Pregnant woman (illustrative) .
(photo credit: INGIMAGE)
Overweight adults aren’t the only ones to suffer from potentially dangerous obstructive sleep apnea (OSA); about a quarter of pregnant women have the condition, according to sleep-medicine researchers in Jerusalem and St. Louis.
Just as pregnant women may be at risk for gestational diabetes and gestational hypertension that develop while carrying their fetuses, they may also develop gestational OSA, in which one stops breathing for several seconds during sleep, the researchers said. The obese most commonly suffer from OSA, putting them at higher risk for high blood pressure, heart disease and type 2 diabetes.
In non-pregnant adults, protocols have been proposed for OSA screening, diagnosis and therapy, with the main treatment being the use of continuous positive airway pressure (CPAP) machines to force air into the nose as they sleep.
But in pregnant women, OSA is usually untreated because it is still under-diagnosed and not fully appreciated as a risk factor for mother and baby.
Now, in an editorial in the International Journal of Obstetric Anesthesia, sleep researchers from Israel and the US recommend a new diagnosis, “Gestational Sleep Apnea” (GSA). This would allow health professionals to properly describe, diagnose and treat OSA in pregnant women.
“Currently there is a lack of uniform criteria to diagnose, treat and classify OSA in the pregnant population, which in turn complicates efforts to determine the risk factors for, and complications of, gestational sleep apnea,” said Prof. Yehuda Ginosar, director of the mother and child anesthesia unit at Hadassah-University Medical Center in Jerusalem’s Ein Kerem who is on the faculty of the Hebrew University’s Faculty of Medicine.
Ginosar is currently a professor of anesthesiology and chief of the division of obstetric anesthesiology at Washington University School of Medicine in St. Louis.
Doctors and patients may attribute daytime tiredness to “just being pregnant” rather than to sleep apnea. In terms of treatment, some physicians and patients might consider the disease too temporary to warrant referral to a sleep-medicine specialist, which usually requires an overnight sleep study for diagnosis (although the recent increased use of sleep monitors at home will encourage more opportunities for diagnosis).
The researchers argue that establishing and coding for a specific diagnosis of gestational sleep apnea will require further investigation to determine criteria and therapies.
But, as in the case of other gestational diseases, it will allow for more targeted surveillance of maternal and fetal outcomes and facilitate epidemiological research to monitor the course of the condition from its beginnings to its possible path to becoming a chronic condition.
“The time has come for our profession to wake up to the diagnosis of gestational sleep apnea. This will allow us to research obstructive sleep apnea in pregnant women more effectively and to develop and implement more effective treatments,” said co-author Dr. Suzanne Karan, a visiting researcher at Hadassah who is an associate professor of anesthesiology and director of the anesthesiology respiratory physiology laboratory at the University of Rochester School of Medicine.