Facco FL, Redline S, Hunter SM, Zee PC, Grobman WA, Silver RM, Louis JM, Pien GW, Mercer B, Chung JH, Bairey Merz CN, Haas DM, Nhan-Chang CL, Simhan HN, Schubert FP, Parry S, Reddy U, Saade GR, Hoffman MK, Levine LD, Wapner RJ, Catov JM, Parker CB, NICHD NuMoM2b Heart Health Study Network, NHLBI NuMoM2b Heart Health Study Network. Sleep disordered breathing in pregnancy and post-delivery: associations with cardiometabolic health. Am J Respir Crit Care Med. 2022 May 15;205(10):1202-13. doi: 10.1164/rccm.202104-0971OC

OBJECTIVE: To determine whether SDB in pregnancy and/or post-delivery is associated with hypertension (HTN) and metabolic syndrome (MS).

METHODS: The nuMoM2b Heart Health Study (n=4,508) followed participants initially recruited during their first pregnancy. Participants returned for a visit 2-7 years after pregnancy. This study examined a subgroup who underwent SDB assessments during their first pregnancy (n=1,964) and a repeat SDB assessment post-delivery (n=1,222). Two SDB definitions were considered: apnea-hypopnea index (AHI) ≥5; oxygen desaturation index (ODI) ≥5. Associations between SDB and incident HTN and MS were evaluated with adjusted risk ratios (aRR).

RESULTS: The aRR for MS given an AHI ≥5 during pregnancy was 1.44 (95% CI 1.08, 1.93), but no association with HTN was found. ODI ≥5 in pregnancy was associated with both an increased risk for HTN (aRR 2.02, 95% CI 1.30, 3.14) and MS (aRR 1.53, 95% CI 1.19, 1.97). Participants with an AHI ≥5 in pregnancy that persisted post-delivery were at higher risk for both HTN (aRR 3.77, 95% CI 1.84, 7.73) and MS (aRR 2.46, 95% 1.59, 3.76). Similar associations were observed for persistent post-delivery ODI ≥5.

CONCLUSIONS: An AHI ≥5 in pregnancy was associated with an increased risk of MS. An ODI ≥5 in pregnancy was significantly associated with both HTN and MS. Participants with persistent elevations in AHI and ODI both during pregnancy and at 2-7 post-delivery were at the highest risk for HTN and MS.