(668) Trends in and outcomes associated with obstructive sleep apnea during deliveries in the U.S.

Obstructive sleep apnea (OSA) in pregnancy has a known association with adverse obstetric outcomes, but population level data is lacking. Our objective was to assess trends in and outcomes associated with OSA during delivery hospitalizations from 2000 to 2019.

Study Design:

This repeated cross-sectional study analyzed delivery hospitalizations among women aged 15-54 years using the National Inpatient Sample. Temporal trends in OSA were analyzed using joinpoint regression to estimate the average annual percent change (AAPC) with 95% confidence intervals (CIs). Survey adjusted logistic regression models were fit to assess the association between OSA and mechanical ventilation or tracheostomy, acute respiratory distress syndrome, hypertensive disorders of pregnancy, peripartum hysterectomy, pulmonary edema/heart failure, stillbirth, and preterm birth.

Results: Of 76,753,013 delivery hospitalizations, 0.07% had a diagnosis of OSA. From 2000 to 2019, the presence of OSA increased from 0.4 to 20.5 cases per 10,000 delivery hospitalizations (AAPC 20.6%) (Figure).  Clinical factors associated with OSA included obesity (4.3% of women without OSA, 57.7% of women with OSA), asthma (3.2% vs. 25.3%), chronic hypertension (2.0% vs. 24.5%), and pregestational diabetes (0.9% vs. 10.9%).  In adjusted analyses, OSA was associated with increased odds of mechanical ventilation or tracheostomy (aOR 21.9, 95% CI 18.0, 26.7), acute respiratory distress syndrome (aOR 5.9, 95% CI 5.4, 6.5), hypertensive disorders of pregnancy (aOR 1.6, 95% CI 1.6, 1.7), stillbirth (aOR 1.2, 95% 1.0, 1.4), pulmonary edema/heart failure (aOR 3.7, 95% CI 2.9, 4.7), peripartum hysterectomy (aOR 1.66, 95% CI 1.23, 2.23), and preterm birth (aOR 1.2, 95% CI 1.1, 1.2) (Table).

Conclusion: OSA diagnoses are increasing in the obstetric population and are associated with a range of adverse outcomes during delivery hospitalizations, independent of obesity. However, the prevalence of OSA measured in this study is lower than estimates reported in smaller prospective cohort studies. These findings support increased screening for OSA in pregnancy.