The intrapartum and perinatal risks of sleep-disordered breathing in pregnancy: a systematic review and metaanalysis

OBJECTIVE DATA: Sleep-disordered breathing is an increasingly common condition in nonobstetric populations and is associated with significant morbidity. The incidence of sleep-disordered breathing in pregnancy is unknown, and it is likely that many cases go undiagnosed. STUDY: A systematic review and metaanalysis was undertaken to determine whether pregnant women who receive a diagnosis of sleep-disordered breathing are more likely to have adverse intrapartum and perinatal outcomes compared with control subjects. STUDY APPRAISAL AND SYNTHESIS METHODS: PubMed, Embase, and Cinahl data-bases were searched for full-text publications in English of sleep-disordered breathing and human pregnancy up to June 2017. Only studies that reported on sleep-disordered breathing in relation to gestational age or birthweight at delivery, preterm birth, mode of delivery, cord pH, Apgar score, nursery admission, stillbirth or perinatal death, meconium at delivery, or wound complications were included. RESULTS: A total of 1576 results were identified; 33 studies met inclusion criteria. Women with sleep-disordered breathing were older (mean difference, 1.66; 95% confidence interval, 1.04-2.28) and had a higher body mass index (mean difference, 3.31; 95% confidence interval, 2.30-4.32) than those who did not. Maternal sleep-disordered breathing was associated significantly with preterm birth (< 37 weeks gestation; odds ratio, 1.86; 95% confidence interval, 1.50-2.31) and low birthweight (< 2500 g; odds ratio, 1.67; 95% confidence interval, 1.00-2.78). These women were also less likely to have a vaginal delivery (odds ratio, 0.61; 95% confidence interval, 0.48-0.78) and to be at a higher risk of having an assisted vaginal delivery (odds ratio, 1.88; 95% confidence interval, 1.10-3.21) or a cesarean delivery (odds ratio, 1.81; 95% confidence interval, 1.55-2.11). The risk of both elective (odds ratio, 1.38; 95% confidence interval, 1.09 - 1.76) and emergency cesarean (odds ratio, 2.52; 95% confidence interval, 1.20-5.29) was increased. In addition, women with sleep-disordered breathing were at a higher risk of having an infant with a 5-minute Apgar score < 7 (odds ratio, 2.14; 95% confidence interval, 1.24-3.71), stillbirth or perinatal death (odds ratio, 2.02; 95% confidence interval, 1.25-3.28), and neonatal nursery admission (odds ratio, 1.90; 95% confidence interval, 1.38-2.61). CONCLUSION: Maternal sleep-disordered breathing is associated with increased risks of adverse intrapartum and perinatal outcomes.