title: Association of obstructive sleep apnea with adverse pregnancy-related outcomes in military hospitals.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is associated with significant morbidity and mortality in non-obstetrical and obstetrical patients.
  
  
  OBJECTIVE
  To estimate the prevalence of OSA and its relationship with pregnancy-related complications in a general obstetric population of Department of Defense beneficiaries receiving direct-care at military treatment facilities.
  
  
  METHODS
  A retrospective cohort study of all women (N=305,001) who gave birth at a military treatment facility from 2008 to 2014. OSA cases were randomly selected and matched on age (3:1 ratio) to non OSA cases. Multivariable logistic regression was used to examine the risks of adverse pregnancy outcomes (cesarean delivery, gestational diabetes, gestational hypertension, preeclampsia, postoperative wound complications, hospital stay greater than five days, acute renal failure, pulmonary edema, preterm delivery, poor fetal growth, and stillbirth) between pregnant women with and without a diagnosis of OSA. Cases were identified using ICD-9 codes, while controlling for demographics, obesity, and medical comorbidities associated with OSA and the outcomes of interest.
  
  
  RESULTS
  We identified 266 cases of OSA (OSA rate=8.7 per 10,000; increased from 6.4 to 9.9 per 10,000 from 2009 to 2013). OSA was associated with a higher odds of cesarean delivery (AOR,1.60; 95% CI, 1.06-2.40), gestational hypertension, (AOR, 2.46; 95% CI, 1.30-4.68), preeclampsia (AOR, 2.42; 95% CI, 1.43-4.09), and preterm delivery (AOR, 1.90; 95% CI, 1.09-3.30).
  
  
  CONCLUSIONS
  Obstructive sleep apnea is associated with adverse maternal and fetal outcomes.
authors.affiliation: Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA, United States; Clinical Investigation Department, Naval Medical Center San Diego, San Diego, CA, United States. Electronic address: dennis.l.spence.mil@mail.mil.
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Spence
authors.affiliation: Clinical Investigation Department, Naval Medical Center San Diego, San Diego, CA, United States.
authors.forename: Rhonda C
authors.initials: RC
authors.lastname: Allen
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Naval Medical Center San Diego, San Diego, CA, United States.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Lutgendorf
authors.affiliation: Clinical Investigation Department, Naval Medical Center San Diego, San Diego, CA, United States.
authors.forename: Virginia R
authors.initials: VR
authors.lastname: Gary
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Naval Medical Center San Diego, San Diego, CA, United States.
authors.forename: John D
authors.initials: JD
authors.lastname: Richard
authors.affiliation: Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA, United States.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D005260:Female; D006772:Hospitals, Military / Q000706:statistics & numerical data; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: DoD: Department of Defense; Fetal-infant outcomes; OSA: Obstructive sleep apnea; Pregnancy complications