Parenting Magazine Blurb--Pregnancy Induced Apnea

socknitster · Post by **socknitster** » Wed Oct 31, 2007 3:24 pm

This months Parenting came and inside there was a short blurb about how it is now thought that some of the cases of hypertension and diabetes in pregnancy are directly related to apnea, pregnancy-induced or otherwise.

I had pregnancy-induced hypertension and no link was ever made. I continued to suffer a few more years.

I KNEW at the time there was something wrong with me or the pregnancy. I had no clue which. I just felt through the whole thing that I could lose the baby at any moment. I did everything the doctor or books told me to do. I slept on my left side almost exclusively. That is the postion in which the baby gets the most oxygen.

I remember one night. I was near the end and I was having a horrible night, tossing and turning and doing my best to sleep on the left, but truly miserable. I must have rolled over to my right side and woke up to the baby thrashing in what I could only describe as seizure-like. It was not typical baby movement. It scared the shit out of me and I called the doctor, right there in the middle of the night and they thought I was being ridiculous. I'd like to look that doctor in the eye right now and tell him he is a complete idiot. Harry turned out to be over 10 lbs (the docs all swore he would be around 8 lbs) and I have no doubt his life was in danger in that moment when I look back on it now.

I'm really glad some light is being shed on this. Pregnancy is hard enough. Pregnancy with undiagnosed severe sleep apnea like I have is at best debilitating and overall just plain scary.

I just wish it could become the topic du jour for a moment so everyone learns about it, instead of a 1 paragraph blurb that a mom may or may not ever see or even connect to her own problems. I didn't even snore.

Jen

Slinky · Post by **Slinky** » Wed Oct 31, 2007 3:43 pm

Well, I certainly didn't encounter anything like you encountered w/any of my 4 pregnancies but then my kids were all 6+ to 7 lbs babies.

And I can't speak for apnea after pregancy either since it was some 30 years after my kids were born before I encountered it.

BUT - it makes sense to me that as the baby takes up more and more of the limited space less room is left for the lungs to expand and diaphragm to move and do its job, ergo, shallow breathing is encouraged even awake in the daytime, much less at night time when we are relaxed sleeping.

I always take the "disorder of the day" information and research w/a large grain of salt. Thru the years there was the hula hoop disorder, the spike heels disorder ... all of which had some basis in fact but were much less drastic than the information first coming out.

Lipgloss42 · Post by **Lipgloss42** » Wed Oct 31, 2007 4:52 pm

I am totally on your page Jen, as you know. I'd LOVE to show that article to my doc... I'll have to scope out his waiting room at my next appt. I'm sure they have Parenting. And hooray to us for having the chance to go through our pregnancies on treatment, giving these babies the BEST health we can give them. I know I was really suffering in my last months too. I'd wake up choking and gasping. I don't recall any thrashing, but I'm sure she was oxygen deprived at times. Thank God we have healthy kids in spite of our undiagnosed conditions.

Hope you have a happy Halloween with Mr. Harry!

jennmary · Post by **jennmary** » Wed Oct 31, 2007 5:40 pm

I too went through a pregnancy with undiagnosed apnea. I remember how tired and horrible I felt. I have genetic condition that makes pregnancy dangerous and high risk as it is....but I am pretty sure part of the reason she was premie may have been apnea related. I went into labor after one very bad night. I am just glad that now I am being treated and that if I ever have another child I wont have to live like that zombie pregnant woman again. Thanks for posting this Jen.

socknitster · Post by **socknitster** » Wed Oct 31, 2007 7:17 pm

Apparantly there is a large aorta that runs on the dorsal side of the uterus. When you sleep on your back with a large baby in the uterus, you can severely cut off oxygen to the baby and your own extremeties. On your right side is better, but left is best. I'm guessing Harry was large enough to put pressure on it and combined with the apnea it was a bad scenario.

I'm so grateful he turned out fine, but I was very scared in that moment.

He had a great Halloween--he was Buzz Lightyear! Last year he was Woody. Can you guess his favorite movie? Hope your little ones has a great Halloween too!

Jen

jennmary · Post by **jennmary** » Thu Nov 01, 2007 12:29 am

Faith was Dorothy from the wizard of oz. She was the only one we saw. Super cute and did really really well, much better than I expected from my beautiful 2 year old to tell the truth. Didnt even fight me about the hand holding. Can you guess her fav movie? lol kind of a strange one for a 2 year old, but she loves the wizard of oz. She has been living in her ruby slippers for 2 weeks.

I did all the left side sleeping too. With a baby that big I am sure you are right.

Going to bed now guys....just to tired to keep my eyes open.

split_city · Post by **split_city** » Thu Nov 01, 2007 1:02 am

Jen,

Some of the background behind my "abdominal compression" study revolves around literature regarding OSA during pregnancy. There haven't been a lot of longnitudinal studies looking at the devolpment of OSA during pregnancy. The diaphragm elevates and lung volume is reduced during pregnancy. These two factors may contribute to OSA. However, increased levels of estrogen during pregnancy act as a ventilatory stimulant, and help to prevent airway collapse. Furthermore, a lot of pregnant women tend to not sleep on their back.

Here are a few abstracts that you might be interested in:

Snoring, pregnancy-induced hypertension, and growth retardation of the fetus.Franklin KA, Holmgren PA, Jönsson F, Poromaa N, Stenlund H, Svanborg E.
Department of Respiratory Medicine, University Hospital, Umeå, Sweden. Karl.Franklin@lung.umu.se

STUDY OBJECTIVE: Our purpose was to study the relationship between snoring and pregnancy-induced hypertension and growth retardation of the fetus. DESIGN: Retrospective, cross-sectional, consecutive case series. SETTING: The Department of Gynecology and Obstetrics, University Hospital, Umeâ, Sweden. Participants and measurements: On the day of delivery, 502 women with singleton pregnancies completed a questionnaire about snoring, witnessed sleep apneas, and daytime fatigue. Data concerning medical complications were taken from the women's casebooks. RESULTS: During the last week of pregnancy, 23% of the women reported snoring every night. Only 4% reported snoring before becoming pregnant. Hypertension developed in 14% of snoring women, compared with 6% of nonsnorers (p < 0.01). Preeclampsia occurred in 10% of snorers, compared with 4% of nonsnorers (p < 0.05). An Apgar score < or = 7 was more common in infants born to habitual snorers. Growth retardation of the fetus, defined as small for gestational age at birth, had occurred in 7.1% of the infants of snoring mothers and 2.6% of the remaining infants (p < 0.05). Habitual snoring was independently predictive of hypertension (odds ratio [OR], 2.03; p < 0.05) and growth retardation (OR, 3.45; p < 0.01) in a logistic regression analysis controlling for weight, age, and smoking. CONCLUSIONS: Snoring is common in pregnancy and is a sign of pregnancy-induced hypertension. Snoring indicates a risk of growth retardation of the fetus.

Severity of sleep-disordered breathing improves following parturition.Edwards N, Blyton DM, Hennessy A, Sullivan CE.
Department of Medicine, The University of Sydney, NSW, Australia. ne@med.usyd.edu.au

STUDY OBJECTIVE: Changes in sleep-disordered breathing associated with late pregnancy have not previously been systematically investigated; however, a number of case reports indicate exacerbation of obstructive sleep apnea in late pregnancy, often in association with maternal hypertension. We aimed to compare the severity of sleep-disordered breathing and associated maternal blood-pressure responses in late pregnancy with the nonpregnant state. DESIGN: Case-controlled, longitudinal study of sleep-disordered breathing during late pregnancy and postpartum. Study Patients: Ten women referred for suspected sleep-disordered breathing during the third trimester of pregnancy. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Full overnight polysomnography and continuous systemic blood pressure were measured during the third trimester of pregnancy and 3 months following delivery. Parameters of sleep-disordered breathing, including apnea hypopnea index and minimum overnight arterial oxyhemoglobin saturation, were compared between antenatal and postnatal studies. An improvement in both apnea-hypopnea index and minimum arterial oxyhemoglobin saturation occurred consistently in all subjects postnatally. In non-rapid eye movement sleep, mean apnea-hypopnea index was reduced from 63 +/- 15 per hour antenatally to 18 +/- 4 per hour postnatally (P = .03), and in rapid eye movement sleep, from 64 +/- 11 per hour to 22 +/- 4 per hour (P = .002). Minimum arterial oxyhemoglobin saturation was increased from 86% +/- 2% antenatally to 91% +/- 1% postnatally (P = .01). Arterial blood-pressure responses to apnea peaked at 170 to 180 mm Hg antenatally, while they only peaked at 130 to 140 mm Hg postnatally. CONCLUSION: This study indicates that late pregnancy may be associated with increased severity of sleep-disordered breathing and associated blood-pressure responses.

Sleep-disordered breathing and upper airway size in pregnancy and post-partum.Izci B, Vennelle M, Liston WA, Dundas KC, Calder AA, Douglas NJ.
Dept. of Sleep Medicine, University of Edinburgh, Scotland, UK.

Sleep-disordered breathing and snoring are common in pregnancy. The aim of this study was to determine whether pregnancy was associated with upper airway narrowing. One-hundred females in the third trimester of pregnancy were recruited and 50 agreed to be restudied 3 months after delivery. One-hundred nonpregnant females were also recruited. Upper airway dimensions were measured using acoustic reflection. Snoring was less common in nonpregnant (17%) than pregnant females (41%; odds ratio (OR) 3.34; 95% confidence interval (CI) 1.65-6.74) and returned to nonpregnant levels after delivery (18%; OR 0.15; 95% CI 0.06-0.40). Pregnant females had significantly smaller upper airways than nonpregnant females at the oropharyngeal junction when seated (mean difference 0.12; 95% CI 0.008-0.25), and smaller mean pharyngeal areas in the seated (mean difference 0.14; 95% CI 0.001-0.28), supine (mean difference 0.11; 95% CI 0.01-0.22) and lateral postures (mean difference 0.13; 95% CI 0.02-0.24) compared with the nonpregnant females. Pregnant females had smaller mean pharyngeal areas compared with post-partum in the seated (mean difference 0.18; 95% CI 0.02-0.32), supine (mean difference 0.20; 95% CI 0.06-0.35) and lateral postures (mean difference 0.26; 95% CI 0.12-0.39). In conclusion, this study confirmed increased snoring and showed narrower upper airways during the third trimester of pregnancy.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Hypopnea

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CPAPopedia Keywords Contained In This Post (Click For Definition): Hypopnea

echo · Post by **echo** » Thu Nov 01, 2007 5:39 am

Wow , very interesting and highly relevant info.

I keep thinking about the OSA and SIDS link too. I don't know if OSA is genetic or not, but there must be some studies which are looking into the link, no? I mean, how expensive and difficult can it be to wire up babies to pulse-ox's for a study THAT CAN SAVE THEIR LIVES? I don't have any kids (yet) but SIDS is the one thing that frightens the heck out of me, especially knowing that I probably had OSA when I was very little, and that it's probably genetic (my father & grandfather were not diagnosed but I'm pretty sure they had it as well..)

gulfpearl · Post by **gulfpearl** » Thu Nov 01, 2007 5:56 am

My second pregnancy 22 years ago I also had undiagnosed OSA. I was in the hospital from the 5th month until the 7th month of preg. My daughter was born through an emergency C- section. She weighed only 2 1/2 lbs at birth. I suffered from hypertension& small for dates the entire preg. The nurse even commented that I stopped breathing in my sleep at regular intervals. I had never heard of OSA back then & I never thought anything about it until I was finally diagnosed with OSA 2 1/2 years ago. I am so lucky she is a healthy 22 year old with no medical problems. As I know now things could have been alot worse.

socknitster · Post by **socknitster** » Thu Nov 01, 2007 1:23 pm

split_city,

Thank you for posting that information! It certainly gives me needed info for my next pregnancy. Now I know I can expect my osa to get worse toward the end of the pregnancy and thank goodness I have an automatic machine which will be able to compensate for that. Being stuck at a certain pressure on a non-data compatible machine would have been as bad as not being on a machine at all.

Makes me really glad that I took the time to educate myself about this disorder and to fight for the right machine where I can watch my own data. It is funny how my ENT who walked with me through this whole process is so proud of me and feels reassured that I am taking good care of myself. I saw him early this week and he said he only needs to see me if something changes and I need to consult him. He totally trusts that I know what I'm doing with my own treatment. I basically proved it to him by bringing in my printouts with circles and arrows and a paragraph ono the back of each one.

Jen