How to manage obstructive sleep apnea in pregnancy

August 21, 2019

Judette Louis, MD, MPH , Linda Street, MD

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.Â For more information on sleep apnea in pregnancy:Â 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.

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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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.

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.

Postoperative care

Implement extended monitoring with special attention to pulse oximetry

For persistent hypoxia, treat with CPAP