During Pregnancy, Obstructive Sleep Apnea And Cardiac Symptoms Have 31 Percent Incidence Of Cardiac Dysfunction

Main Category: Pregnancy / Obstetrics
Also Included In: Sleep / Sleep Disorders / Insomnia;  Cardiovascular / Cardiology
Article Date: 13 Feb 2013 - 1:00 PST


In a study to be presented on February 15 between 8 a.m., and 10 a.m. PST, at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting ™, in San Francisco, researchers will report findings that women with obstructive sleep apnea (OSA) and cardiac symptoms have a 31 percent incidence of cardiac dysfunction. The use of echocardiograms should be considered in the clinical management of these women.

OSA is characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. These pauses can last from at least ten seconds to minutes, and may occur five to 30 times or more an hour; this can lead to cardiovascular disease. The objective of the trial was to measure the incidence of OSA among pregnant and reproductive women.

The cohort was made up of 1,265 women between the ages of 15-45 who met the Apnea-Hypopnea Index (AHI) criteria for OSA based on nocturnal Polysomnogram testing. Data was gathered from 2005-2012 at a tertiary care center. Sleep lab data and individual transthoracic echocardiogram reports were reviewed.

"As obesity rates increase among reproductive age women, the frequency of obstructive sleep apnea and cardiovascular disease in pregnancy is anticipated to rise. The increased hemodynamic demands of pregnancy can cause women with underlying cardiac disease to decompensate," said Laura K.P. Vricella, MD, fellow, Maternal-Fetal Medicine at MetroHealth Medical Center.

"We found a 31 percent incidence of abnormal echocardiograms among symptomatic women with obstructive sleep apnea. Further investigation is needed to understand the relationship between obstructive sleep apnea and cardiovascular disease and their impact on pregnant women."

The results for the 1,265 women were broken into three categories of AHI:

• 665 (53%) mild
• 305 (24%) moderate
• 295 (23%) severe

Those with mild and severe AHI were similar in age, race and Body Mass Index.

Research revealed that women who all had cardiac symptoms had a 31 percent incidence of cardiac dysfunction. It was determined than an echocardiogram should be considered during the clinical management of these women.

Abstract 38: Obstructive sleep apnea and cardiovascular disease in pregnant and non-pregnant women.

Objective: Obstructive sleep apnea (OSA), marked by recurrent hypoxemia-reoxygenation cycles with resultant systemic inflammation and oxidative vascular injury is independently associated with cardio vascular disease in the general population. We aim to estimate the incidence of cardiovascular disease among pregnant and reproductive aged women with OSA.

Study Design: 1265 consecutive women aged 15-45 who met criteria for OSA based on Apnea-Hypopnea Index (AHI) during nocturnal polysomnogram (PSG) from 2005-2012 at a tertiary care center were included. Sleep lab data and individual transthoracic echocardiogram (TTE) were performed based on patient symptoms. Individual reports were reviewed.

Results: Among the cohort, 665 of 1,265 women (53%) had mild (AHI 515), 305 (24%) had moderate (AHI 1530), and 295 (23%) had severe (AHI >30) OSA. Those with mild moderate and severe OSA was similar in age, race, and body mass index. Of 331 who underwent TTE, 103 (31%) had evidence of heart disease: 33 had left ventricular hypertrophy (LV mass index >110g, 10%), 73 had chamber dilation (22%), 10 had pulmonary hypertension (systolic pulmonary artery pressure >50 mmHg, 3%), 10 had valve disease (3%), 23 (7%) had systolic or diastolic dysfunction. TTE abnormalities were similarly frequent within OSA severity groups (27% mild, 31% moderate, 34% severe OSA, p = .2). Among the 79 pregnant women, 32 had an echocardiogram. Pregnant and nonpregnant women had similar rates of severe OSA (33 v. 22%) and abnormal TTE (31 v. 31%) (p>.5 for each).

Conclusion: Pregnant gravidas with OSA and cardiac symptoms have a 31% incidence of cardiac dysfunction. Echocardiogram should be considered during the clinical management of these women.

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