How to manage obstructive sleep apnea in pregnancy

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Management of OSA in pregnant women should continue through the postpartum period and should be multidisciplinary. 

Management of OSA in pregnant women should continue through the postpartum period and should be multidisciplinary. For more information on sleep apnea in pregnancy: Obstructive sleep apnea in pregnancy- What you need to know

References:

9. Louis J, Auckley D, Miladinovic B, et al. Perinatal outcomes associated with obstructive sleep apnea in obese pregnant women. Obstet Gynecol. 2012;120(5):1085-1092.33. Saravanakumar K, Rao SG, Cooper GM. Obesity and obstetric anaesthesia. Anaesthesia. 2006;61(1):36-48.34. Munnur U, de Boisblanc B, Suresh MS. Airway problems in pregnancy. Critical care medicine. 2005;33(10 Suppl):S259-268.35. Chung F, Memtsoudis SG, Ramachandran SK, et al. Society of anesthesia and sleep medicine guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesthesia and analgesia. 2016;123(2):452.17. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep M. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2009;5(3):263-276.

Sleeping pregnant

Antenatal care

  • At-risk women should be identified

  • Women with known or suspected OSA should be evaluated by a sleep medicine specialist

  • A multidisciplinary approach including a discussion on labor analgesia should ensue; anesthesia consultation may be helpful.

  • Women who use continuous positive airway pressure (CPAP) for treatment should bring their devices to the hospital for continuation in the postpartum period

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Delivery

Intrapartum care

  • Regional methods such as epidural are preferred to IV opioids and if difficulty is anticipated or anesthesia is not readily available, early placement of an epidural catheter can be considered

  • Airway assessment should occur upon admission, with preparation for the possibility of a difficult intubation, should the need arise. 

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Surgeons

During surgery

  • Neuraxial methods such as spinal or epidural are preferred

  • If general anesthesia is needed, pre-oxygenate, anticipate possible difficult airway, use short-acting anesthetic medications, ensure adequate reversal of neuromuscular blockade, exudate awake in head-up position. 

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Postpartum care

Postoperative care

  • Implement extended monitoring with special attention to pulse oximetry

  • For persistent hypoxia, treat with CPAP

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