Untreated Sleep Apnea In Mothers And Preterm (Premature) Births

Did you know that if a pregnant woman has untreated sleep apnea, the risk of her delivering her baby prematurely increases?

A 2017 study conducted at the University of California San Francisco showed that women diagnosed with insomnia or obstructive sleep apnea (OSA) had nearly double the risk of early premature delivery—that is, birth before 34 weeks—as compared to women without sleep disorders. A 2016 Thai study published in the journal Sleep Breath showed similar increased risk of preterm birth. 

Early preterm births come with their own sets of health risks for mother and child. But what many people don’t realize is that “preemie” infants also have a higher likelihood of developing sleep apnea and sleep disordered breathing as children and adults.

A 2012 study published in the journal SLEEP looked at the health data of almost 400,000 children across a period of four years. The researchers discovered that infants born preterm (before 32 weeks) were diagnosed with sleep apnea at a significantly increased rate as compared to children born to term. Of these, almost 86% went on to have adenoid or tonsils surgery in order to correct their sleep apnea. (3)

Sleep apnea in pregnant women clearly has ramifications beyond the immediate risks the apnea poses to the mother. Pregnant women with untreated sleep apnea may deliver early, and these premature babies are at a higher risk of developing apnea as children or later in life. If preterm infant girls go on have children themselves, they have an increased risk of delivering preterm babies—thus continuing the cycle.

We at Premier Sleep Associates consider the big picture when we treat patients for snoring and apnea using oral appliance therapy. Treating OSA is about more than stopping snoring and feeling rested. (Though both of these are important!) Therapy for apnea is also about improving and protecting your health, both in the short term and into the future. And in the case of pregnancy, getting diagnosed with apnea and treated for it is an important preventative measure not just for your own health, but also for your baby’s.

Pregnancy, Sleep Apnea, and Snoring

If you’re pregnant and you’ve begun snoring, you’re not alone. Snoring is quite common during pregnancy, even in women who have never snored before. About one in three pregnant women will start snoring, particularly in the second and third trimesters, and often with a notable increase in the last week or two before giving birth.

The cause of pregnancy snoring is often nasal congestion due to an increase of pregnancy hormones during the second trimester. This flood of hormones, combined with increased blood flow throughout the body, leads to swelling of the tissue lining the nose. This creates a narrowing of the nasal passages. In addition, gaining weight during pregnancy, in combination with the shifting position of the uterus, can put pressure on the diaphragm. This crowding can make breathing more difficult.

Due to these factors, the increased effort you expend to inhale during sleep can cause reverberations of any excess tissue lining the airway; these vibrations in the throat cause snoring. Also, if you gain an excessive amount of weight during pregnancy, you may have an excess of fatty tissue lining the throat, which can create an airway obstruction, causing apnea events (cessations of breathing) during sleep.

Health Consequences of Untreated Apnea in Pregnant Women

Because apnea stops you from getting enough oxygen, it always carries dangers for your health, even when you’re not pregnant. Untreated sleep apnea puts individuals at an increased risk for high blood pressure, stroke, cardiovascular disease, diabetes, and chronic sleepiness. Fragmented sleep from apnea can also contribute to mood disorders like depression, and anxiety.

However, during pregnancy apnea is particularly worrisome because of the particular health risks it poses to the mother and child during this high-risk time. Having untreated apnea can make you more susceptible to serious pregnancy-related conditions like:

• Hypertension (high blood pressure). Though it may go away after you give birth, high blood pressure that develops during pregnancy must be monitored because it can lead to low birth weight or may progress to the more dangerous preeclampsia.

• Preeclampsia. This condition is characterized by high blood pressure plus organ damage. If not detected and treated quickly, preeclampsia can be life-threatening.

• Gestational diabetes. Diabetes that develops during pregnancy can lead to complications for the baby like a high birth weight, respiratory distress syndrome, or preterm birth. Infants may also be more prone to developing Type 2 diabetes as children and adults. For the mother, gestational diabetes can contribute to hypertension and preeclampsia. Mothers may also be more likely to develop Type 2 diabetes after giving birth.

Apnea during pregnancy poses a very real risk to mother and child. The best way to minimize these risks is to see a physician if you begin snoring, particularly if you’re having additional symptoms of high blood pressure or oxygen deprivation such as swelling in the legs or headaches.

If your doctor thinks you may have apnea, she or he may refer you to a sleep medicine physician who can screen you and schedule you for a sleep study to verify the presence and severity of apnea so you can pursue treatment.

Treating Apnea with an Oral Appliance

If you receive a diagnosis of mild to moderate apnea, your sleep medicine physician may recommend that you use a dental device to open your airway during sleep. A dental oral appliance fitted for you by a sleep medicine dentist is now an approved first-line therapy for treating obstructive apnea. Also called a sleep apnea mouthpiece (or an anti-snoring mouthpiece), it’s a custom-fitted splint you wear in your mouth. Currently, the FDA has approved over 100 different styles for use in the treatment of snoring and obstructive sleep apnea.

For many people, this form of apnea therapy is easier to use than a CPAP machine with a mask and tubing; this can be particularly true for pregnant women, who may have trouble finding a comfortable sleep position as it is, without having to deal with bedside medical equipment. People who use oral appliances tend to have positive experiences and results, which means they’re likely to comply with their therapy and see the health benefits.

If you’re pregnant and you think you may have sleep apnea, don’t hesitate to talk to your doctor. Undiagnosed apnea can harm your health and put you at risk for a preterm birth. See your doctor and ask about a sleep study or home sleep test to confirm a diagnosis of obstructive sleep apnea.

If you live in the Bellevue or Seattle area, ask your sleep medicine physician about getting a referral to Premier Sleep Associates for an oral appliance. Premier Sleep is proud to be among the 2,800 dentists around the world who are are qualified to fit you for an oral apnea device.