Obstructive Sleep Apnea in Pregnancy – Development, Impact and Potential Mechanisms

Author(s): Hannah Martin, Kathleen M Antony, Sathish Kumar

Obstructive sleep apnea (OSA) is a common sleep disturbance shown to lead to significant morbidity in the general population. The development of sleep disturbances during pregnancy is potentially linked to anatomical and physiological changes during gestation, such as increased weight, uterine volume, the elevation of the diaphragm, upper airway remodeling, and changes in hormones such as estrogens and progesterone. During pregnancy, it has been reported that OSA is associated with adverse outcomes for the mother and offspring, though precise underlying mechanisms have not yet been elucidated. OSA during pregnancy has been associated with an increased risk of preeclampsia, gestational hypertension, gestational diabetes mellitus (GDM), perinatal depression, and effects on the fetus, such as impaired growth, congenital abnormalities, and neurobehavioral conditions. Several reports have supported these associations in pregnant women, and further study has revealed potential mechanisms of disease to include oxidative stress, autophagy, inflammation, and endothelial dysfunction. The purpose of this review is to outline the known associations between gestational OSA and adverse peri- and postnatal outcomes, collate evidence supporting potential underlying mechanisms, and highlight gaps in the knowledge to create a comprehensive overview of the effects of OSA in pregnancy and suggest where further research should be aimed.