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Anesthesia for the Pregnant Patient with Obstructive Sleep Apnea

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Abstract

Obstructive sleep apnea (OSA) is one of the sleep-related breathing disorders. Most prominent symptoms are snoring, periodic awakening during sleep, and daytime sleepiness. Over a period of time, OSA leads to increase in vascular resistance and metabolic disturbances. Pregnancy-related physiological changes make pregnant patients prone to OSA or increase the severity of previously existing OSA. OSA is related to increased maternal and fetal morbidity including systemic and pulmonary hypertension, preeclampsia, gestational diabetes, fetal growth retardation, preterm birth, lower Apgar scores at birth, and cesarean delivery. The diagnostic tools, except polysomnography, are limited to general nonpregnant population. This chapter focuses on the problems related to OSA, its diagnosis, and management during pregnancy.

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References

  1. Abdullah HR, Nagappa M, Siddiqui N, Chung F. Diagnosis and treatment of obstructive sleep apnea during pregnancy. Curr Opin Anaesthesiol. 2016;29:317–24.

    Article  Google Scholar 

  2. Louis JM, Mogos MF, Salemi JL, Redline S, Salihu HM. Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009. Sleep. 2014;37:843–9.

    Article  Google Scholar 

  3. Contreras G, Gutiérrez M, Beroíza T, Fantín A, Oddó H, Villarroel L, et al. Ventilatory drive and respiratory muscle function in pregnancy. Am Rev Respir Dis. 1991;144:837–41.

    Article  CAS  Google Scholar 

  4. Louis JM, Auckley D, Sokol RJ, Mercer BM. Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy. Am J Obstet Gynecol. 2010;202:261.e1–5.

    Article  Google Scholar 

  5. Campos-Rodriguez F, Martinez-Garcia MA, de la Cruz-Moron I, Almeida-Gonzalez C, Catalan-Serra P, Montserrat JM. Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment: a cohort study. Ann Intern Med. 2012;156:115–22.

    Article  Google Scholar 

  6. Louis J, Auckley D, Bolden N. Management of Obstructive Sleep Apnea in pregnant women. Obstet Gynecol. 2012;119:864–8.

    Article  Google Scholar 

  7. Sahin FK, Koken G, Cosar E, Saylan F, Fidan F, Yilmazer M, et al. Obstructive sleep apnea in pregnancy and fetal outcome. Int J Gynaecol Obstet. 2008;100:141–6.

    Article  Google Scholar 

  8. Chen YH, Kang JH, Lin CC, Wang IT, Keller JJ, Lin HC. Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J Obstet Gynecol. 2012;206:136.e1–5.

    Article  Google Scholar 

  9. Lockhart EM, Ben Abdallah A, Tuuli MG, Leighton BL. Obstructive sleep Apnea in pregnancy: assessment of current screening tools. Obstet Gynecol. 2015;126:93–102.

    Article  Google Scholar 

  10. Ding X-X, Wu Y-L, Xu S-J, Zhang SF, Jia XM, Zhu RP, et al. A systematic review and quantitative assessment of sleep-disordered breathing during pregnancy and perinatal outcomes. Sleep Breath. 2014;18:703–13.

    Article  Google Scholar 

  11. Xu T, Feng Y, Peng H, Guo D, Li T. Obstructive sleep apnea and the risk of perinatal outcomes: a meta-analysis of cohort studies. Sci Rep. 2014;4:6982.

    Article  CAS  Google Scholar 

  12. Health Quality Ontario. Polysomnography in patients with obstructive sleep apnea: an evidence-based analysis. Ont Heal Technol Assess Ser. 2006;6:1–38.

    Google Scholar 

  13. Nagappa M, Liao P, Wong J, Auckley D, Ramachandran SK, Memtsoudis S, et al. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep Apnea among different populations: a systematic review and meta-analysis. PLoS One. 2015;10:e0143697.

    Article  Google Scholar 

  14. Facco FL, Ouyang DW, Zee PC, Grobman WA. Development of a pregnancy-specific screening tool for sleep apnea. J Clin Sleep Med. 2012;8:389–94.

    PubMed  PubMed Central  Google Scholar 

  15. Pien GW, Pack AI, Jackson N, Maislin G, Macones GA, Schwab RJ. Risk factors for sleep-disordered breathing in pregnancy. Thorax. 2014;69:371–7.

    Article  Google Scholar 

  16. Blyton DM, Sullivan CE, Edwards N. Reduced nocturnal cardiac output associated with preeclampsia is minimized with the use of nocturnal nasal CPAP. Sleep. 2004;27:79–84.

    Article  Google Scholar 

  17. Guilleminault C, Palombini L, Poyares D, Takaoka S, Huynh NT-L, El-Sayed Y. Pre-eclampsia and nasal CPAP: part 1. Early intervention with nasal CPAP in pregnant women with risk-factors for pre-eclampsia: preliminary findings. Sleep Med. 2007;9:9–14.

    Article  Google Scholar 

  18. Booth JM, Tonidandel AM. Peripartum management of obstructive sleep Apnea. Clin Obstet Gynecol. 2017;60:405–17.

    Article  Google Scholar 

  19. Zaremba S, Mueller N, Heisig AM, Shin CH, Jung S, Leffert LR, et al. Elevated upper body position improves pregnancy-related OSA without impairing sleep quality or sleep architecture early after delivery. Chest. 2015;148:936–44.

    Article  Google Scholar 

  20. Melzack R, Kinch R, Dobkin P, Lebrun M, Taenzer P. Severity of labour pain: influence of physical as well as psychologic variables. Can Med Assoc J. 1984;130:579–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Booth JM, Pan JC, Ross VH, Russell GB, Harris LC, Pan PH. Combined spinal epidural technique for labor analgesia does not delay recognition of epidural catheter failures: a single-center retrospective cohort survival analysis. Anesthesiology. 2016;125:516–24.

    Article  CAS  Google Scholar 

  22. Hamilton CL, Riley ET, Cohen SE. Changes in the position of epidural catheters associated with patient movement. Anesthesiology. 1997;86:778–84. discussion 29A.

    Article  CAS  Google Scholar 

  23. Ankichetty SP, Angle P, Joselyn AS, Chinnappa V, Halpern S. Anesthetic considerations of parturients with obesity and obstructive sleep apnea. J Anaesthesiol Clin Pharmacol. 2012;28:436–43.

    Article  Google Scholar 

  24. Kodali B-S, Chandrasekhar S, Bulich LN, Topulos GP, Datta S. Airway changes during labor and delivery. Anesthesiology. 2008;108:357–62.

    Article  Google Scholar 

  25. Ahuja P, Jain D, Bhardwaj N, Jain K, Gainder S, Kang M. Airway changes following labor and delivery in preeclamptic parturients: a prospective case control study. Int J Obstet Anesth. 2018;33:17–22.

    Article  CAS  Google Scholar 

  26. Carvalho B. Respiratory depression after neuraxial opioids in the obstetric setting. Anesth Analg. 2008;107:956–61.

    Article  Google Scholar 

  27. Kato R, Shimamoto H, Terui K, Yokota K, Miyao H. Delayed respiratory depression associated with 0.15 mg intrathecal morphine for cesarean section: a review of 1915 cases. J Anesth. 2008;22:112–6.

    Article  Google Scholar 

  28. Gupta K, Prasad A, Nagappa M, Wong J, Abrahamyan L, Chung F. Risk factors for opioid-induced respiratory depression and failure to rescue: a review. Curr Opin Anaesthesiol. 2018;31:110–9.

    PubMed  Google Scholar 

  29. Corso R, Russotto V, Gregoretti C, Cattano D. Perioperative management of obstructive sleep apnea: a systematic review. Minerva Anestesiol. 2018;84:81–93.

    PubMed  Google Scholar 

  30. Lam KK, Kunder S, Wong J, Doufas AG. Obstructive sleep apnea, pain, and opioids: is the riddle solved? Curr Opin Anaesthesiol. 2016;29:134–40.

    Article  Google Scholar 

  31. Fusco P, Scimia P, Paladini G, Fiorenzi M, Petrucci E, Pozone T, et al. Transversus abdominis plane block for analgesia after Cesarean delivery. A systematic review. Minerva Anestesiol. 2015;81:195–204.

    CAS  PubMed  Google Scholar 

  32. Champaneria R, Shah L, Wilson MJ, Daniels JP. Clinical effectiveness of transversus abdominis plane (TAP) blocks for pain relief after caesarean section: a meta-analysis. Int J Obstet Anesth. 2016;28:45–60.

    Article  CAS  Google Scholar 

  33. Adesope O, Ituk U, Habib AS. Local anaesthetic wound infiltration for postcaesarean section analgesia: a systematic review and meta-analysis. Eur J Anaesthesiol. 2016;33:731–42.

    Article  CAS  Google Scholar 

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Seyhan, T.Ö., Büyük, D. (2018). Anesthesia for the Pregnant Patient with Obstructive Sleep Apnea. In: Gunaydin, B., Ismail, S. (eds) Obstetric Anesthesia for Co-morbid Conditions. Springer, Cham. https://doi.org/10.1007/978-3-319-93163-0_17

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  • DOI: https://doi.org/10.1007/978-3-319-93163-0_17

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-93162-3

  • Online ISBN: 978-3-319-93163-0

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