August 16, 2016

A new diagnosis code is needed for pregnant women who suffer from obstructive sleep apnea (OSA) — the recurrent cessation or limitation of normal breathing during sleep – say Israeli and American researchers.

The sleep scientists explain that the term ‘‘gestational sleep apnea” (GSA) would allow health professionals to properly describe, diagnose and treat OSA in pregnant women, and would parallel other established transient diagnoses of pregnancy, like gestational hypertension and gestational diabetes mellitus.

“Currently there is a lack of uniform criteria to diagnose, treat and classify OSA in the pregnant population, which in turn complicates efforts to determine the risk factors for, and complications of, gestational sleep apnea,” said Dr. Yehuda Ginosar, director of the Mother and Child Anesthesia Unit at the Hebrew University-Hadassah Medical Center and professor at the Hebrew University’s Faculty of Medicine.

In an editorial in the International Journal of Obstetric Anesthesia, Ginosar and co-author Dr. Suzanne Karan say the new diagnosis is critical because the consequences of untreated OSA include but are not limited to high blood pressure, high blood sugar and heart disease.

Karan, a visiting researcher at the Hebrew University-Hadassah Medical Center, is an associate professor of anesthesiology and director of the Anesthesiology Respiratory Physiology Laboratory at the University of Rochester School of Medicine in New York.

Risk factor

At least 15 million Americans and 350 million people worldwide suffer from OSA. Recent studies reveal that one-quarter of pregnant women may suffer from GSA.

In non-pregnant adults, protocols have been proposed for OSA screening, diagnosis and therapy. However, in pregnant women sleep apnea is usually untreated, since it is still under-diagnosed and not fully appreciated as a risk factor for negative outcomes for mother and baby.

Ginosar – who is currently professor of anesthesiology and chief of the obstetric anesthesiology at Washington University School of Medicine – and Karan note that OSA has been more widely appreciated as endemic in the general female population, particularly during pregnancy.

Moreover, they note that “pregnancy-related morbidity related to OSA has been well established. Maternal adverse effects include a more than five-fold increase in in-hospital mortality due to multiple diagnoses including cardiomyopathy and pulmonary embolism.”

The sleep researchers cite that doctors and patients may erroneously attribute daytime tiredness to “just being pregnant” rather than to sleep apnea.

They also mention that in terms of treatment, some physicians and patients might consider the disease too temporary to warrant referral to a sleep specialist.

“The time has come for our profession to wake up to the diagnosis of gestational sleep apnea. This will allow us to research obstructive sleep apnea in pregnant women more effectively, and to develop and implement more effective treatments,” said Karan.

The researchers argue that establishing and coding for a specific diagnosis of GSA will require further investigation to determine criteria and therapies. As with other gestational diseases, the diagnosis code will allow for more targeted surveillance of maternal and fetal outcomes, and facilitate epidemiologic research to monitor the course of the condition from its genesis to its possible path to treatment.

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Jason Harris

Jason Harris

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