Obstructive sleep apnea in pregnancy

Obesity rates among pregnant mothers in Malaysia has reached epidemic proportions and remains a significant global and national health burden, both to the mother and the fetus.

Prevention remains the key and although we have made significant advancements with regards to the optimization and management of obese mothers, such as universal screening for diabetes and gestational diabetes, venous thromboembolism risk assessment and initiation of thromboprophylaxis and prevention of pre-eclampsia via the initiation of aspirin, screening and active management of obstructive  sleep apnea (OSA) remains an essential pregnancy intervention which is yet to be appropriately addressed and developed as a standard of care for these high risk mothers.

Although the true incidence of OSA among pregnant mothers remains understudied, the clinical presentation may often be missed as “normal” during pregnancy and hence it remains a diagnostic challenge. Although there has been several validated questionnaires for OSA among pregnant mothers, it remains inaccurate in prediction and as a screening tool for OSA during pregnancy. Treatment on the other hand has been proven to have significant maternal and fetal benefits, especially with regards to prevention of preeclampsia, growth restricted fetus and even improvement in preterm delivery and 5 minute Apgar scores of the fetus.

This lecture will review the importance and availability of various screening modalities for obstructive sleep apnea among pregnant mothers and will highlight the benefits of treatment of OSA during pregnancy, apart from highlighting the importance for better research and development of standardised guidelines for optimal pregnancy outcomes, as we precisely progress towards optimal maternal and fetal outcomes among such patients.