Sleep apnea-related hypoxic burden as a predictor of pregnancy and neonatal outcome

To determine the clinical impact of sleep apnea-related hypoxic burden in pregnant women and neonates. This is a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) study. Hypoxia burden was calculated from the home sleep apnea test (HSAT) and defined as the total area under respiratory events. Logistic regression analysis assessed the relationship between hypoxia burden and pregnancy / neonatal outcomes. A total of 3006 subjects in the early term, and 2326 subjects in the middle term of pregnancy, had HSAT. A hypoxic burden greater than 6.8%min was present in 1740 at early term and associated with a higher risk of preeclampsia (odds ratio 1.297, 95% confidence interval 1.032-1.630, p: 0.026) after adjusted by obstructive sleep apnea (OSA) severity. In the middle term, 1058 subjects had a hypoxia burden more than 11.8%min, which was a predictor for higher incidence of gestational diabetes (OR 1.795, 95% CI 1.097-2.938, p: 0.020) and an Apgar < 7 at 1 minute (OR 1.446, 95% CI 1.079-1.939, p: 0.012) after adjusted by obstructive sleep apnea (OSA) severity. After adjusted by oxygenation disturbance index, HB was not related with Apgar < 7 at 1 minute (p:0.565). The hypoxic burden is an independent predictor for preeclampsia and gestational diabetes and an Apgar < 7 at 1 minute.