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Snoring and Sleep Apnea During Pregnancy and Postpartum Period

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ENT Diseases: Diagnosis and Treatment during Pregnancy and Lactation

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Abstract

Sleep-disordered breathing (SDB) is a group of disorders that includes a spectrum ranging from simple snoring to obstructive sleep apnea (OSA). Sleep disorders impair the quality of life in pregnant women and cause many symptoms such as daytime sleepiness, fatigue, and lack of concentration, and it also has very severe obstetric (hypertension, preeclampsia, diabetes, and depression) and fetal (small for gestational age, preterm birth, intrauterine growth retardation, low APGAR, etc.) consequences. The diagnosis and management of SDB in pregnancy are challenging due to most symptoms being indistinguishable from the general symptoms and signs of pregnancy. Although the gold standard method for diagnosis is all-night polysomnography, it is not always applicable during pregnancy. Management of SDB in pregnancy is also a subject of debate. Prescribing drugs in pregnant patients is not recommended. It is important to prevent weight gain and obesity during pregnancy. Continuous positive airway pressure (CPAP) remains the most effective treatment modality in SDB during pregnancy.

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References

  1. Pien GW, Schwab RJ. Sleep disorders during pregnancy. Sleep. 2004;27:1405–17.

    Article  PubMed  Google Scholar 

  2. Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh Sleep Quality Index (PSQI): a new instrument for psychiatric research and practice. Psychiatry Res. 1989;28:193–213.

    Article  CAS  PubMed  Google Scholar 

  3. Sharma SK, Nehra A, Sinha S, et al. Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study. Sleep Breath. 2016;20(1):87–93.

    Article  CAS  PubMed  Google Scholar 

  4. Moore LG, McCullough RE, Weil JV. Increased HVR in pregnancy: relationship to hormonal and metabolic changes. J Appl Physiol. 1985;62(1):158–63.

    Article  Google Scholar 

  5. Jensen D, Wolfe LA, Slatkovska L, et al. Effects of human pregnancy on the ventilatory chemoreflex response to carbon dioxide. Am J Physiol Regul Integr Comp Physiol. 2005;288(5):R1369–75.

    Article  CAS  PubMed  Google Scholar 

  6. Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol. 1998;84(3):1055–62.

    Article  CAS  PubMed  Google Scholar 

  7. Ursavaş A, Karadağ M. Sleep breathing disorders in pregnancy. Tuberk Toraks. 2009;57:237–43.

    PubMed  Google Scholar 

  8. Izci B, Vennelle M, Liston WA, et al. Sleep-disordered breathing and upper airway size in pregnancy and post-partum. Eur Respir J. 2006;27(2):321–7.

    Article  CAS  PubMed  Google Scholar 

  9. Venkata C, Venkateshiah SB. Sleep-disordered breathing during pregnancy. J Am Board Fam Med. 2009;22(2):158–68.

    Article  PubMed  Google Scholar 

  10. Maasilta P, Bachour A, Teramo K, et al. Sleep-related disordered breathing during pregnancy in obese women. Chest. 2001;120(5):1448–54.

    Article  CAS  PubMed  Google Scholar 

  11. Pilkington S, Carli F, Dakin MJ, et al. Increase in Mallampati score during pregnancy. Br J Anaesth. 1995;74(6):638–42.

    Article  CAS  PubMed  Google Scholar 

  12. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.

    Article  CAS  PubMed  Google Scholar 

  13. Rimpilä V, Jernman R, Lassila K, et al. Upper-airway flow limitation and transcutaneous carbon dioxide during sleep in normal pregnancy. Sleep Med. 2017;36:67–74.

    Article  PubMed  Google Scholar 

  14. Ayrım A, Keskin EA, Ozol D, et al. Influence of self-reported snoring and witnessed sleep apnea on gestational hypertension and fetal outcome in pregnancy. Arch Gynecol Obstet. 2011;283:195–9.

    Article  PubMed  Google Scholar 

  15. Kump K, Whalen C, Tishler PV, et al. Assessment of the validity and utility of a sleep symptom questionnaire. Am J Respir Crit Care Med. 1994;150:735–41.

    Article  CAS  PubMed  Google Scholar 

  16. Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002;162:893–900.

    Article  PubMed  Google Scholar 

  17. Franklin KA, Holmgren PA, Jonsson F, et al. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus. Chest. 2000;117:137–41.

    Article  CAS  PubMed  Google Scholar 

  18. Loube DI, Poceta JS, Morales MC, et al. Self-reported snoring in pregnancy: association with fetal outcome. Chest. 1996;109:885–9.

    Article  CAS  PubMed  Google Scholar 

  19. Tsai SY, Lee PL, Lee CN. Snoring and blood pressure in third-trimester normotensive pregnant women. J Nurs Scholarsh. 2018;50(5):522–9.

    Article  PubMed  Google Scholar 

  20. Pien GW, Fife D, Pack AI, et al. Changes in symptoms of sleep-disordered breathing during pregnancy. Sleep. 2005;28:1299–305.

    Article  PubMed  Google Scholar 

  21. O’Brien LM, Bullough AS, Owusu JT, et al. Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study. Am J Obstet Gynecol. 2012;207(6):487.

    PubMed  PubMed Central  Google Scholar 

  22. Qiu C, Enquobahrie D, Frederick IO, et al. Glucose intolerance and gestational diabetes risk in relation to sleep duration and snoring during pregnancy: a pilot study. BMC Womens Health. 2010;10:17.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Louis JM, Koch MA, Reddy UM, et al. Predictors of sleep-disordered breathing in pregnancy. Am J Obstet Gynecol. 2018;218(5):521.e1–521.e12.

    Article  Google Scholar 

  24. Champagne KA, Kimoff RJ, Barriga PC, et al. Sleep disordered breathing in women of childbearing age & during pregnancy. Indian J Med Res. 2010;131:285–301.

    PubMed  Google Scholar 

  25. Izci-Balserak B, Pien GW. Sleep-disordered breathing and pregnancy: potential mechanisms and evidence for maternal and fetal morbidity. Curr Opin Pulm Med. 2010;16:574–82.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263–76.

    Article  PubMed  Google Scholar 

  27. Bourjeily G, Raker CA, Chalhoub M, et al. Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing. Eur Respir J. 2010;36(4):849–55.

    Article  CAS  PubMed  Google Scholar 

  28. Ohida T, Kaneita Y, Osaki Y, et al. Is passive smoking associated with sleep disturbance among pregnant women? Sleep. 2007;30(9):1155–61.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kalmbach DA, Cheng P, Sangha R, et al. Insomnia, short sleep, and snoring in mid-to-late pregnancy: disparities related to poverty, race, and obesity. Nat Sci Sleep. 2019;11:301–15.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Williams MA, Gelaye B, Qiu C, et al. Habitual snoring and asthma comorbidity among pregnant women. J Asthma. 2011;48(1):91–7.

    Article  PubMed  Google Scholar 

  31. Guinhouya BC, Bisson M, Dubois L, et al. Body weight status and sleep disturbances during pregnancy: does adherence to gestational weight gain guidelines matter? J Womens Health. 2019;28(4):535–43.

    Article  Google Scholar 

  32. Pérez-Chada D, Videla AJ, O’Flaherty M, et al. Snoring, witnessed sleep apneas and pregnancy-induced hypertension. Acta Obstet Gynecol Scand. 2007;86(7):788–92.

    Article  PubMed  Google Scholar 

  33. Guilleminault C, Kreutzer M, Chang JL. Pregnancy, sleep disordered breathing and treatment with nasal continuous positive airway pressure. Sleep Med. 2004;5(1):43–51.

    Article  PubMed  Google Scholar 

  34. Yang Z, Zhu Z, Wang C, et al. Association between adverse perinatal outcomes and sleep disturbances during pregnancy: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2022;35(1):166–74.

    Article  PubMed  Google Scholar 

  35. Köken G, Sahin FK, Cosar E, et al. Oxidative stress markers in pregnant women who snore and fetal outcome: a case control study. Acta Obstet Gynecol Scand. 2007;86:1317–21.

    Article  PubMed  Google Scholar 

  36. Connolly G, Razak AR, Hayanga A, et al. Inspiratory flow limitation during sleep in pre-eclampsia: comparison with normal pregnant and non-pregnant women. Eur Respir J. 2001;18:672–6.

    Article  CAS  PubMed  Google Scholar 

  37. Fung AM, Wilson DL, Barnes M, et al. Obstructive sleep apnea and pregnancy: the effect on perinatal outcomes. J Perinatol. 2012;32:399–406.

    Article  CAS  PubMed  Google Scholar 

  38. Tauman R, Many A, Deutsch V, et al. Maternal snoring during pregnancy is associated with enhanced fetal erythropoiesis—a preliminary study. Sleep Med. 2011;12:518–22.

    Article  PubMed  Google Scholar 

  39. Hermansen MC. Nucleated red blood cells in the fetus and newborn. Arch Dis Child Fetal Neonatal Ed. 2001;84:F211–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Su MC, Chiu KL, Ruttanaumpawan P, et al. Difference in upper airway collapsibility during wakefulness between men and women in response to lower-body positive pressure. Clin Sci. 2009;116:713–20.

    Article  Google Scholar 

  41. Edwards N, Blyton DM, Kirjavainen T, et al. Nasal continuous positive airway pressure reduces sleep-induced blood pressure increments in preeclampsia. Am J Respir Crit Care Med. 2000;162:252–7.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  43. Gooley JJ, Mohapatra L, Twan DCK. The role of sleep duration and sleep disordered breathing in gestational diabetes mellitus. Neurobiol Sleep Circadian Rhythms. 2017;4:34–43.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Reutrakul S, Zaidi N, Wroblewski K, et al. Sleep disturbances and their relationship to glucose tolerance in pregnancy. Diabetes Care. 2011;34(11):2454–7.

    Article  PubMed  PubMed Central  Google Scholar 

  45. O’Brien LM, Owusu JT, Swanson LM. Habitual snoring and depressive symptoms during pregnancy. BMC Pregnancy Childbirth. 2013;13:113.

    Article  PubMed  PubMed Central  Google Scholar 

  46. O’Brien LM, Bullough AS, Owusu JT, et al. Snoring during pregnancy and delivery outcomes: a cohort study. Sleep. 2013;36(11):1625–32.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Sahin FK, Köken G, Cosar E, et al. Obstructive sleep apnea in pregnancy and fetal outcome. Int J Gynaecol Obstet. 2008;100:141–6.

    Article  PubMed  Google Scholar 

  48. Micheli K, Komninos I, Bagkeris E, et al. Sleep patterns in late pregnancy and risk of preterm birth and fetal growth restriction. Epidemiology. 2011;22(5):738–44.

    Article  PubMed  Google Scholar 

  49. Tauman R, Sivan Y, Katsav S. Maternal snoring during pregnancy is not associated with fetal growth restriction. J Matern Fetal Neonatal Med. 2012;25(8):1283–6.

    Article  PubMed  Google Scholar 

  50. Dunietz GL, Shedden K, Schisterman EF, et al. Associations of snoring frequency and intensity in pregnancy with time-to-delivery. Paediatr Perinat Epidemiol. 2018;32(6):504–11.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Cai XH, Li ML, Xu XF, et al. Zhonghua Jie He He Hu Xi Za Zhi. 2010;33(5):331–5.

    PubMed  Google Scholar 

  52. August EM, Salihu HM, Biroscak BJ, et al. Systematic review on sleep disorders and obstetric outcomes: scope of current knowledge. Am J Perinatol. 2013;30(4):323–34.

    Article  PubMed  Google Scholar 

  53. Salihu HM, King L, Patel P, et al. Association between maternal symptoms of sleep disordered breathing and fetal telomere length. Sleep. 2015;38(4):559–66.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Favilli A, Laurenti E, Stagni GM, et al. Effects of sodium hyaluronate on symptoms and quality of life in women affected by pregnancy rhinitis: a pilot study. Gynecol Obstet Invest. 2019;84(2):159–65.

    Article  CAS  PubMed  Google Scholar 

  55. Dominiguez JE, Street L, Louis J. Management of obstructive sleep apnea in pregnancy. Obstet Gynecol Clin North Am. 2018;45(2):233–47.

    Article  Google Scholar 

  56. Dominiguez JE, Krystal AD, Habib AS. Obstructive sleep apnea in pregnant women: a review of pregnancy outcomes and an approach to management. Anesth Analg. 2018;127(5):1167–77.

    Article  Google Scholar 

  57. Balserak Bİ, Zhu B, Grandner MA, et al. Obstructive sleep apnea in pregnancy: performance of a rapid screening tool. Sleep Breath. 2019;23:425–32.

    Article  PubMed  Google Scholar 

  58. Street LM, Aschenbrenner CA, Houle TT, et al. Gestational obstructive sleep apnea: biomarker screening models and lack of postpartum resolution. J Clin Sleep Med. 2018;14(4):549–55.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Ayyar L, Shaib F, Guntupalli K. Sleep-disordered breathing in pregnancy. Sleep Med Clin. 2018;13(3):349–57.

    Article  PubMed  Google Scholar 

  60. Karaduman M, Sarı O, Aydoğan Ü, et al. Evaluation of obstructive sleep apnea symptoms in pregnant women with chronic disease. J Matern Fetal Neonatal Med. 2016;29(20):3379–85.

    CAS  PubMed  Google Scholar 

  61. Gupta R, Rawat VS. Sleep and sleep disorders in pregnancy. In: Steegers EAP, Cipolla MJ, Miller EC, editors. Handbook of clinical neurology, vol. 172. Elsevier; p. 169–186.

    Google Scholar 

  62. Pearson F, Batterham AM, Cope S. The STOP-Bang questionnaire as a screening tool for obstructive sleep apnea in pregnancy. J Clin Sleep Med. 2019;15(5):705–10.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Bin YS, Cistulli PA, Ford JB. Population-based study of sleep apnea in pregnancy and maternal and infant outcomes. J Clin Sleep Med. 2016;12(6):871–7.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Redhead K, Walsh J, Galbally M, et al. Obstructive sleep apnea is associated with depressive symptoms in pregnancy. Sleep. 2020;43(5):zsz270.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Medical School, Department of Otorhinolaryngology, Zonguldak Bülent Ecevit University, Zonguldak, Turkey

    Duygu Erdem & Sultan Şevik Eliçora

  2. Department of Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy

    Giulio Cesare Passali

Authors
  1. Duygu Erdem
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  2. Sultan Şevik Eliçora
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  3. Giulio Cesare Passali
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Corresponding author

Correspondence to Duygu Erdem .

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Editors and Affiliations

  1. Department of Otorhinolaryngology, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey

    Cemal Cingi

  2. Department of Otorhinolaryngology, Derince Training and Research Hospital, Faculty of Medicine, Health Sciences University, Kocaeli, Turkey

    Halil Erdem Özel

  3. Department of Otorhinolaryngology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey

    Nuray Bayar Muluk

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Erdem, D., Şevik Eliçora, S., Passali, G.C. (2022). Snoring and Sleep Apnea During Pregnancy and Postpartum Period. In: Cingi, C., Özel, H.E., Bayar Muluk, N. (eds) ENT Diseases: Diagnosis and Treatment during Pregnancy and Lactation. Springer, Cham. https://doi.org/10.1007/978-3-031-05303-0_17

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  • DOI: https://doi.org/10.1007/978-3-031-05303-0_17

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