Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study

Published:September 10, 2012DOI:


      This study aimed to prospectively examine the impact of chronic vs pregnancy-onset habitual snoring on gestational hypertension, preeclampsia, and gestational diabetes.

      Study Design

      Third-trimester pregnant women were recruited from a large, tertiary medical center from March 2007 through December 2010 and screened for the presence and duration of habitual snoring, as a known marker for sleep-disordered breathing. Clinical diagnoses of gestational hypertension, preeclampsia, and gestational diabetes were obtained.


      Of 1719 pregnant women, 34% reported snoring, with 25% reporting pregnancy-onset snoring. After adjusting for confounders, pregnancy-onset, but not chronic, snoring was independently associated with gestational hypertension (odds ratio, 2.36; 95% confidence interval, 1.48–3.77; P < .001) and preeclampsia (odds ratio, 1.59; 95% confidence interval, 1.06–2.37; P = .024) but not gestational diabetes.


      New-onset snoring during pregnancy is a strong risk factor for gestational hypertension and preeclampsia. In view of the significant morbidity and health care costs associated with hypertensive diseases of pregnancy, simple screening of pregnant women may have clinical utility.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Young T.
        • Evans L.
        • Finn L.
        • Palta M.
        Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women.
        Sleep. 1997; 20: 705-706
        • Peppard P.E.
        • Young T.
        • Palta M.
        • Dempsey J.
        • Skatrud J.
        Longitudinal study of moderate weight change and sleep-disordered breathing.
        JAMA. 2000; 284: 3015-3021
        • Hedman C.
        • Pohjasvaara T.
        • Tolonen U.
        • Suhonen-Malm A.S.
        • Myllyla V.V.
        Effects of pregnancy on mothers' sleep.
        Sleep Med. 2002; 3: 37-42
        • Pien G.W.
        • Fife D.
        • Pack A.I.
        • Nkwuo J.E.
        • Schwab R.J.
        Changes in symptoms of sleep-disordered breathing during pregnancy.
        Sleep. 2005; 28: 1299-1305
        • Franklin K.A.
        • Holmgren P.A.
        • Jonsson F.
        • Poromaa N.
        • Stenlund H.
        • Svanborg E.
        Snoring, pregnancy-induced hypertension, and growth retardation of the fetus.
        Chest. 2000; 117: 137-141
        • Izci B.
        • Martin S.E.
        • Dundas K.C.
        • Liston W.A.
        • Calder A.A.
        • Douglas N.J.
        Sleep complaints: snoring and daytime sleepiness in pregnant and pre-eclamptic women.
        Sleep Med. 2005; 6: 163-169
        • Young T.
        • Peppard P.
        • Palta M.
        • et al.
        Population-based study of sleep-disordered breathing as a risk factor for hypertension.
        Arch Intern Med. 1997; 157: 1746-1752
        • Nieto F.J.
        • Young T.B.
        • Lind B.K.
        • et al.
        Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study.
        JAMA. 2000; 283: 1829-1836
        • Nieto F.J.
        • Peppard P.E.
        • Young T.B.
        Sleep disordered breathing and metabolic syndrome.
        WMJ. 2009; 108: 263-265
        • Peppard P.E.
        • Young T.
        • Palta M.
        • Skatrud J.
        Prospective study of the association between sleep-disordered breathing and hypertension.
        N Engl J Med. 2000; 342: 1378-1384
        • Shahar E.
        • Whitney C.W.
        • Redline S.
        • et al.
        Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study.
        Am J Respir Crit Care Med. 2001; 163: 19-25
        • Hu F.B.
        • Willett W.C.
        • Colditz G.A.
        • et al.
        Prospective study of snoring and risk of hypertension in women.
        Am J Epidemiol. 1999; 150: 806-816
        • Khan K.S.
        • Wojdyla D.
        • Say L.
        • Gulmezoglu A.M.
        • Van Look P.F.
        WHO analysis of causes of maternal death: a systematic review.
        Lancet. 2006; 367: 1066-1074
        • Perez-Chada D.
        • Videla A.J.
        • O'Flaherty M.E.
        • et al.
        Snoring, witnessed sleep apneas and pregnancy-induced hypertension.
        Acta Obstet Gynecol Scand. 2007; 86: 788-792
        • Bourjeily G.
        • Raker C.A.
        • Chalhoub M.
        • Miller M.A.
        Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing.
        Eur Respir J. 2010; 36: 849-855
        • Ursavas A.
        • Karadag M.
        • Nalci N.
        • Ercan I.
        • Gozu R.O.
        Self-reported snoring, maternal obesity and neck circumference as risk factors for pregnancy-induced hypertension and preeclampsia.
        Respiration. 2008; 76: 33-39
        • Louis J.M.
        • Auckley D.
        • Sokol R.J.
        • Mercer B.M.
        Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy.
        Am J Obstet Gynecol. 2010; 202: 261.e1-261.e5
        • Kump K.
        • Whalen C.
        • Tishler P.V.
        • et al.
        Assessment of the validity and utility of a sleep-symptom questionnaire.
        Am J Respir Crit Care Med. 1994; 150: 735-741
        • Young T.
        • Shahar E.
        • Nieto F.J.
        • et al.
        Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study.
        Arch Intern Med. 2002; 162: 893-900
        • Bliwise D.L.
        • Nekich J.C.
        • Dement W.C.
        Relative validity of self-reported snoring as a symptom of sleep apnea in a sleep clinic population.
        Chest. 1991; 99: 600-608
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gotzsche P.C.
        • Vandenbroucke J.P.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Lancet. 2007; 370: 1453-1457
        • Loube D.I.
        • Poceta J.S.
        • Morales M.C.
        • Peacock M.D.
        • Mitler M.M.
        Self-reported snoring in pregnancy: association with fetal outcome.
        Chest. 1996; 109: 885-889
      1. Rasmussen K.M. Yaktine A.L. Committee to Reexamine IOM Pregnancy Weight Guidelines, Food and Nutrition Board, Board on Children, Youth and Families, Institute of Medicine, National Research Council. Weight gain during pregnancy: reexamining the guidelines. National Academies Press, Washington, DC2009
        • Nehring I.
        • Schmoll S.
        • Beyerlein A.
        • Hauner H.
        • von Kries R.
        Gestational weight gain and long-term postpartum weight retention: a meta-analysis.
        Am J Clin Nutr. 2011; 94: 1225-1231
        • Champagne K.A.
        • Kimoff R.J.
        • Barriga P.C.
        • Schwartzman K.
        Sleep disordered breathing in women of childbearing age and during pregnancy.
        Indian J Med Res. 2010; 131: 285-301
        • Guilleminault C.
        • Querra-Salva M.
        • Chowdhuri S.
        • Poyares D.
        Normal pregnancy, daytime sleeping, snoring and blood pressure.
        Sleep Med. 2000; 1: 289-297
        • Tauman R.
        • Many A.
        • Deutsch V.
        • et al.
        Maternal snoring during pregnancy is associated with enhanced fetal erythropoiesis–a preliminary study.
        Sleep Med. 2011; 12: 518-522
        • Hermansen M.C.
        Nucleated red blood cells in the fetus and newborn.
        Arch Dis Child Fetal Neonatal Ed. 2001; 84: F211-F215
        • Facco F.L.
        • Grobman W.A.
        • Kramer J.
        • Ho K.H.
        • Zee P.C.
        Self-reported short sleep duration and frequent snoring in pregnancy: impact on glucose metabolism.
        Am J Obstet Gynecol. 2010; 203: 142.e1-142.e5
        • Qiu C.
        • Enquobahrie D.
        • Frederick I.O.
        • Abetew D.
        • Williams M.A.
        Glucose intolerance and gestational diabetes risk in relation to sleep duration and snoring during pregnancy: a pilot study.
        BMC Womens Health. 2010; 10: 17
        • Powe C.E.
        • Levine R.J.
        • Karumanchi S.A.
        Preeclampsia, a disease of the maternal endothelium: the role of antiangiogenic factors and implications for later cardiovascular disease.
        Circulation. 2011; 123: 2856-2869
        • Lavie L.
        Oxidative stress–a unifying paradigm in obstructive sleep apnea and comorbidities.
        Prog Cardiovasc Dis. 2009; 51: 303-312
        • Izci-Balserak B.
        • Pien G.W.
        Sleep-disordered breathing and pregnancy: potential mechanisms and evidence for maternal and fetal morbidity.
        Curr Opin Pulm Med. 2010; 16: 574-582
        • Okun M.L.
        • Roberts J.M.
        • Marsland A.L.
        • Hall M.
        How disturbed sleep may be a risk factor for adverse pregnancy outcomes.
        Obstet Gynecol Surv. 2009; 64: 273-280
        • Su M.C.
        • Chiu K.L.
        • Ruttanaumpawan P.
        • et al.
        Difference in upper airway collapsibility during wakefulness between men and women in response to lower-body positive pressure.
        Clin Sci (Lond). 2009; 116: 713-720
        • Edwards N.
        • Blyton D.M.
        • Kirjavainen T.
        • Kesby G.J.
        • Sullivan C.E.
        Nasal continuous positive airway pressure reduces sleep-induced blood pressure increments in preeclampsia.
        Am J Respir Crit Care Med. 2000; 162: 252-257
        • Poyares D.
        • Guilleminault C.
        • Hachul H.
        • et al.
        Pre-eclampsia and nasal CPAP, part 2: hypertension during pregnancy, chronic snoring, and early nasal CPAP intervention.
        Sleep Med. 2007; 9: 15-21
        • O'Brien L.M.
        • Bullough A.S.
        • Hewlett M.M.
        • Martel K.
        • et al.
        Associations between habitual snoring and polysomnogram-defined SDB in pregnant women.
        Sleep. 2011; 34: A320

      Linked Article

      • Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study
        American Journal of Obstetrics & GynecologyVol. 208Issue 6
        • Preview
          I commend O'Brien et al1 for drawing attention to a potentially dangerous yet overlooked clinical condition in pregnancy in the article entitled, “Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study.” Particularly interesting is the observation that pregnancy-onset habitual snoring or what I term “gestational obstructive sleep apnea (OSA)” may be more problematic then superimposed OSA. The opportunity for intervention trials to determine a treatment effect on pregnancy-induced hypertension and preeclampsia is evident; however, the results of such trials should not cloud the fact that, once the patient with snoring is diagnosed definitively with clinically significant OSA, she should be treated effectively.
        • Full-Text
        • PDF