Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009.
OBJECTIVE
A recent trend in increasing rates of severe maternal morbidity and mortality despite quality improvements has been noted. The goal of this study is to estimate the national prevalence of obstructive sleep apnea (OSA) in pregnant women and examine associations between OSA and pregnancy-related morbidities, including in-hospital maternal mortality.


METHODS
A retrospective, cross-sectional analysis.


METHODS
A nationally representative sample of maternal hospital discharges from 1998-2009.


METHODS
The analytic sample included 55,781,965 pregnancy-related inpatient hospital discharges.


METHODS
N/A.


RESULTS
The Nationwide Inpatient Sample (NIS) database was used to identify hospital stays for women who were pregnant or gave birth. Among these women, we determined length of hospital stay, in-hospital mortality, and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify OSA 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 OSA and each outcome. The overall rate of OSA was 3.0 per 10,000; however, the rate climbed substantially from 0.7 in 1998 to 7.3 in 2009, with an average annual increase of 24%. After controlling for obesity and other potential confounders, OSA was associated with increased odds of pregnancy-related morbidities including preeclampsia (OR, 2.5; 95% CI, 2.2-2.9), eclampsia (OR, 5.4; 95% 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). Women with OSA experienced a more than fivefold increased odds of in-hospital mortality (95% CI, 2.4-11.5). The adverse effects of OSA on selected outcomes were exacerbated by obesity.


CONCLUSIONS
Obstructive sleep apnea is associated with severe maternal morbidity, cardiovascular morbidity, and in-hospital death. Targeted interventions may improve pregnancy outcomes in this group.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL.
Judette M
JM
Louis
Maternal and Child Health Comparative Effectiveness Research Group, Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL.
Mulubrhan F
MF
Mogos
Maternal and Child Health Comparative Effectiveness Research Group, Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL.
Jason L
JL
Salemi
Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Boston, MA.
Susan
S
Redline
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL ; Maternal and Child Health Comparative Effectiveness Research Group, Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL.
Hamisu M
HM
Salihu
D000328:Adult; D009202:Cardiomyopathies / Q000150:complications / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D009017:Morbidity; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000401:mortality*; D011256:Pregnancy Outcome; D015995:Prevalence; D011655:Pulmonary Embolism / Q000150:complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
maternal mortality; obstructive sleep apnea; preeclampsia; pregnancy; pulmonary embolus