Treating sleep-disordered breathing in pregnancy may improve fetal health
A new study suggests that treatment of mild sleep-disordered breathing with continuous positive airway pressure (CPAP) therapy in pregnant women with preeclampsia improves fetal activity levels, a marker of fetal well-being.
Results show that the average number of fetal movements increased from 319 during a night without CPAP treatment to 592 during the subsequent night with CPAP therapy. During the course of the night without CPAP treatment, the number of fetal movements decreased steadily by 7.4 movements per hour. In contrast, the number of fetal movements increased by 12.6 per hour during the night with CPAP therapy.
“What would otherwise have been considered clinically unimportant or minor ‘snoring’ likely has major effects on the blood supply to the fetus, and that fetus in turn protects itself by reducing movements,” said Colin Sullivan, PhD, the study’s principal investigator. “This can be treated with readily available positive airway pressure therapy and suggests that measurement of fetal activity during a mother’s sleep may be an important and practical method of assessing fetal well-being.”
The three-part study, appearing in the January issue of the journal SLEEP, began with the validation of a fetal activity monitor against ultrasound in 20 normal, third-trimester pregnant women. The next phase of the study measured fetal movement overnight in 20 women with moderate to severe preeclampsia and 20 matched control subjects. Results show that the number of fetal movements during maternal sleep was significantly lower in the preeclampsia group (289) than the control group (689).
In the final phase of the study, fetal movement was measured on consecutive nights in 10 women with moderate to severe preeclampsia, the first night without treatment and the second night with nasal CPAP therapy. The women had mild sleep-disordered breathing with an apnea/hypopnea index of 7.0 breathing pauses per hour of sleep. A minimal mean CPAP pressure of 7 cm H2O was needed to eliminate upper airway obstruction and airflow limitation.
“Maternal SDB represents a unique opportunity to study the effect of in utero exposures on postnatal development and future risk. This has major implications for public health,” Louise M. O’Brien, PhD, MS, associate professor at the University of Michigan, wrote in a commentary on the study. “It raises the possibility that a simple, noninvasive therapy for SDB may improve fetal well-being.”
According to the authors, preeclampsia affects about five percent of pregnancies and is dangerous for the mother as well as a risk factor for fetal growth restriction. It involves the onset of high blood pressure and protein in the urine after the 20th week of pregnancy.
I sometimes feel short of breath now that I’m pregnant. Is this common?
Yes, many women experience this sensation as their pregnancy advances. You may even notice it early in pregnancy, although at that stage it’s more often sensed as a heightened awareness of the need to breathe.
You need more oxygen during pregnancy, and your body adapts to meet this need in several ways. An increase in hormones, particularly progesterone, directly affects your lungs and stimulates the respiratory center in your brain. And while the number of breaths you take per minute actually changes very little during pregnancy, the amount of air you inhale and exhale with each breath increases significantly.
Later in pregnancy, as your growing uterus puts pressure on your diaphragm, your breathing might feel more labored – especially if you are carrying your baby high, are carrying multiples, or have excessive amniotic fluid.
You may get some relief a few weeks before you’re due, especially if it’s your first pregnancy. This is when some women experience lightening (the baby dropping into the pelvis).
Is there anything I can do about feeling short of breath?
This feeling is usually harmless and normal. But it’s a good idea to take things a bit more slowly and remember not to push yourself too hard when being active.
Sit up straight and keep your shoulders back, especially when sitting, to give your lungs as much room to expand as possible. When you’re in bed at night, propping yourself up a bit with a few extra pillows might give you some relief.
Once you give birth, your breathing will soon go back to feeling like it did before you were pregnant.
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To request a copy of the study, “Treatment of Sleep Disordered Breathing Reverses Low Fetal Activity Levels in Preeclampsia” or the commentary “Positive Airway Pressure as a Therapy for Preeclampsia?”, or to arrange an interview with an AASM spokesperson, please contact Communications Coordinator Lynn Celmer.
The monthly, peer-reviewed, scientific journal SLEEP is published online by the Associated Professional Sleep Societies LLC, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The AASM is a professional membership society that is the leader in setting standards and promoting excellence in sleep medicine health care, education and research.
Conscious breathing is a cornerstone of yoga practice. Several classic poses are ideal for easing your breathing while pregnant. Do the child’s pose to stretch your back and to relax at the end of the day. Sit on your knees on a yoga mat or carpeted floor. Stretch your arms out in front and let your forehead rest comfortably on the floor.
The warrior’s poses open up your torso and help you focus on posture and balance. From a standing position, step back with your left foot. Lower your torso into the stretch until your right knee is directly above your right foot. Stretch your right arm out in front of you and your left arm to the rear. Hold for five to 10 seconds, then repeat on the other side.
A prenatal yoga class is a good way to learn yoga postures and breathing techniques. If a prenatal yoga class is not available in your area, take a standard yoga class but let your instructor know that you are pregnant. A good video yoga class will help you learn poses, but you will not have an instructor available to correct your posture.
The American Academy of Sleep Medicine considers sleep disorders an illness that has reached epidemic proportions. Board-certified sleep medicine physicians in an AASM-accredited sleep center provide effective treatment.
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Lynn Celmer
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630-737-9700 x9364
American Academy of Sleep Medicine