Sleep-disordered Breathing in Pregnancy and after Delivery Associations with Cardiometabolic Health

Rationale: Knowledge gaps exist regarding health implications of sleep-disordered breathing (SDB) identified in pregnancy and/or after delivery. Objectives: To determine whether SDB in pregnancy and/or after delivery is associated with hypertension (HTN) and metabolic syndrome (MS). Methods: nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be Heart Health Study) (N = 4,508) followed participants initially recruited during their first pregnancy. Participants returned for a visit 2-7 years after pregnancy. This study examined a subgroup who underwent SDB assessments during their first pregnancy (n = 1,964) and a repeat SDB assessment after delivery (n = 1,222). Two SDB definitions were considered: 1) apnea-hypopnea index (AHI) >= 5 and 2) oxygen desaturation index (ODI) >= 5. Associations between SDB and incident HTN and MS were evaluated with adjusted risk ratios (aRRs). Measurements and Main Results: The aRR for MS given an AHI >= 5 during pregnancy was 1.44 (95% confidence interval [CI], 1.08-1.93), but no association with HTN was found. ODI >= 5 in pregnancy was associated with both an increased risk for HTN (aRR, 2.02; 95% CI, 1.30-3.14) and MS (aRR, 1.53; 95% CI, 1.19-1.97). Participants with an AHI >= 5 in pregnancy that persisted after delivery were at higher risk for both HTN (aRR, 3.77; 95% CI, 1.84-7.73) and MS (aRR, 2.46; 95% CI, 1.59-3.76). Similar associations were observed for persistent ODI >= 5 after delivery. Conclusions: An AHI >= 5 in pregnancy was associated with an increased risk of MS. An ODI >= 5 in pregnancy was significantly associated with both HTN and MS. Participants with persistent elevations in AHI and ODI during pregnancy and at 2-7 years after delivery were at the highest risk for HTN and MS.

Automated summary

There is a link between sleep-disordered breathing (SDB) during pregnancy and/or after delivery with hypertension (HTN) and metabolic syndrome (MS). This study found that an apnea-hypopnea index (AHI) >= 5 during pregnancy was associated with an increased risk of MS, while an oxygen desaturation index (ODI) >= 5 during pregnancy was significantly associated with both HTN and MS. Participants who had persistently elevated AHI and ODI during pregnancy and at 2-7 years after delivery had the highest risk for HTN and MS.