Association between Sleep Disordered Breathing and Neonatal Outcomes in Nulliparous Individuals

Arlin Delgado, Anthony M. Kendle, Tara Randis, Keyur Donda, Jason L. Salemi, Francesca L. Facco, Corette B. Parker, Uma M. Reddy, Robert M. Silver, Robert C. Basner, Judith H. Chung, Frank P. Schubert, Grace W. Pien, Susan Redline, Samuel Parry, William A Grobman, Phyllis C. Zee, Judette M. Louis*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective Our objective was to determine whether objectively measured sleep-disordered breathing (SDB) during pregnancy is associated with an increased risk of adverse neonatal outcomes in a cohort of nulliparous individuals. Study Design Secondary analysis of the nuMom2b sleep disordered breathing substudy was performed. Individuals underwent in-home sleep studies for SDB assessment in early (6-15 weeks' gestation) and mid-pregnancy (22-31 weeks' gestation). SDB was defined as an apnea-hypopnea index ≥5 events/h at either time point. The primary outcome was a composite outcome of respiratory distress syndrome, transient tachypnea of the newborn, or receipt of respiratory support, treated hyperbilirubinemia or hypoglycemia, large-for-gestational age, seizures treated with medications or confirmed by electroencephalography, confirmed sepsis, or neonatal death. Individuals were categorized into (1) early pregnancy SDB (6-15 weeks' gestation), (2) new onset mid-pregnancy SDB (22-31 weeks' gestation), and (3) no SDB. Log-binomial regression was used to calculate adjusted risk ratios (RR) and 95% confidence intervals (CIs) representing the association. Results Among 2,106 participants, 3% (n = 75) had early pregnancy SDB and 5.7% (n = 119) developed new-onset mid-pregnancy SDB. The incidence of the primary outcome was higher in the offspring of individuals with early (29.3%) and new onset mid-pregnancy SDB (30.3%) compared with individuals with no SDB (17.8%). After adjustment for maternal age, chronic hypertension, pregestational diabetes, and body mass index, new onset mid-pregnancy SDB conferred increased risk (RR = 1.43, 95% CI: 1.05, 1.94), where there was no longer statistically significant association between early pregnancy SDB and the primary outcome. Conclusion New onset, mid-pregnancy SDB is independently associated with neonatal morbidity. Key Points Sleep disordered breathing (SDB) is a common condition impacting pregnancy with known maternal risks. Objectively defined SDB in pregnancy was associated with a composite of adverse neonatal outcomes. New onset SDB in mid pregnancy conferred statistically significant increased risk.

Original languageEnglish (US)
JournalAmerican journal of perinatology
StateAccepted/In press - 2022


  • neonatology
  • obstetrics
  • sleep disordered breathing

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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