Conley YP, Roberts JM (2013) Psychometric evaluation of the Epworth sleepiness scale in an obstetric population. Sleep Med 14(1):116–121. doi:10.1016/j.sleep.2012.10.007

    Article  PubMed  Google Scholar 

  9. Ulander M, Arestedt K, Svanborg E, Johansson P, Brostrom A (2013) The fairness of the Epworth sleepiness scale: two approaches to differential item functioning. Sleep & breathing = Schlaf & Atmung 17(1):157–165. doi:10.1007/s11325-012-0664-8

    Article  Google Scholar 

  10. Broughton Pipkin F, Roberts JM (2000) Hypertension in pregnancy. J Hum Hypertens 14(10–11):705–724

    Article  CAS  PubMed  Google Scholar 

  11. August EM, Salihu HM, Biroscak BJ, Rahman S, Bruder K, Whiteman VE (2013) Systematic review on sleep disorders and obstetric outcomes: scope of current knowledge. Am J Perinatol 30(4):323–334. doi:10.1055/s-0032-1324703

    Article  PubMed  Google Scholar 

  12. Pamidi S, Pinto LM, Marc I, Benedetti A, Schwartzman K, Kimoff RJ (2013) Maternal sleep-disordered breathing and adverse pregnancy outcomes—a systematic review and meta-analysis. Am J Obstet Gynecol. doi:10.1016/j.ajog.2013.07.033

    PubMed  Google Scholar 

  13. Marsal K, Persson PH, Larsen T, Lilja H, Selbing A, Sultan B (1996) Intrauterine growth curves based on ultrasonically estimated foetal weights. Acta Paediatr 85(7):843–848

    Article  CAS  PubMed  Google Scholar 

  14. Berry RB, Gamaldo CE, Harding SM, Brooks R, Lloyd RM, Vaughn BV, Marcus CL (2015) AASM scoring manual version 2.2 updates: new chapters for scoring infant sleep staging and home sleep apnea testing. J Clin Sleep Med 11(11):1253–1254. doi:10.5664/jcsm.5176

    Article  PubMed  PubMed Central  Google Scholar 

  15. Iber C, American Academy of Sleep Medicine (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specifications. American Academy of Sleep Medicine. Westchester, IL

    Google Scholar 

  16. Montserrat JM, Farre R, Navajas D (2001) New technologies to detect static and dynamic upper airway obstruction during sleep. Sleep Breath 5(4):193–206. doi:10.1007/s11325-001-0193-3

    Article  CAS  PubMed  Google Scholar 

  17. Bloch KE, Li Y, Sackner MA, Russi EW (1997) Breathing pattern during sleep disruptive snoring. Eur Respir J 10(3):576–586

    CAS  PubMed  Google Scholar 

  18. Guilleminault C, Querra-Salva M, Chowdhuri S, Poyares D (2000) Normal pregnancy, daytime sleeping, snoring and blood pressure. Sleep Med 1(4):289–297

    Article  CAS  PubMed  Google Scholar 

  19. Antony KM, Agrawal A, Arndt ME, Murphy AM, Alapat PM, Guntupalli KK, Aagaard KM (2014) Obstructive sleep apnea in pregnancy: reliability of prevalence and prediction estimates. J Perinatol. doi:10.1038/jp.2014.48

    PubMed Central  Google Scholar 

  20. Sahin FK, Koken G, Cosar E, Saylan F, Fidan F, Yilmazer M, Unlu M (2008) Obstructive sleep apnea in pregnancy and fetal outcome. Int J Gynaecol Obstet 100(2):141–146. doi:10.1016/j.ijgo.2007.08.012

    Article  PubMed  Google Scholar 

  21. Champagne K, Schwartzman K, Opatrny L, Barriga P, Morin L, Mallozzi A, Benjamin A, Kimoff RJ (2009) Obstructive sleep apnoea and its association with gestational hypertension. Eur Respir J 33(3):559–565. doi:10.1183/09031936.00122607

    Article  CAS  PubMed  Google Scholar 

  22. Reid J, Skomro R, Cotton D, Ward H, Olatunbosun F, Gjevre J, Guilleminault C (2011) Pregnant women with gestational hypertension may have a high frequency of sleep disordered breathing. Sleep 34(8):1033–1038. doi:10.5665/SLEEP.1156

    Article  PubMed  PubMed Central  Google Scholar 

  23. Facco FL, Ouyang DW, Zee PC, Grobman WA (2014) Sleep disordered breathing in a high-risk cohort prevalence and severity across pregnancy. American journal of perinatology. doi:10.1055/s-0033-1363768

    PubMed  PubMed Central  Google Scholar 

  24. Facco FL, Lappen J, Lim C, Zee PC, Grobman WA (2013) Preeclampsia and sleep-disordered breathing: a case-control study. Pregnancy Hypertens 3(2):133–139. doi:10.1016/j.preghy.2013.01.005

    PubMed  PubMed Central  Google Scholar 

  25. Louis J, Auckley D, Miladinovic B, Shepherd A, Mencin P, Kumar D, Mercer B, Redline S (2012) Perinatal outcomes associated with obstructive sleep apnea in obese pregnant women. Obstet Gynecol 120(5):1085–1092. doi:10.1097/AOG.0b013e31826eb9d8

    PubMed  Google Scholar 

  26. Edwards N, Blyton DM, Hennessy A, Sullivan CE (2005) Severity of sleep-disordered breathing improves following parturition. Sleep 28(6):737–741

    Article  PubMed  Google Scholar 

  27. Gislason T, Benediktsdottir B, Bjornsson JK, Kjartansson G, Kjeld M, Kristbjarnarson H (1993) Snoring, hypertension, and the sleep apnea syndrome. An epidemiologic survey of middle-aged women. Chest 103(4):1147–1151

    Article  CAS  PubMed  Google Scholar 

  28. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235. doi:10.1056/nejm199304293281704

    Article  CAS  PubMed  Google Scholar 

  29. Franklin KA, Sahlin C, Stenlund H, Lindberg E (2013) Sleep apnoea is a common occurrence in females. Eur Respir J 41(3):610–615. doi:10.1183/09031936.00212711

    Article  PubMed  Google Scholar 

  30. Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R, Portable Monitoring Task Force of the American Academy of Sleep M (2007) Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 3(7):737–747

    PubMed  Google Scholar 

  31. Aurora RN, Swartz R, Punjabi NM (2014) Misclassification of obstructive sleep apnea severity with automated scoring of home sleep recordings. Chest. doi:10.1378/chest.14-0929

    PubMed Central  Google Scholar 

  32. Berry RB, Hill G, Thompson L, McLaurin V (2008) Portable monitoring and autotitration versus polysomnography for the diagnosis and treatment of sleep apnea. Sleep 31(10):1423–1431

    PubMed  PubMed Central  Google Scholar 

  33. Arnardottir ES, Isleifsson B, Agustsson JS, Sigurdsson GA, Sigurgunnarsdottir MO, Sigurdarson GT, Saevarsson G, Sveinbjarnarson AT, Hoskuldsson S, Gislason T (2015) How to measure snoring? A comparison of the microphone, cannula and piezoelectric sensor. Journal of sleep research. doi:10.1111/jsr.12356

    Google Scholar 

  34. Simpson AP (2001) Dynamic consequences of differences in male and female vocal tract dimensions. J Acoust Soc Am 109(5 Pt 1):2153–2164

    Article  CAS  PubMed  Google Scholar 

  35. Martin SE, Mathur R, Marshall I, Douglas NJ (1997) The effect of age, sex, obesity and posture on upper airway size. Eur Respir J 10(9):2087–2090

    Article  CAS  PubMed  Google Scholar 

  36. Moore KL, Dalley AF (2009) Clinically oriented anatomy, 6 edn. Williams and Wilkins, Baltimore

  37. Signal TL, Paine SJ, Sweeney B, Priston M, Muller D, Smith A, Lee KA, Huthwaite M, Reid P, Gander P (2014) Prevalence of abnormal sleep duration and excessive daytime sleepiness in pregnancy and the role of socio-demographic factors: comparing pregnant women with women in the general population. Sleep Med 15(12):1477–1483. doi:10.1016/j.sleep.2014.07.007

    Article  PubMed  Google Scholar 

  38. Hedman C, Pohjasvaara T, Tolonen U, Suhonen-Malm AS, Myllyla VV (2002) Effects of pregnancy on mothers’ sleep. Sleep Med 3(1):37–42

    Article  CAS  PubMed  Google Scholar 

  39. Ko H, Shin J, Kim MY, Kim YH, Lee J, Kil KC, Moon HB, Lee G, Sa-Jin K, Kim BI (2012) Sleep disturbances in Korean pregnant and postpartum women. J Psychosom Obstet Gynaecol 33(2):85–90. doi:10.3109/0167482X.2012.658465

    Article  PubMed  Google Scholar 

  40. Bourjeily G, Raker C, Chalhoub M, Miller M (2013) Excessive daytime sleepiness in late pregnancy may not always be normal: results from a cross-sectional study. Sleep & breathing = Schlaf & Atmung 17(2):735–740. doi:10.1007/s11325-012-0753-8

    Article  Google Scholar 

  41. Izci B, Martin SE, Dundas KC, Liston WA, Calder AA, Douglas NJ (2005) Sleep complaints: snoring and daytime sleepiness in pregnant and pre-eclamptic women. Sleep Med 6(2):163–169. doi:10.1016/j.sleep.2004.12.007

    Article  PubMed  Google Scholar 

  42. Douglas NJ (2003) Home diagnosis of the obstructive sleep apnoea/hypopnoea syndrome. Sleep Med Rev 7(1):53–59

    Article  PubMed  Google Scholar 

  43. Gay PC, Selecky PA (2010) Are sleep studies appropriately done in the home? Respir Care 55(1):66–75

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Lena Harder, M.D., for initial scoring of the recordings of the pregnant women. We also thank research midwives Pia Cederholm and Cecilia Rostedt at the antenatal care center for valuable help with recruiting the women and collecting data.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Linköping University, University Hospital, 581 85, Linköping, SE, Sweden

    Maria Sarberg, Marie Bladh & Ann Josefsson

  2. Department of Clinical and Experimental Medicine, Linköping University, University Hospital, 581 85, Linköping, SE, Sweden

    Maria Sarberg, Marie Bladh & Ann Josefsson

  3. Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden

    Eva Svanborg

Authors
  1. Maria Sarberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie Bladh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ann Josefsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eva Svanborg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Sarberg.

Ethics declarations

Funding

No funding was received for this research.

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sarberg, M., Bladh, M., Josefsson, A. et al. Sleepiness and sleep-disordered breathing during pregnancy. Sleep Breath 20, 1231–1237 (2016). https://doi.org/10.1007/s11325-016-1345-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-016-1345-9

Keywords

Search

Navigation