ABSTRACT
BACKGROUND
: Population level data on obstructive sleep apnea (OSA) among pregnant women in the
United States and associated risk for adverse outcomes during delivery may be of clinical
importance and public health significance.
OBJECTIVE
: To assess trends in and outcomes associated with OSA during delivery hospitalizations.
STUDY DESIGN
: This repeated cross-sectional study analyzed delivery hospitalizations using the
National Inpatient Sample. Temporal trends in OSA were analyzed using joinpoint regression
to estimate the average annual percent change (AAPC) with 95% confidence intervals
(CIs). Survey adjusted logistic regression models were fit to assess the association
between OSA and mechanical ventilation or tracheostomy, acute respiratory distress
syndrome, hypertensive disorders of pregnancy, peripartum hysterectomy, pulmonary
edema/heart failure, stillbirth, and preterm birth.
RESULTS
: From 2000 to 2019, an estimated 76,753,013 delivery hospitalizations were identified
of which 54,238 (0.07%) had a diagnosis of OSA. During the study period, the presence
of OSA during delivery hospitalizations increased from 0.4 to 20.5 cases per 10,000
delivery hospitalizations (AAPC 20.6%, 95% CI 19.1%, 22.2%). Clinical factors associated
with OSA included obesity (4.3% of women without OSA, 57.7%% of women with OSA), asthma
(3.2% of women without OSA, 25.3% of women with OSA), chronic hypertension (2.0% of
women without OSA, 24.5% of women with OSA), and pregestational diabetes (0.9% of
women without OSA, 10.9% of women with OSA). In adjusted analyses accounting for obesity,
other clinical factors, demographics, and hospital characteristics, OSA was associated
with increased odds of mechanical ventilation or tracheostomy (aOR 21.9, 95% CI 18.0,
26.7), acute respiratory distress syndrome (aOR 5.9, 95% CI 5.4, 6.5), hypertensive
disorders of pregnancy (aOR 1.6, 95% CI 1.6, 1.7), stillbirth (aOR 1.2, 95% 1.0, 1.4),
pulmonary edema/heart failure (aOR 3.7, 95% CI 2.9, 4.7), peripartum hysterectomy
(aOR 1.66, 95% CI 1.23, 2.23), and preterm birth (aOR 1.2, 95% CI 1.1, 1.2).
CONCLUSION
: OSA diagnoses are increasingly common in the obstetric population and are associated
with a range of adverse obstetric outcomes during delivery hospitalizations.
Keywords
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Article info
Publication history
Accepted:
October 6,
2022
Received in revised form:
October 4,
2022
Received:
July 29,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
