Breathing during sleep may change during pregnancy: as a pregnancy unfolds, there may be a clear progression from soft to loud snoring, and even pauses or disruptions of breathing that characterize a condition calledsleep apnea. Sleep apnea as it occurs in pregnancy has clearly-recognized risk factors, symptoms, and treatments. Discover how obstructive sleep apnea may affect pregnancy and what can be done to effectively treat the condition to ensure the health of both mother and child.

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A woman in a deep sleep

Risk Factors

Fortunately, the overall risk of developing sleep apnea during pregnancy is relatively low, due to a couple of factors: first, levels ofprogesteroneare high during pregnancy—an apparently protective state, since the hormone activates muscles that dilate the airway.In addition, progesterone increases the brain’s responsiveness to carbon dioxide levels, and the delivery of oxygen to the body’s tissues also improves with increased heart rate and enlargement of the peripheral blood vessels. Second, due to physical discomfort associated with late pregnancy, less time is spent sleeping on the back, which is associated with an increased risk of sleep apnea.

Sleep apnea may nevertheless occur. Although the precise prevalence is not known, it’s estimated to affect 10% of pregnant women. Sleep apnea occurs more often in women who are overweight or obese, and excessive weight gain during pregnancy may also increase risk. Women with a large neck size also have more sleep apnea.In addition, nasal congestion due to high levels of progesterone can contribute to the condition. Lung volumes may be reduced due to pressure from the developing fetus, resulting in an increased breathing rate.Exposure to smoking is also a clear risk factor for developing sleep apnea.

Symptoms

Women who are afflicted with sleep apnea in pregnancy develop symptoms that are similar to the condition when it occurs in other contexts. These symptoms include:

The condition is likely under-diagnosed. It may be important to seek an evaluation from a sleep specialist, especially after the sixth month of pregnancy, when symptoms may worsen. High-risk women with obesity, preeclampsia, gestational diabetes and intrauterine growth retardation should be evaluated. This may include an overnight sleep study called apolysomnogram.

Treatment

It is important to treat pregnancy-related sleep apnea, as it can contribute to adverse consequences in both the mother and fetus. Sleep apnea is associated with gestational hypertension, diabetes, and unplanned Caesarian sections.It may also lead to fetal growth restriction and prolonged labor. Severely affected women may develop obesity hypoventilation syndrome.

During pregnancy, it can be helpful for women to sleep on their sides. The gold standard treatment is the use ofcontinuous positive airway pressure (CPAP). In severe cases with associated obesity, or in twin pregnancy, bilevel therapy may be employed.The pressure settings used in these treatments will need to be adjusted during pregnancy. As natural weight gain occurs, the pressure will likewise need to be increased. In rare cases, the use of supplemental oxygen, or a surgical procedure called a tracheostomy, may be required.

If you feel you have signs or symptoms that are suggestive of sleep apnea during pregnancy, you should contact your healthcare provider to discuss arranging the needed tests and treatments to help you rest and breathe easier.

10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Sleep Foundation.Pregnancy and sleep.John Hopkins Medicine.The dangers of uncontrolled sleep apnea.Lee J, Eklund EE, Lambert-messerlian G, et al.Serum progesterone levels in pregnant women with obstructive sleep apnea: a case control study.J Womens Health (Larchmt). 2017;26(3):259-265. doi:10.1089/jwh.2016.5917HelpGuide.org.Sleep apnea.National Sleep Foundation.How weight affects sleep apnea.Stanford Children’s Health.The lungs in pregnancy.Tzeng YL, Chen SL, Chen CF, Wang FC, Kuo SY.Sleep trajectories of women undergoing elective cesarean section: effects on body weight and psychological well-being.PLoS ONE. 2015;10(6):e0129094. doi:10.1371/journal.pone.0129094Liu C, Chen MS, Yu H.The relationship between obstructive sleep apnea and obesity hypoventilation syndrome: a systematic review and meta-analysis.Oncotarget. 2017;8(54):93168-93178. doi:10.18632/oncotarget.21450Langner S, Halank M, Kolditz M, Schiemanck S, Höffken G.Twin pregnancy and severe obstructive sleep apnea.Z Geburtshilfe Neonatol. 2007;211(2):93-7. doi:10.1055/s-2006-942180Camacho M, Zaghi S, Chang ET, Song SA, Szelestey B, Certal V.Mini tracheostomy for obstructive sleep apnea: an evidence based proposal.Int J Otolaryngol. 2016;2016:7195349. doi:10.1155/2016/7195349Additional ReadingKryger, MHet al. Principles and practice of sleep medicine.ExpertConsult, 5th edition, 2011, pp. 1576-1577.

10 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Sleep Foundation.Pregnancy and sleep.John Hopkins Medicine.The dangers of uncontrolled sleep apnea.Lee J, Eklund EE, Lambert-messerlian G, et al.Serum progesterone levels in pregnant women with obstructive sleep apnea: a case control study.J Womens Health (Larchmt). 2017;26(3):259-265. doi:10.1089/jwh.2016.5917HelpGuide.org.Sleep apnea.National Sleep Foundation.How weight affects sleep apnea.Stanford Children’s Health.The lungs in pregnancy.Tzeng YL, Chen SL, Chen CF, Wang FC, Kuo SY.Sleep trajectories of women undergoing elective cesarean section: effects on body weight and psychological well-being.PLoS ONE. 2015;10(6):e0129094. doi:10.1371/journal.pone.0129094Liu C, Chen MS, Yu H.The relationship between obstructive sleep apnea and obesity hypoventilation syndrome: a systematic review and meta-analysis.Oncotarget. 2017;8(54):93168-93178. doi:10.18632/oncotarget.21450Langner S, Halank M, Kolditz M, Schiemanck S, Höffken G.Twin pregnancy and severe obstructive sleep apnea.Z Geburtshilfe Neonatol. 2007;211(2):93-7. doi:10.1055/s-2006-942180Camacho M, Zaghi S, Chang ET, Song SA, Szelestey B, Certal V.Mini tracheostomy for obstructive sleep apnea: an evidence based proposal.Int J Otolaryngol. 2016;2016:7195349. doi:10.1155/2016/7195349Additional ReadingKryger, MHet al. Principles and practice of sleep medicine.ExpertConsult, 5th edition, 2011, pp. 1576-1577.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Sleep Foundation.Pregnancy and sleep.John Hopkins Medicine.The dangers of uncontrolled sleep apnea.Lee J, Eklund EE, Lambert-messerlian G, et al.Serum progesterone levels in pregnant women with obstructive sleep apnea: a case control study.J Womens Health (Larchmt). 2017;26(3):259-265. doi:10.1089/jwh.2016.5917HelpGuide.org.Sleep apnea.National Sleep Foundation.How weight affects sleep apnea.Stanford Children’s Health.The lungs in pregnancy.Tzeng YL, Chen SL, Chen CF, Wang FC, Kuo SY.Sleep trajectories of women undergoing elective cesarean section: effects on body weight and psychological well-being.PLoS ONE. 2015;10(6):e0129094. doi:10.1371/journal.pone.0129094Liu C, Chen MS, Yu H.The relationship between obstructive sleep apnea and obesity hypoventilation syndrome: a systematic review and meta-analysis.Oncotarget. 2017;8(54):93168-93178. doi:10.18632/oncotarget.21450Langner S, Halank M, Kolditz M, Schiemanck S, Höffken G.Twin pregnancy and severe obstructive sleep apnea.Z Geburtshilfe Neonatol. 2007;211(2):93-7. doi:10.1055/s-2006-942180Camacho M, Zaghi S, Chang ET, Song SA, Szelestey B, Certal V.Mini tracheostomy for obstructive sleep apnea: an evidence based proposal.Int J Otolaryngol. 2016;2016:7195349. doi:10.1155/2016/7195349

National Sleep Foundation.Pregnancy and sleep.

John Hopkins Medicine.The dangers of uncontrolled sleep apnea.

Lee J, Eklund EE, Lambert-messerlian G, et al.Serum progesterone levels in pregnant women with obstructive sleep apnea: a case control study.J Womens Health (Larchmt). 2017;26(3):259-265. doi:10.1089/jwh.2016.5917

HelpGuide.org.Sleep apnea.

National Sleep Foundation.How weight affects sleep apnea.

Stanford Children’s Health.The lungs in pregnancy.

Tzeng YL, Chen SL, Chen CF, Wang FC, Kuo SY.Sleep trajectories of women undergoing elective cesarean section: effects on body weight and psychological well-being.PLoS ONE. 2015;10(6):e0129094. doi:10.1371/journal.pone.0129094

Liu C, Chen MS, Yu H.The relationship between obstructive sleep apnea and obesity hypoventilation syndrome: a systematic review and meta-analysis.Oncotarget. 2017;8(54):93168-93178. doi:10.18632/oncotarget.21450

Langner S, Halank M, Kolditz M, Schiemanck S, Höffken G.Twin pregnancy and severe obstructive sleep apnea.Z Geburtshilfe Neonatol. 2007;211(2):93-7. doi:10.1055/s-2006-942180

Camacho M, Zaghi S, Chang ET, Song SA, Szelestey B, Certal V.Mini tracheostomy for obstructive sleep apnea: an evidence based proposal.Int J Otolaryngol. 2016;2016:7195349. doi:10.1155/2016/7195349

Kryger, MHet al. Principles and practice of sleep medicine.ExpertConsult, 5th edition, 2011, pp. 1576-1577.

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