Obstructive sleep apnea-associated hypertensive disorders in pregnancy: a literature review and clinical management strategies.

Abstract

Obstructive sleep apnea (OSA) has long been recognized as a significant risk factor for hypertension, and in recent years, its association with hypertensive disorders of pregnancy (HDP) has gained increasing attention, especially in the unique population of pregnant women. However, this relationship remains underappreciated in clinical practice. While early studies have suggested a link between OSA and adverse pregnancy outcomes, the mechanisms connecting OSA to HDP are not fully understood. This literature review explores potential pathways, including intermittent hypoxia, oxidative stress, systemic inflammation, dysregulation of the sympathetic nervous system, endothelial dysfunction, and atherosclerosis. It also examines current treatments, especially CPAP therapy, and its variable effectiveness in managing HDP symptoms, as well as potential alternatives such as throat strengthening exercises and external hypoglossal stimulation. Future research should focus on improving OSA screening during pregnancy, developing better diagnostic tools, and integrating routine OSA evaluations in prenatal care for early intervention. Clarifying the mechanisms linking OSA and HDP will help refine treatment strategies. Large-scale, randomized controlled trials are needed to assess the efficacy of combination therapies and develop evidence-based clinical guidelines.