CHEST Releases Guideline on Sleep-Disordered Breathing in Pregnancy

Key takeaways:

• The new guideline provides nine evidence-based recommendations for managing obstructive sleep apnea in pregnant patients.
• It was developed to address the need for more specific guidance on screening, diagnosing, treating, and reevaluating sleep-disordered breathing during pregnancy.
• Sleep-disordered breathing in pregnancy is associated with adverse outcomes for both the parent and the fetus, including preterm birth and a higher risk of admission to the neonatal ICU.
• Due to limited available evidence, all nine recommendations are conditional and noted with a very low level of certainty.

The American College of Chest Physicians (CHEST) recently released a new clinical guideline on obstructive sleep apnea (OSA) in pregnancy. Published in the journal CHEST, the guideline contains nine evidence-based recommendations for caring for pregnant patients with OSA.

The full guideline, “Obstructive Sleep Apnea (OSA) in Pregnancy – An American College of Chest Physicians Clinical Practice Guideline,” was developed to address the need for more specific guidance, as there is minimal direction available on how best to screen, diagnose, treat, and reevaluate for sleep-disordered breathing (SDB) in this patient population.

“What I want most from this guideline is to put sleep-disordered breathing on the radar for pregnant patients and their providers,” says Carolyn D’Ambrosio, MD, FCCP, lead author on the guideline, in a release. “All too often, symptoms during pregnancy are dismissed as frivolous or temporary, but the reality is that disordered breathing can have serious consequences both to the parent and the fetus. The guideline also serves as a reminder that not everything goes away postpartum.”

According to the guideline, measures of SDB have been associated with adverse fetal growth outcomes, a higher risk of admission to the neonatal intensive care unit at birth, a longer hospital stay, congenital anomalies, and preterm birth.

Due to limited available evidence, all nine conditional recommendations are noted with a very low level of certainty of evidence. The recommendations are:

• In pregnant individuals on CPAP for OSA prior to pregnancy, we suggest APAP be used rather than continued CPAP.
• In pregnant individuals, we suggest screening for sleep–disordered breathing.
• In pregnant individuals being screened for sleep–disordered breathing, we suggest screening using either a pregnancy-specific tool or a standard screening tool.
• In pregnant individuals undergoing evaluation for OSA, we suggest either at-home diagnostic devices or lab-based diagnostics be used.
• In pregnant individuals diagnosed with OSA during pregnancy, we suggest that treatment be offered to those with an AHI of 5-15 when accompanied by symptoms sequelae or comorbidities / additional risk factors. For AHI of > 15, PAP therapy is recommended regardless of symptoms or comorbidities.
• In pregnant individuals diagnosed with OSA during pregnancy for whom treatment is recommended, we suggest that any form of PAP treatment be used rather than no treatment.
• In pregnant individuals diagnosed with OSA during pregnancy for whom treatment is recommended, we suggest using PAP therapy rather than alternatives to PAP therapy.
• In pregnant individuals currently on PAP therapy for OSA diagnosed during pregnancy and with residual sleepiness, we suggest using scheduled naps whenever possible, and only using stimulants on an as-needed basis after failure of scheduled naps.
• In postpartum individuals previously diagnosed with OSA during pregnancy, we suggest reassessment for SDB.

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