Diagnosis and management of sleep disorders in pregnancy

There are many different ways in which sleep data can be collected, the gold standard, however, is to measure sleep using polysomnography (PSG) as this provides an objective assessment of the sleep-wake cycle over the entire sleep period (Baker et al, 1999).

Much of the data regarding sleep in pregnancy is limited to self-administered questionnaires and to diaries: very few recent studies have used PSG. However, it is recognised that undertaking multiple sleep studies at different time points during pregnancy is difficult. Despite this there is evidence to suggest that sleep disorders in pregnancy can in certain individuals have adverse outcomes for the mother or baby and therefore it would be useful to develop a screening tool that could be administered quickly by health professionals during routine pregnancy consultations.

A simple and cost-effective alternative to PSG is to use actigraphy and sleep diaries. There are now many wrist-watch style actigraphs available. They are activated by movement and can differentiate when a person is awake or asleep, many also now have light monitors incorporated in them as well. They are useful in identifying night time awakenings and for determining their subsequent duration. When used in conjunction with self-recorded sleep diaries, actigraphs can help to establish a very detailed sleep pattern.

Questionnaires administered to a bed partner can also help to establish a diagnosis of sleep disordered breathing. OSA is a common but often unrecognised condition in women of childbearing age. The likelihood is increased however in women with a past or current history of polycystic ovary syndrome, depression, hypertension, diabetes, hypothyroidism, metabolic syndrome, obesity (Champagne et al, 2010). The diagnostic test of choice would be a PSG, and referral to a sleep specialist to confirm and treat primary sleep disorders may be required. Further research is also required to establish if the management thresholds for treatment of OSA in non-pregnant women are applicable to pregnant women.

Pharmacological treatment of sleep disorders in pregnancy needs to be viewed with caution, given the potential for harm to the foetus. Similar caution needs to extend to women who are breastfeeding.


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