Pregnancy insomnia and sleep apnea linked to complications

Pregnancy insomnia and sleep apnea linked to complications | Image Credit: © WavebreakMediaMicro - © WavebreakMediaMicro - stock.adobe.com.

The risks of ischemic placental disease (IPD), preterm birth, and severe morbidity (SM) are increased in women with singleton pregnancies presenting with insomnia or obstructive sleep apnea (OSA), according to a recent study published in JAMA Network Open.¹

Nearly 70% of pregnant patients are impacted by sleeping disorders, which have been linked to hormone fluctuations and physiological changes such as weight gain and increased respiratory drive. Links have also been identified for OSA with IPD and SM.

“While much of the literature on sleep disorders in pregnancy has focused on OSA, insomnia is the most common sleep disorder, and the prevalence increases throughout pregnancy and the postpartum period,” wrote investigators.

Defining sleep disorders

The population-based cross-sectional study was conducted to determine the link between insomnia and IPD and SM risks, alongside comparing these associations with those of OSA. Singleton live births between January 1, 2011, and December 31, 2020, in California were included in the analysis.

Data was obtained from hospital discharge, emergency department, and Department of Health Care Access and Information records linked to birth certificates. Diagnoses and procedures, including insomnia and OSA, were based on International Classification of Diseases codes.

IPD was classified as placental abruption, hypertensive disorders of pregnancy, and a small for gestational age (SGA) neonate, defined as birth weight under the tenth percentile for sex and gestational age. Preterm birth was defined as delivery under 37 weeks’ gestation.

Severe maternal morbidity was based on the CDC definition. Covariates included race and ethnicity, age at delivery, education level, expected payer for delivery, parity, country of birth, smoking during pregnancy, mode of delivery, hypertension without preeclampsia, and diabetes.

Risks of IPD

There were 4,145,096 singleton live births of patients aged 13 to 55 years included in the final analysis, 0.1% of whom had insomnia, 0.1% OSA, and 99.7% neither condition. Of mothers, 48.7% were Hispanic, 26.4% non-Hispanic White, 14.6% Asian, 4.8% non-Hispanic black, and 5.5% other race or ethnicity.

An adjusted relative risk (ARR) for any IPD of 1.42 was reported in women with insomnia vs those with no sleep disorders. In those with OSA, the ARR was 1.57. Placental abruption was more likely in both insomnia and OSA patients, but only those with insomnia had an elevated risk of SGA neonate birth, with an ARR of 1.23.

For preterm birth, the ARR was 1.81 in patients with insomnia and 1.73 in those with OSA vs neither disorder. Additionally, a subanalysis for birth under 28-weeks gestation indicated ARRs of 2.42 and 2.10, respectively.

Severe morbidity risks

SM was also more likely in patients with insomnia and OSA vs neither disorder, with ARRs of 2.26 and 2.81, respectively. Additionally, the ARRs for nontransfusion SM were 2.74 and 3.76, respectively, highlighting a further increase in risk.

Additional ARRs included 2.38 and 2.27, respectively, for disseminated intravascular coagulation, 4.23 and 2.64, respectively, for disseminated intravascular coagulation, 2.66 and 2.65, respectively, for sepsis, 3.61 and 3.36, respectively, for shock, 3.72 and 3.25, respectively, for air or thrombotic embolism, and 3.02 and 2.46, respectively, for hysterectomy.

Overall, the data highlighted increased risks of IPD and SM in singleton live birth cases of women with insomnia and OSA. These risks included placental abruption, SGA birth, and preterm birth.

“Our findings underscore the need for further studies to identify best practices around screening and treatment for insomnia and randomized studies to evaluate the impact of insomnia treatment in prevention of adverse outcomes,” wrote investigators.

References

1. Ross N, Baer RJ, Oltman SP, et al. Ischemic placental disease and severe morbidity in pregnant patients with sleep disorders. JAMA Netw Open. 2025;8(9):e2532189. doi:10.1001/jamanetworkopen.2025.32189
2. Louis JM, Mogos MF, Salemi JL, Redline S, Salihu HM. Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009. Sleep. 2014;37(5):843-9. doi: 10.5665/sleep.3644