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Continuous positive airway pressure treatment of obstructive sleep apnea and hypertensive complications in high-risk pregnancy

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

To evaluate whether or not continuous positive airway pressure (CPAP) treatment in pregnancies complicated by obstructive sleep apnea (OSA) is associated with a decrease in hypertensive disorders of pregnancy.

Methods

This was a retrospective cohort study of perinatal outcomes in women who underwent objective OSA testing and treatment as part of routine clinical care during pregnancy. Where diagnostic criteria for OSA were reached (respiratory event index (REI) ≥ 5 events per hour), patients were offered CPAP therapy. Obstetrical outcomes were compared between the control group (no OSA), the group with untreated OSA (OSA diagnosed, not CPAP compliant), and the group with treated OSA (OSA diagnosed and CPAP compliant), with CPAP compliance defined as CPAP use ≥ 4 h, 70% of the time or greater. A composite hypertension outcome combined diagnoses of gestational hypertension (gHTN) and preeclampsia (PreE) of any severity.

Results

The study comprised outcomes from 177 completed pregnancies. Our cohort was characterized by obesity, with average body mass indices > 35 kg/m2, and average maternal age > 30 years old. CPAP was initiated at an average gestational age of 23 weeks (12.1–35.3 weeks), and average CPAP use was 5.9 h (4–8.5 h). The composite hypertension outcome occurred in 43% of those without OSA (N = 77), 64% of those with untreated OSA (N = 77), and 57% of those with treated OSA, compliant with CPAP (N = 23) (p = 0.034).

Conclusion

Real-world data in this small study suggest that CPAP therapy may modulate the increased risk of hypertensive complications in pregnancies complicated by OSA.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Facco FL, Parker CB, Reddy UM et al (2017) Association between sleep-disordered breathing and hypertensive disorders of pregnancy and gestational diabetes mellitus. Obstet Gynecol 129(1):31–41

    Article  PubMed  PubMed Central  Google Scholar 

  2. Louis JM, Auckley D, Sokol RJ, Mercer BM (2010) Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy. American journal of obstetrics and gynecology. 202(3):261–265

    Article  Google Scholar 

  3. Sanapo L, Goldman D, Bourjeily G (2021) Obstructive sleep apnea in pregnancy: 1 sleep study may not be enough in high-risk women. J Clin Sleep Med 17(9):1953–1956

    Article  PubMed  PubMed Central  Google Scholar 

  4. Khalid F, Ayache M, Auckley D (2021) The differential impact of respiratory event scoring criteria on CPAP eligibility in women and men. J Clin Sleep Med. 17:2409

    Article  PubMed  PubMed Central  Google Scholar 

  5. Antony KM, Jacobson NM, Rice L, Wiedmer AM, Mourey H, Bazalakova MH (2021) Obstructive sleep apnea in pregnancy: early lessons from our sleep pregnancy clinic. WMJ 120(1):34–40

    PubMed  PubMed Central  Google Scholar 

  6. Johns EC, Hill EA, Stevie WB et al (2021) High prevalence of obstructive sleep apnea in pregnant women with class III obesity: a prospective cohort study. J Clin Sleep Med. 18:423–432

    Article  Google Scholar 

  7. Pamidi S, Pinto LM, Marc I, Benedetti A, Schwartzman K, Kimoff RJ (2014) Maternal sleep-disordered breathing and adverse pregnancy outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol 210(1):52 e51-52 e14

    Article  Google Scholar 

  8. Bazalakova M (2017) Sleep disorders in pregnancy. Semin Neurol 37(6):661–668

    Article  PubMed  Google Scholar 

  9. Brown MC, Best KE, Pearce MS, Waugh J, Robson SC, Bell R (2013) Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. Eur J Epidemiol 28(1):1–19

    Article  PubMed  Google Scholar 

  10. Pedrosa RP, Drager LF, Gonzaga CC et al (2011) Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension 58(5):811–817

    Article  CAS  PubMed  Google Scholar 

  11. Jerath R, Barnes VA, Fadel HE (2009) Mechanism of development of pre-eclampsia linking breathing disorders to endothelial dysfunction. Med Hypotheses 73(2):163–166

    Article  PubMed  Google Scholar 

  12. Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 96(4):1897–1904

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Schobel HP, Fischer T, Heuszer K, Geiger H, Schmieder RE (1996) Preeclampsia – a state of sympathetic overactivity. N Engl J Med 335(20):1480–1485

    Article  CAS  PubMed  Google Scholar 

  14. Tichanon P, Wilaiwan K, Sopida S, Orapin P, Watchara B, Banjamas I (2016) Effect of continuous positive airway pressure on airway inflammation and oxidative stress in patients with obstructive sleep apnea. Can Respir J 2016:3107324

    Article  PubMed  PubMed Central  Google Scholar 

  15. Panoutsopoulos A, Kallianos A, Kostopoulos K et al (2012) Effect of CPAP treatment on endothelial function and plasma CRP levels in patients with sleep apnea. Med Sci Monit. 18(12):CR747-751

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Poyares D, Guilleminault C, Hachul H et al (2007) Pre-eclampsia and nasal CPAP: part 2. Hypertension during pregnancy, chronic snoring, and early nasal CPAP intervention. Sleep Med 9(1):15–21

    Article  PubMed  Google Scholar 

  17. Edwards N, Blyton DM, Kirjavainen T, Kesby GJ, Sullivan CE (2000) Nasal continuous positive airway pressure reduces sleep-induced blood pressure increments in preeclampsia. Am J Respir Crit Care Med 162(1):252–257

    Article  CAS  PubMed  Google Scholar 

  18. Guilleminault C, Palombini L, Poyares D, Takaoka S, Huynh NT, El-Sayed Y (2007) Pre-eclampsia and nasal CPAP: part 1. Early intervention with nasal CPAP in pregnant women with risk-factors for pre-eclampsia: preliminary findings. Sleep Med. 9(1):9–14

    Article  PubMed  Google Scholar 

  19. Facco FL, Ouyang DW, Zee PC, Grobman WA (2012) Development of a pregnancy-specific screening tool for sleep apnea. J Clin Sleep Med 8(4):389–394

    Article  PubMed  PubMed Central  Google Scholar 

  20. Dominguez JE, Grotegut CA, Cooter M, Krystal AD, Habib AS (2018) Screening extremely obese pregnant women for obstructive sleep apnea. Am J Obstet Gynecol 219(6):613 e611–613 e610

  21. Berry RB, Budhiraja R, Gottlieb DJ et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 8(5):597–619

    Article  PubMed  PubMed Central  Google Scholar 

  22. Antony KM, Ma J, Mitchell KB, Racusin DA, Versalovic J, Aagaard K (2015) The preterm placental microbiome varies in association with excess maternal gestational weight gain. Am J Obstet Gynecol 212(5):653 e651–616

    Article  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. Am J Perinatol 31(10):899–904

    Article  PubMed  PubMed Central  Google Scholar 

  24. O’Brien LM, Bullough AS, Chames MC et al (2014) Hypertension, snoring, and obstructive sleep apnoea during pregnancy: a cohort study. BJOG 121(13):1685–1693

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Stajic D, Ilic D, Vukovic J, Baturan B, Ilic A, Milovancev A (2021) The effect of continuous positive airway pressure treatment on hypertensive disorder in pregnant women with obstructive sleep apnea. Sleep Breath 26:297–305

    Article  PubMed  Google Scholar 

  26. Javaheri S, Barbe F, Campos-Rodriguez F et al (2017) Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol 69(7):841–858

    Article  PubMed  PubMed Central  Google Scholar 

  27. Malhotra A, Ayappa I, Ayas N et al (2021) Metrics of sleep apnea severity: beyond the apnea-hypopnea index. Sleep 44(7):1–16

  28. Link BN, Eid C, Bublitz MH et al (2019) Pulse transit time in pregnancy: a new way to diagnose and classify sleep disordered breathing? Sleep 42(5):1–8

  29. O’Brien TE, Ray JG, Chan WS (2003) Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 14(3):368–374

    Article  PubMed  Google Scholar 

  30. Reiter J, Zleik B, Bazalakova M, Mehta P, Thomas RJ (2016) Residual events during use of CPAP: prevalence, predictors, and detection accuracy. J Clin Sleep Med 12(8):1153–1158

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank the University of Wisconsin School of Medicine and Public Health Departments of Obstetrics and Gynecology and Neurology, Unity Point Health-Meriter’s Center for Perinatal Care, and Wisconsin Sleep for their support in the development of the obstetric sleep clinic. We thank the Department of Biology Course Biology 152 for fostering collaboration between undergraduate students and clinical research mentors. We thank Rebecca Weise, RT, RPSGT, and Kenneth Kloes, RRT, RPSGT, for the reliable and expeditious triaging of pregnancy referrals for sleep evaluations, and Julie Maxwell, RRT, RPSGT, and James Neville, CRT, RPSGT, for processing and scoring of home sleep apnea tests and optimization of the treatment initiation and clinic follow up workflow for pregnant patients.

Funding

Via the use of REDCap for clinical tracking, the project described was supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR002373.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1010 Mound Street, Madison, WI, USA

    Alexandra Lauren Rice, Sakshi Bajaj, Abigail M. Wiedmer & Kathleen M. Antony

  2. Department of Biology, University of Wisconsin-Madison, Madison, WI, USA

    Alexandra Lauren Rice, Abigail M. Wiedmer & Natalie Jacobson

  3. Department of Neurology, Wisconsin Sleep, Wisconsin Institute for Sleep and Consciousness, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI, 53705, USA

    Alexandra Lauren Rice, Abigail M. Wiedmer, Natalie Jacobson & Mihaela H. Bazalakova

  4. Department of Obstetrics and Gynecology, Division of Reproductive Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA

    Aleksandar K. Stanic

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  1. Alexandra Lauren Rice
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  4. Natalie Jacobson
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  6. Kathleen M. Antony
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  7. Mihaela H. Bazalakova
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All the authors have read and approved the manuscript.

Corresponding author

Correspondence to Mihaela H. Bazalakova.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee. Institutional review board (IRB) approval for this study was obtained from UnityPoint Health-Meriter (IRB 2019–014).

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The authors declare no competing interests.

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The University of Wisconsin-Madison.

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Rice, A.L., Bajaj, S., Wiedmer, A.M. et al. Continuous positive airway pressure treatment of obstructive sleep apnea and hypertensive complications in high-risk pregnancy. Sleep Breath 27, 621–629 (2023). https://doi.org/10.1007/s11325-022-02669-0

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  • DOI: https://doi.org/10.1007/s11325-022-02669-0

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