title: Perinatal outcomes associated with obstructive sleep apnea in obese pregnant women.
abstract: OBJECTIVE
  To investigate the associations between obstructive sleep apnea (OSA) and maternal and neonatal morbidities in a cohort of obese gravid women.
  
  
  METHODS
  Participants were enrolled in a prospective observational study designed to screen for OSA and describe the possible risk factors for and outcomes of OSA among obese (body mass index [BMI, calculated as weight (kg)/[height (m)]2] 30 or higher) pregnant women. Women underwent an overnight sleep study using a portable home monitor. Studies were manually scored by a central masked sleep reading center using American Academy of Sleep Medicine diagnostic criteria. An apnea hypopnea index of 5 or more was considered diagnostic of OSA. Perinatal outcomes were compared between women with and without OSA.
  
  
  RESULTS
  Among 175 women, OSA prevalence was 15.4% (13 mild, 9 moderate, 5 severe). Compared with no OSA (apnea hypopnea index less than 5), the OSA group had a higher BMI (46.8±12.2 compared with 38.1±7.5; P=.002) and more chronic hypertension (55.6% compared with 32.4%, P=.02). Maternal complications included maternal death (n=1, amniotic fluid embolus [no OSA group]) and cardiac arrest (n=1, intraoperative at cesarean delivery [OSA group]). One previable birth and two stillbirths occurred in the no OSA group. Among live births, OSA was associated with more frequent cesarean delivery (65.4% compared with 32.8%; P=.003), preeclampsia (42.3% compared with 16.9%; P=.005), and neonatal intensive care unit admission (46.1% compared with 17.8%; P=.002). After controlling for BMI, maternal age, and diabetes, OSA (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.1-11.3), previous preeclampsia (OR 2.79, 95% CI 1.09-7.19), and hypertension (OR 4.25, 95% CI 1.67-10.77) were associated with development of preeclampsia.
  
  
  CONCLUSIONS
  Obstructive sleep apnea among obese pregnant women is associated with more frequent preeclampsia, neonatal intensive care unit admissions, and cesarean delivery.
  
  
  METHODS
  II.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, MetroHealth Medical Center-Case Western Reserve University School of Medicine, Cleveland, Ohio 44109, USA. jlouis1@health.usf.edu
authors.forename: Judette
authors.initials: J
authors.lastname: Louis
authors.forename: Dennis
authors.initials: D
authors.lastname: Auckley
authors.forename: Branko
authors.initials: B
authors.lastname: Miladinovic
authors.forename: Anna
authors.initials: A
authors.lastname: Shepherd
authors.forename: Patricia
authors.initials: P
authors.lastname: Mencin
authors.forename: Deepak
authors.initials: D
authors.lastname: Kumar
authors.forename: Brian
authors.initials: B
authors.lastname: Mercer
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D009017:Morbidity; D009765:Obesity / Q000150:complications*; D017286:Polysomnography; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult