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Obesity and Weight Management Obstructive Sleep Apnea in Pregnancy—More Questions than Answers Soha Patel MD, MPH 1 and Judette M Louis, MD, MPH 2 1. Resident; 2. Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida, US Abstract The role of obstructive sleep apnea (OSA) in pregnancy is not well studied, but an increasing body of literature appears to indicate that there may be adverse maternal and fetal health effects of the disease. OSA is associated with a twofold risk for pre-eclampsia. The small size of the existing investigations still leave unanswered questions about the consequences of OSA as it relates to some other clinically relevant outcomes such as eclampsia, stillbirth, and maternal mortality. A consistent body of literature has emerged demonstrating an increased risk for insulin resistance and diabetes associated with OSA. However, among pregnant women, the association appears to be related to short sleep duration. Well-designed and adequately powered studies are required to further delineate the role of OSA and sleep duration on pregnancy outcome and the mechanisms of those effects. Keywords Sleep apnea, pregnancy, short sleep duration, gestational diabetes, obesity, glucose intolerance Disclosure: Soha Patel MD, MPH, has no conflicts of interest to declare. Judette M Louis MD, MPH, has provided expert witness testimony for Hutton and Hutton, LLC. Received: June 18, 2013 Accepted: July 26, 2013 Citation: US Endocrinology, 2013;9(2):153–6 Correspondence: Judette M Louis, MD, MPH, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle Suite 6055, Tampa, FL 33606, US. E: jlouis1@health.usf.edu The global obesity pandemic has been well documented and affects both high- and low-income countries. 1 In the US, two-thirds of adults are classified as either overweight or obese. 2,3 In tandem with the high prevalence of obesity is a change in the prevalence of obesity among reproductive-aged women. Therefore, obesity-related morbid conditions such as chronic hypertension and diabetes are also increasing. 4–7 literature on OSA in pregnancy, associated outcomes, and suggest future directions for research. Epidemiology One obesity-related condition, which has received increased attention in recent years, is sleep disordered breathing (SDB). SDB refers to a group of disorders characterized by abnormal respiratory patterns (i.e. apneas) or abnormal gas exchange (i.e. hypoxia) during sleep. SDB ranges in severity from snoring, to the most severe form, obstructive sleep apnea (OSA). 8 OSA is defined as entirely absent or severely reduced airflow during sleep in spite of respiratory effort. It is characterized by recurrent episodes of complete or partial upper airway collapse during sleep leading to decreased airflow, hypoxemia, and recurrent arousals from sleep. 9 The medical consequences of OSA in the general population have been well documented and include excessive daytime sleepiness, fatigue, cognitive dysfunction, and impaired quality of life. 10 OSA is frequently associated with cardiovascular and metabolic disorders such as hypertension and diabetes. In addition, OSA may contribute to arrhythmias, heart failure, insulin resistance, diabetes, dyslipidemia, and atherosclerosis progression. 11 OSA is an increasingly common condition. The prevalence of SDB as defined by an apnea-hypopnea index (AHI) ≥15 among women aged 30– 39 was 4  % among women in the Wisconsin Sleep Cohort. 12 Subsequent studies have reported prevalence of OSA among reproductive age women that is estimated to be 0.6–7 %, depending on the population and the diagnostic criteria used. 12,13 That prevalence rises to 11–20  % among pregnant women, with the highest prevalence observed among obese gravidas. 12,14–16 Determining the true prevalence of OSA in pregnancy is difficult secondary to the diagnostic challenges that pregnancy presents. Validated questionnaires have been demonstrated to be poorly predictive of OSA among pregnant women and may overestimate the prevalence of OSA. 17–19 This may be secondary to an overlap between symptoms from physiologic pregnancy changes and symptoms of OSA. The gold standard for OSA diagnosis is the nocturnal polysomnogram. 9 This test is expensive, and the time constraints proved to be inhibitive, in particular to women who may be unable to spend the night away from home. The use of unattended portable monitors in the home is increasing but has been approved for limited populations. 20 The role of OSA in pregnancy is not as well studied, but an increasing body of literature appears to indicate that there may be maternal and fetal health effects of the disease. In this article, we will review the published While this alternative is widely used in research, many of the portable devices have not been validated in pregnant women. However, reports from small groups of women indicate that there is considerable © TO U CH MEDICAL MED IA 2013 153