title: Changes in symptoms of sleep-disordered breathing during pregnancy.
abstract: BACKGROUND
  Although incident snoring is common in pregnant women and has been proposed as a potential risk factor for adverse maternal-fetal outcomes, the development of sleep-disordered breathing during pregnancy has not been prospectively described.
  
  
  METHODS
  Using the Apnea Symptom Score from the Multivariable Apnea Prediction Index and the Epworth Sleepiness Scale, we prospectively assessed symptoms of sleep-disordered breathing and daytime somnolence in 155 women to determine whether symptoms increased during pregnancy and the characteristics associated with increasing symptoms.
  
  
  RESULTS
  We found that sleep-disordered breathing symptoms (Apnea Symptom Score, 0.44 (SEM 0.58) vs 0.95 (0.09, P < .001) and the degree of daytime somnolence (Epworth Sleepiness Scale, 8.6 (0.3) vs 10.2 (0.4), P = .0003) increased significantly during pregnancy. Women with higher baseline body mass indexes and greater increases in neck circumference during pregnancy reported higher apnea symptom scores. Of the 155 subjects, 11.4% reported an increase in Apnea Symptom Score of 2 units or more, consistent with a clinically significant increase in symptoms; these women experienced a significantly greater increase in subjective sleepiness than other subjects (P = .03). Excessive daytime somnolence (Epworth Sleepiness Scale > 10) was prevalent throughout pregnancy (31.0%-45.5%).
  
  
  CONCLUSIONS
  Our data demonstrate that symptoms of sleep-disordered breathing increase during pregnancy and that more than 10% of our subjects may be at risk for developing sleep apnea during pregnancy. Excessive daytime somnolence was highly prevalent even early in pregnancy and became increasingly common as pregnancy progressed.
authors.affiliation: Center for Sleep & Respiratory Neurobiology, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. gpien@mail.med.upenn.edu
authors.forename: Grace W
authors.initials: GW
authors.lastname: Pien
authors.forename: Daniel
authors.initials: D
authors.lastname: Fife
authors.forename: Allan I
authors.initials: AI
authors.lastname: Pack
authors.forename: J Emeka
authors.initials: JE
authors.lastname: Nkwuo
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schwab
mesh_terms: D000328:Adult; D015992:Body Mass Index; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*