Sleep Disordered Breathing in Pregnancy: An Obstetric Anesthesiologist's Perspective

Anesthesiologists play a pivotal role in the management of high risk obstetric patients on labor and delivery. In the past decade sleep disordered breathing (SDB) in pregnancy and its associated comorbidities of difficult airway, pregnancy related hypertensive diseases; preeclampsia, gestational diabetes and intrauterine growth restriction were recognized and investigated. Moderate to severe SDB affects 1-5% of women of childbearing age although it is likely much higher as the majority of women with SDB remain undiagnosed. The American Society of Anesthesiologists has published obstructive sleep apnea (OSA) practice guidelines for the general surgical population but not the obstetric patient and there is no discussion of this condition in the updated ASA practice guidelines for obstetric anesthesia. Also, validated OSA questionnaires used to screen for OSA in the general population are not appropriate tools to use in high risk parturients. This article discusses how to recognize and optimize clinical anesthetic management of the high risk parturient diagnosed with SDB. It also considers some of the unique physiological changes of pregnancy that impact the parturient with SDB and questionably the fetus.