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College of Public Health, University of South Florida, Maternal & Child Health Comparative Effectiveness Research Group, Department of Epidemiology & Biostatistics, Tampa, FL
College of Public Health, University of South Florida, Maternal & Child Health Comparative Effectiveness Research Group, Department of Epidemiology & Biostatistics, Tampa, FL
College of Public Health, University of South Florida, Maternal & Child Health Comparative Effectiveness Research Group, Department of Epidemiology & Biostatistics, Tampa, FL
To evaluate the risk of pregnancy related diabetes and hypertensive disease associated with obstructive sleep apnea.
Study Design
This study used data from the 1998-2009 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS). Among hospital discharges for women who were pregnant or gave birth, we used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify discharges with and without a diagnosis of OSA. The outcomes of interest were gestational diabetes (n=2,489,181), pre-eclampsia (n=1,798,066), eclampsia (n=56,395), gestational hypertension (n=1,798,066), and preterm labor (n=4,889,853). We assessed trends in OSA-related discharges among maternal discharges using jointpoint regression. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI), using SAS survey procedures to account for the NIS sampling design.
Results
During the study period, there were a total of 55,781,965 pregnancy-related discharges. The rate of OSA from 1998-2009 was approximately 3.0 discharges per 10,000. However, the 1998 rate of 0.73 per 10,000 climbed to 7.3 per 10,000 in 2009, with an average annual increase of 24%. After controlling for age, race, and household income, women with OSA demonstrated an increased odds of gestational diabetes, pre-eclampsia, eclampsia, gestational hypertension, and preterm labor. Even after further adjustment for selected clinical conditions, including maternal obesity, OSA still remained risk factor for each outcome, except preterm labor.
Conclusion
The rate of OSA-related discharges among pregnancies has increased over the decade. OSA is independently associated with increased risks of pregnancy related gestational diabetes, and hypertensive diseases, including preeclampsia and eclampsia. Given public health implications of OSA complicating pregnancy, attention should be paid to reversing the trend of increasing OSA in women of reproductive age.
Adjusted estimates (odds ratios [AOR] and 95% confidence intervals [CI] for the association between obstructive sleep apnea and gestational diabetes, pre-eclampsia, eclampsia, gestational hypertension, and preterm labor
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