Sleep disordered breathing and the risk of severe maternal morbidity in women with preeclampsia: A population-based study

Isabelle Malhamé; Margaret H Bublitz; Danielle Wilson; Laura Sanapo; Elizabeth Rochin; Ghada Bourjeily

doi:10.1016/j.preghy.2022.10.013

Sleep disordered breathing and the risk of severe maternal morbidity in women with preeclampsia: A population-based study

Pregnancy Hypertens. 2022 Dec:30:215-220. doi: 10.1016/j.preghy.2022.10.013. Epub 2022 Nov 2.

Authors

Isabelle Malhamé¹, Margaret H Bublitz², Danielle Wilson³, Laura Sanapo², Elizabeth Rochin⁴, Ghada Bourjeily⁵

Affiliations

¹ Department of Medicine, McGill University Health Centre, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada.
² Psychiatry and Human Behavior and Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States.
³ Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.
⁴ National Perinatal Information Center, Providence, RI, United States.
⁵ Psychiatry and Human Behavior and Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States. Electronic address: Ghada_Bourjeily@brown.edu.

Abstract

Objective: Obstructive sleep apnea (OSA) may exacerbate the widespread endothelial dysfunction seen in preeclampsia, potentially worsening clinical outcomes. We aimed to assess whether OSA is associated with an increased risk of severe maternal morbidity, cardiovascular morbidity, and healthcare utilization among women with preeclampsia.

Study design: We performed a retrospective cohort study utilizing data from the National Perinatal Information Center (2010-2014) in the United States.The cohort comprised women with preeclampsia. We estimated the association between OSA and the outcomes using logistic regression analyses and determined odds ratio adjusted for demographic factors and comorbidities (OR_adj) and associated 95% confidence intervals (CI).

Main outcome measures: The primary outcome was a composite of mortality and severe maternal morbidity comprising intensive care unit (ICU) admission, acute renal failure, pulmonary edema, pulmonary embolism, congestive heart failure, cardiomyopathy, and stroke. Secondary outcomes comprised the subset of cardiovascular events, as well as increased healthcare utilization (including Cesarean delivery, preterm birth, ICU admission, and prolonged length of hospital stay).

Results: In total, 71,159 women had preeclampsia, including 270 (0.4 %) with OSA. Women with preeclampsia and OSA were more likely to experience severe maternal morbidity than women without OSA (OR_adj 2.65, 95 % CI [1.94-3.61]). Moreover, women with concomitant OSA had more severe cardiovascular morbidity than women without OSA (OR_adj 5.05, 95 % CI [2.28-11.17]). Accordingly, OSA was associated with increased healthcare utilization in women with preeclampsia (OR_adj. 2.26, 95 % CI [1.45-3.52]).

Conclusion: In women with preeclampsia, OSA increases the risk for severe maternal morbidity, cardiovascular morbidity, and healthcare utilization.

Keywords: Maternal morbidity; OSA; Obstructive sleep apnea; Peripartum; Postpartum; Preeclampsia; Pregnancy; Sleep disordered breathing.

MeSH terms

Cardiomyopathies* / complications
Female
Humans
Infant, Newborn
Pre-Eclampsia* / epidemiology
Pregnancy
Premature Birth*
Retrospective Studies
Sleep Apnea Syndromes* / complications
Sleep Apnea, Obstructive* / complications
United States / epidemiology

Abstract

MeSH terms

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