Sleep apnea tied to diabetes and hypertension during pregnancy


Pregnant women who suffer from certain breathing problems during sleep more likely to develop complications such as high blood pressure and diabetes, recent AMERICAN research suggests.

In the study of more than 3,000 women, researchers did a home-based sleep studies twice during the pregnancy to check for what is known as sleep apnea, a very serious sleep disorder where repeated stops and starts to breathe. Risk factors for sleep apnea include older age and obesity.

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Women with sleep apnea were almost twice as likely to develop what is known as pre-eclampsia, a type of pregnancy-related high blood pressure, and up to 3.5 times more likely to develop pregnancy-related diabetes, the study found.

“Although we found an association with sleep disordered breathing prior to the development of both pregnancy-related hypertensive disorders and gestational diabetes, we cannot conclude that the universal screening and treatment of sleep-disordered breathing during pregnancy would reduce the risk of these adverse outcomes,” said lead study author Dr. Francesca Facco, of the University of Pittsburgh’s Magee-Women’s Hospital.

That is because, even among people who are not pregnant, there is no conclusive evidence that the most common treatment of apnea can reduce the risk of developing hypertension or diabetes, Facco said by e-mail.

For the most common apnea treatment, patients wear breathing masks at night. The masks are connected to a machine that provides continuous positive airway pressure (CPAP), which splints the airway open with a stream of air, so that the upper airway can’t collapse during sleep.

Some patients can’t tolerate sleeping with a CPAP machines. This intervention is not recommended for pregnant women, especially if they have only mild apnea, Facco said.

“We do not know whether the treatment of sleep-disordered breathing during the pregnancy will improve clinical outcomes in the pregnancy, and our study cannot answer that question,” Facco added.

Sleep tests done for the study found that early in the pregnancy, between six and 15 weeks of pregnancy, 3.6 percent of the women had apnea. Later in the pregnancy when they had gained more weight between 22 and 31 weeks of pregnancy, 8.3 percent of the women had apnea.

Overall, 6 percent of the women had pre-eclampsia, 13 percent had pregnancy-related hypertensive disorders, and 4 percent developed gestational diabetes, researchers report in the journal Obstetrics and Gynecology.

Early in pregnancy, women with apnea were 94 percent more likely to develop pre-eclampsia, and 46 percent more likely to have hypertensive disorders and 3.5 times more likely to develop diabetes than women without sleep-disordered breathing.

Women who had apnea later in the pregnancy were 95 percent more likely to develop pre-eclampsia, 73 percent more likely to develop hypertensive disorders, and 2.8 times more likely to have diabetes than women without sleep-disordered breathing.

The study is observational and does not prove apnea are the causes of these complications during the pregnancy.

A limitation of the study is the potential for home-based sleep tests to some cases of apnea unnoticed, may be an underestimation of the prevalence of sleep-disordered breathing.

“Currently, we are still more data is needed on the question of whether the improvement or the treatment of sleep disordered breathing will reduce the risk of high blood pressure or diabetes during pregnancy,” said Dr. Sirimon Reutrakul, a researcher at the Mahidol University in Bangkok which is not involved in the study.

“However, overweight or obesity is a risk factor for high blood pressure and diabetes during pregnancy, as well as the sleep-disordered breathing,” Reutrakul added by e-mail. “Therefore, keeping a healthy body weight through diet and exercise should reduce the risk for these problems.”

Women have a lot of health reasons to start pregnancy at a healthy weight and a younger age, two things that can also lower the chance of apnea, said Dr. Marie-Pierre St-Onge, a researcher at Columbia University Medical Center in New York, who was not involved in the study.

“Obstructive sleep apnea is associated with obesity,” St-Onge said by e-mail.

“Although this study does not find an interaction between weight status and the OSA to hypertension and diabetes, I would suggest that women’s pregnancy at a normal weight, and weight is suitable for their weight status,” she said.

“When possible, avoiding of delaying pregnancy to a more advanced age, it would be advisable,” St-Onge added.

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