Changes in symptoms of sleep-disordered breathing during pregnancy

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.