Obstructive sleep apnea linked to maternal deaths

A study of a nationally representative sample of hospitalized women who were pregnant or gave birth shows a link between obstructive sleep apnea and maternal death. The findings, published in SLEEP, point to a need for targeted interventions to improve pregnancy outcomes in women with apnea.

More than 55 million pregnancy-related inpatient hospital discharges spanning 1998 to 2009 were represented in the study. The retrospective, cross-sectional analysis looked at information in the Nationwide Inpatient Sample database on hospital stays for women who were pregnant or gave birth. Investigators determined length of hospital stay and in-hospital morality and used ICD-9-CM codes to identify obstructive sleep apnea and other outcome measures.

Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between obstructive sleep apnea and outcome. The overall rate of obstructive sleep apnea was 3.0 per 10,000 but rose from 0.7 in 1998 to 7.3 in 2009, with an average annual increase of 24%.

Click here for screening questions for sleep apnea

After controlling for obesity and other potential confounders, the researchers found that obstructive sleep apnea was associated with increased odds of pregnancy-related morbidities including preeclampsia (OR, 2.5; 95% CI, 2.2-2.9), eclampsia (OR, 5.4; CI, 3.3-8.9), cardiomyopathy (OR, 9.0; 95% CI, 7.5-10.9) and pulmonary embolism (OR, 4.5; 95% CI, 2.3-8.9). Risk of in-hospital mortality was more than five times higher in women with obstructive sleep apnea (95% CI, 2.4-11.5). Obesity exacerbated the adverse effects of obstructive sleep apnea on some outcomes.

To get weekly advice for today's Ob/Gyn, subscribe to the Contemporary Ob/Gyn Special Delivery.