Excessive daytime sleepiness during pregnancy should raise the alarm

By Lucy Piper, Senior medwireNews Reporter

Excessive daytime sleepiness (EDS) is a common occurrence in pregnant women, particularly during the third trimester, but researchers warn that it might not always be physiologically normal.

They found that EDS correlated with snoring and apneic breathing, which are symptoms of sleep-disordered breathing (SDB), and their presence in conjunction with EDS should therefore raise suspicion of obstructive sleep apnea syndrome (OSAS).

Felix del Campo (Universidad de Valladolid, Spain) and Carlos Zamarrón (Hospital Clínico Universitario, Santiago de Compostela, Spain) comment on the findings published in Sleep and Breathing in a related editorial.

"There has been an increased interest regarding the presence of OSAS in pregnant women as a result of its potential impact in areas such as gestational hypertension, gestational diabetes, and fetal damage."

They also refer to the potential consequences of maternal OSAS for the fetus, including a deceleration of heart rate, lower Apgar score, an enhanced risk for preterm birth, and lower fetal weight.

Given the findings of Ghada Bourjeily (Brown University, Providence, Rhode Island, USA) and colleagues, the editorialists advise physicians to be aware that certain symptoms in pregnancy, such as snoring, EDS, and poor sleep "may be associated to something beyond pregnancy and may involve associated complications that require a correct diagnosis and treatment."

Bourjeily and team surveyed 1000 women soon after giving birth using questions from the multivariable apnea prediction index regarding snoring, gasping, and witnessed apneas in the last 3 months of pregnancy. The 990 women who gave a full response then completed Epworth Sleepiness Scale (ESS) questions.

The mean ESS score was 7.1, and 19.2% of women had a score above 10, denoting EDS.

ESS scores increased significantly with increasing maternal age, pre-pregnancy body mass index (BMI), BMI at delivery, and neck circumference.

Almost 37% of the women reported one or more symptoms of SDB during the last 3 months of pregnancy, of which loud snoring was the most common.

Loud snoring, gasping/snorting, and choking/apneas were all associated with higher mean ESS scores. For example, women reporting snoring frequently or always had average ESS scores of 7.6 and 8.1, respectively, compared with 6.5 among women who never snored.

The only symptom of SDB that did not show a linear relationship with ESS score was choking/apneas.

Nevertheless, in multiple linear regression analysis, loud snoring, gasping, and apneas were all statistically significant independent predictors of mean ESS score.

Women who snored or experienced gasping or apneas scored on average 0.3, 0.4, and between 0.1 and 1.9 higher on the ESS, respectively, than women without these symptoms.

The researchers conclude that "clinical prediction tools need to be developed for pregnant women and validated to help predict SDB in this population with frequent symptoms."

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