Sleep and Breathing

, Volume 20, Issue 4, pp 1231–1237 | Cite as

Sleepiness and sleep-disordered breathing during pregnancy

  • Maria Sarberg
  • Marie Bladh
  • Ann Josefsson
  • Eva Svanborg
Sleep Breathing Physiology and Disorders • Original Article



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.


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.


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.


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.


Pregnancy Snoring Sleep recordings Sleep-disordered breathing Obstructive sleep apnea Epworth sleepiness scale 



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.

Compliance with ethical standards


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.


  1. 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 CrossRefPubMedGoogle Scholar
  2. 2.
    Loube DI, Poceta JS, Morales MC, Peacock MD, Mitler MM (1996) Self-reported snoring in pregnancy: association with fetal outcome. Chest 109(4):885–889CrossRefPubMedGoogle Scholar
  3. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 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 CrossRefPubMedGoogle Scholar
  5. 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 CrossRefGoogle Scholar
  6. 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 CrossRefPubMedGoogle Scholar
  7. 7.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545CrossRefPubMedGoogle Scholar
  8. 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 CrossRefPubMedGoogle Scholar
  9. 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 CrossRefGoogle Scholar
  10. 10.
    Broughton Pipkin F, Roberts JM (2000) Hypertension in pregnancy. J Hum Hypertens 14(10–11):705–724CrossRefPubMedGoogle Scholar
  11. 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 CrossRefPubMedGoogle Scholar
  12. 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 PubMedGoogle Scholar
  13. 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):843–848CrossRefPubMedGoogle Scholar
  14. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 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, ILGoogle Scholar
  16. 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 CrossRefPubMedGoogle Scholar
  17. 17.
    Bloch KE, Li Y, Sackner MA, Russi EW (1997) Breathing pattern during sleep disruptive snoring. Eur Respir J 10(3):576–586PubMedGoogle Scholar
  18. 18.
    Guilleminault C, Querra-Salva M, Chowdhuri S, Poyares D (2000) Normal pregnancy, daytime sleeping, snoring and blood pressure. Sleep Med 1(4):289–297CrossRefPubMedGoogle Scholar
  19. 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 PubMedCentralGoogle Scholar
  20. 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 CrossRefPubMedGoogle Scholar
  21. 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 CrossRefPubMedGoogle Scholar
  22. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 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 PubMedPubMedCentralGoogle Scholar
  24. 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 PubMedPubMedCentralGoogle Scholar
  25. 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 PubMedGoogle Scholar
  26. 26.
    Edwards N, Blyton DM, Hennessy A, Sullivan CE (2005) Severity of sleep-disordered breathing improves following parturition. Sleep 28(6):737–741CrossRefPubMedGoogle Scholar
  27. 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):1147–1151CrossRefPubMedGoogle Scholar
  28. 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 CrossRefPubMedGoogle Scholar
  29. 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 CrossRefPubMedGoogle Scholar
  30. 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):737–747PubMedGoogle Scholar
  31. 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 PubMedCentralGoogle Scholar
  32. 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):1423–1431PubMedPubMedCentralGoogle Scholar
  33. 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. 34.
    Simpson AP (2001) Dynamic consequences of differences in male and female vocal tract dimensions. J Acoust Soc Am 109(5 Pt 1):2153–2164CrossRefPubMedGoogle Scholar
  35. 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):2087–2090CrossRefPubMedGoogle Scholar
  36. 36.
    Moore KL, Dalley AF (2009) Clinically oriented anatomy, 6 edn. Williams and Wilkins, BaltimoreGoogle Scholar
  37. 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 CrossRefPubMedGoogle Scholar
  38. 38.
    Hedman C, Pohjasvaara T, Tolonen U, Suhonen-Malm AS, Myllyla VV (2002) Effects of pregnancy on mothers’ sleep. Sleep Med 3(1):37–42CrossRefPubMedGoogle Scholar
  39. 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 CrossRefPubMedGoogle Scholar
  40. 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 CrossRefGoogle Scholar
  41. 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 CrossRefPubMedGoogle Scholar
  42. 42.
    Douglas NJ (2003) Home diagnosis of the obstructive sleep apnoea/hypopnoea syndrome. Sleep Med Rev 7(1):53–59CrossRefPubMedGoogle Scholar
  43. 43.
    Gay PC, Selecky PA (2010) Are sleep studies appropriately done in the home? Respir Care 55(1):66–75PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Maria Sarberg
    • 1
    • 2
  • Marie Bladh
    • 1
    • 2
  • Ann Josefsson
    • 1
    • 2
  • Eva Svanborg
    • 3
  1. 1.Department of Obstetrics and GynaecologyLinköping UniversityLinköpingSweden
  2. 2.Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
  3. 3.Department of Clinical NeurophysiologyLinköping UniversityLinköpingSweden

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