Does the Risk of Sleep Apnea Increase During Pregnancy?

Hormonal, physical, and respiratory changes that occur during pregnancy may affect sleep patterns. Some expectant mothers may begin to snore even if they did not snore before, existing snoring may become more noticeable, or breathing difficulties may occur during sleep. These changes may contribute to an increased risk, particularly for obstructive sleep apnea.

Not every instance of snoring during pregnancy means sleep apnea. Nasal congestion, sleeping position, weight gain, and temporary pregnancy-related changes may also cause snoring. However, if snoring is accompanied by breathing pauses during sleep, waking up choking, morning headaches, or significant daytime sleepiness, it is important to evaluate the possibility of sleep apnea.

Why May Pregnancy Increase the Risk of Sleep Apnea?

Changes that affect the risk of sleep apnea during pregnancy cannot be explained by a single mechanism. Hormone levels, tissues in the upper airway, weight changes, sleeping position, and the expectant mother’s health before pregnancy may all play a role.

The risk may not be the same during every stage of pregnancy. Because changes around the airway and weight gain may become more noticeable in the later months, sleep apnea may become more prominent in some people during the third trimester.

Hormonal Changes

Increased hormone levels during pregnancy may cause greater blood flow and swelling in the tissues of the nose and upper airway. This may make breathing through the nose more difficult and contribute to the airway becoming more likely to narrow during sleep.

Hormonal changes may also affect the regulation of breathing and sleep structure. However, hormonal changes alone do not mean that a person will definitely develop sleep apnea.

Nasal Congestion and Airway Swelling

Nasal congestion may be common during pregnancy. Swelling of the lining of the upper airway may cause the expectant mother to breathe through the mouth and may increase breathing sounds at night.

Persistent nasal congestion may disrupt sleep quality. However, regular snoring, breathing pauses, or noticeable breathing effort during sleep should not be attributed only to nasal congestion.

Weight Gain

A certain amount of weight gain is an expected physiological process during pregnancy. However, having excess weight before pregnancy or gaining more weight than expected for the person’s health during pregnancy may increase pressure around the upper airway.

When fat tissue around the neck and throat increases, the airway may narrow more easily during sleep. Restrictive diets should not be used for weight management during pregnancy. Nutrition and weight monitoring should be planned by an obstetrician and, when necessary, a dietitian.

Growth of the Uterus and Breathing Mechanics

As pregnancy progresses, the growing uterus may affect the movement of the diaphragm. Breathing may feel as though it requires more effort, particularly when lying down.

Mild shortness of breath may occur during pregnancy, but significant shortness of breath at rest, chest pain, bluish discoloration, or sudden deterioration should not be considered normal. In the presence of these symptoms, the person should apply to a healthcare institution without waiting for a sleep test or online consultation.

Sleeping Position

Sleeping on the back during the later stages of pregnancy may increase discomfort, snoring, or breathing difficulty in some expectant mothers. The tongue and soft tissues moving backward may also contribute to narrowing of the airway.

Sleeping position may affect each person differently. The appropriate sleeping position during pregnancy should be assessed together with an obstetrician by considering the expectant mother’s stage of pregnancy and health status.

Who Is at Greater Risk of Sleep Apnea During Pregnancy?

Sleep apnea does not develop in every pregnant person. Certain characteristics may increase the risk, but these factors do not establish a diagnosis on their own.

Situations that may require more careful evaluation for sleep apnea during pregnancy include:

• Having a sleep apnea diagnosis before pregnancy
• Regular and loud snoring before pregnancy
• Excess weight or obesity
• Significant weight gain during pregnancy
• A larger neck circumference
• Older maternal age
• Chronic high blood pressure
• High blood pressure during pregnancy or preeclampsia
• Gestational diabetes
• Polycystic ovary syndrome
• Nasal congestion or structural narrowing of the upper airway
• A family history of sleep apnea
• Smoking
• Multiple pregnancy
• Heart or lung disease

Obesity, older age, and snoring are among the important factors that may increase the likelihood of sleep apnea during pregnancy. However, sleep apnea may also occur in younger expectant mothers with a normal body weight because of anatomical or respiratory factors.

What Are the Symptoms of Sleep Apnea During Pregnancy?

Sleep apnea symptoms may occur differently at night and during the day. The expectant mother may not notice breathing pauses that occur during sleep. Therefore, observations by a partner or someone sleeping in the same room may be important.

Because fatigue, nighttime awakenings, and daytime sleepiness may be common during pregnancy, sleep apnea symptoms may be confused with the natural changes of pregnancy. Evaluation is required when symptoms are new, progressively worsen, or noticeably affect daily life.

Symptoms That May Be Seen at Night

Symptoms that may occur during sleep include:

• New or increasingly loud snoring
• Observed pauses in breathing during sleep
• Waking up choking or gasping for air
• Sleeping with the mouth open
• Frequent awakenings throughout the night
• Restless sleep
• Heavy sweating
• Frequent nighttime urination
• Noticeable breathing effort during sleep
• Waking with palpitations

Not every episode of snoring indicates sleep apnea. It is important to share symptoms with a healthcare professional, particularly when breathing pauses, suspected low oxygen levels, or a choking sensation are present.

Symptoms That May Be Seen During the Day

Symptoms that may occur during the day include:

• Morning headaches
• Dry mouth in the morning
• Waking unrefreshed despite getting enough sleep
• Significant daytime sleepiness
• Persistent fatigue
• Difficulty concentrating
• Forgetfulness
• Irritability and mood changes
• Difficulty continuing daily activities
• Dozing while driving or in quiet environments

Sleep apnea in women may not always appear with obvious snoring. More general symptoms such as insomnia, headaches, frequent waking, fatigue, and daytime sleepiness may also occur.

Is Snoring Normal During Pregnancy?

Snoring may begin during pregnancy because of nasal congestion, weight changes, and swelling of the tissues in the upper airway. A person who previously snored only occasionally may snore more frequently during the later stages of pregnancy.

Occasional mild snoring does not always indicate sleep apnea. However, evaluation for sleep apnea may be required when snoring occurs on many nights of the week, progressively becomes more severe, or appears together with breathing pauses.

Snoring should be taken more seriously when it occurs with the following symptoms:

• Breathing pauses during sleep
• Waking up choking
• Severe morning headaches
• High blood pressure that is difficult to control
• Significant daytime sleepiness
• Waking unrefreshed
• Suspected low oxygen levels at night
• Symptoms becoming more noticeable as pregnancy progresses

Can Sleep Apnea Affect Blood Pressure During Pregnancy?

Repeated breathing pauses throughout the night in sleep apnea may cause blood oxygen levels to fall and activate the body’s stress response. This process may affect blood pressure regulation.

Studies have found an association between sleep apnea during pregnancy and gestational hypertension and preeclampsia. However, this association does not mean that every expectant mother with sleep apnea will definitely develop high blood pressure or preeclampsia. Weight, age, genetic predisposition, and other health conditions may also affect the risk.

If there is a severe headache, blurred vision or flashing lights, upper abdominal pain, sudden swelling of the face and hands, significant shortness of breath, or a high blood pressure reading, a routine sleep assessment should not be awaited. The expectant mother should contact the obstetric care team or emergency medical services without delay.

Is Sleep Apnea Associated with Gestational Diabetes?

Sleep interruptions and oxygen changes caused by sleep apnea may affect glucose metabolism and insulin sensitivity. Research has found an association between sleep apnea during pregnancy and gestational diabetes.

However, sleep apnea is not the only cause of gestational diabetes. Many factors may play a role, including family history, excess weight, age, previous pregnancy history, and metabolic health. An expectant mother with suspected sleep apnea should not delay routine screening for gestational diabetes.

Can Sleep Apnea During Pregnancy Affect the Baby?

An expectant mother’s inability to maintain sufficient and uninterrupted breathing throughout the night should be evaluated in terms of both maternal health and pregnancy monitoring. Associations have been reported between sleep apnea and outcomes such as preterm birth, low birth weight, and cesarean delivery.

These associations do not mean direct cause and effect. Because people with sleep apnea may also have excess weight, hypertension, gestational diabetes, or other health conditions, the risk may vary from person to person. Regular obstetric follow-up and sleep assessment when required help support the comprehensive management of the health of the mother and baby.

How Is Sleep Apnea Diagnosed During Pregnancy?

Sleep apnea is not diagnosed only by looking at snoring or daytime fatigue. During the evaluation, the expectant mother’s symptoms, stage of pregnancy, weight changes, medications, and accompanying health conditions are reviewed.

Observations about breathing pauses made by someone sleeping in the same room may also be valuable. However, breathing and oxygen levels during sleep may need to be objectively recorded to assess the symptoms accurately.

Medical History and Physical Assessment

During the assessment, the healthcare professional may ask when snoring started, whether breathing pauses occur at night, whether daytime sleepiness affects daily life, and whether there was a previous diagnosis of sleep apnea.

Nasal congestion, neck circumference, blood pressure, weight changes, and accompanying conditions may also be considered. Screening questionnaires may help identify risk, but they do not establish a diagnosis on their own.

Sleep Test

During a sleep test, data such as airflow, breathing movements, blood oxygen level, heart rate, and snoring may be recorded. Comprehensive polysomnography performed in a hospital may additionally evaluate sleep stages, brain waves, eye movements, and muscle activity.

The appropriate test should be selected according to the expectant mother’s symptoms, health status, and risk of sleep apnea. Screening, diagnosis, and treatment decisions during pregnancy should be made on an individual basis.

Can an At-Home Sleep Test Be Performed During Pregnancy?

An at-home sleep test may help evaluate suspected obstructive sleep apnea in suitable expectant mothers. Depending on the device, airflow through the nose, chest and abdominal breathing movements, blood oxygen level, heart rate, snoring, and sleeping position may be recorded.

The test is generally performed using sensors placed externally on the body and does not involve radiation. Performing the test in the person’s usual sleeping environment may make the process more comfortable for some expectant mothers who find it difficult to sleep in a hospital.

However, an at-home sleep test is not automatically suitable for every pregnant person. A comprehensive hospital-based sleep test may be preferred when there is serious heart or lung disease, suspected central sleep apnea, the possibility of another sleep disorder, or a need for more detailed measurements.

A normal home test result may not always completely rule out sleep apnea when strong symptoms continue. In such a case, the test may need to be repeated or a more comprehensive assessment may be performed in a sleep center.

Is a Sleep Test Safe During Pregnancy?

A sleep test is a recording procedure performed for diagnostic purposes. Devices used at home usually include externally placed breathing, pulse, and oxygen sensors. These tests do not involve radiation or medication administration.

It is important for the device to be placed appropriately for the expectant mother and for the test process to be carried out according to the healthcare team’s instructions. Regular medications, the current stage of pregnancy, and accompanying health conditions should be shared with the healthcare team before the test.

If the expectant mother experiences significant shortness of breath, chest pain, a feeling of fainting, bleeding, regular painful contractions, or a noticeable reduction in the baby’s movements during the test, she should contact the obstetric care team or emergency medical services instead of trying to complete the test.

How Is Sleep Apnea Treated During Pregnancy?

Treatment is planned according to the type and severity of sleep apnea, stage of pregnancy, symptoms, and the expectant mother’s other health conditions. Starting to use a device, stopping treatment, or changing existing settings without medical guidance is not appropriate during pregnancy.

CPAP devices that provide positive airway pressure may be used during pregnancy when considered necessary. Because pregnancy causes changes in the body, device settings may need to be reassessed during pregnancy or after delivery.

Approaches that may be evaluated during treatment include:

• Planning positive airway pressure treatment
• Reviewing existing CPAP settings
• Evaluating nasal congestion and allergy symptoms
• Determining a pregnancy-appropriate sleeping position
• Continuing weight monitoring recommended by the obstetrician
• Not delaying high blood pressure and gestational diabetes checks
• Monitoring sleep symptoms throughout pregnancy
• Performing a reassessment after delivery

Sleep apnea treatment during pregnancy does not replace regular obstetric follow-up. Coordinated assessment by an obstetrician, a physician working in sleep health, and other necessary specialties is important.

Does Sleep Apnea Resolve After Delivery?

Pregnancy-related nasal congestion, swelling, and certain physical changes may decrease after delivery. Therefore, sleep apnea symptoms that began or worsened during pregnancy may improve after delivery in some people.

However, reduced symptoms do not show that sleep apnea has completely resolved. The problem may continue in people who had excess weight, narrowing of the upper airway, or existing sleep apnea before pregnancy.

If snoring, breathing pauses, morning headaches, or daytime sleepiness continue after delivery, a follow-up assessment should be performed. People who use CPAP should not stop using their device without the recommendation of a healthcare professional. Although sleep apnea that becomes more severe during pregnancy may improve after delivery, individual follow-up remains important.

Which Symptoms Require Emergency Evaluation?

Suspected sleep apnea generally requires planned assessment. However, an online consultation, at-home test, or routine appointment should not be awaited for certain symptoms during pregnancy.

The expectant mother should contact the obstetric care team, a healthcare institution, or emergency medical services directly in the following situations:

• Significant or sudden shortness of breath at rest
• Chest pain or pressure in the chest
• Bluish discoloration of the lips or face
• Fainting or a change in consciousness
• A prolonged and noticeable pause in breathing
• A severe and persistent headache
• Blurred vision or flashing lights
• Severe pain in the upper abdomen
• Sudden swelling of the face and hands
• A very high blood pressure reading
• Vaginal bleeding
• Regular and painful contractions
• A noticeable reduction in the baby’s movements

This content is intended for general information. People who have symptoms of sleep apnea during pregnancy should be evaluated by their own obstetrician and a physician experienced in sleep health.

Evaluate Your Sleep Health at Home During Pregnancy with Happ Health

New or worsening snoring, breathing pauses during sleep, morning headaches, and significant daytime sleepiness during pregnancy may require evaluation for sleep apnea.

Happ Health is a digital health platform that supports access to healthcare services from home or remotely. The suitability of the Happ Health at-home sleep test service for an expectant mother should be evaluated by considering the stage of pregnancy, symptoms, accompanying conditions, and obstetric follow-up.

For suitable individuals, the process of recording breathing and oxygen data during sleep in the person’s own sleeping environment may be planned. The results may support the determination of the necessary healthcare steps. An at-home sleep test does not replace regular pregnancy follow-up and does not promise a definite diagnosis or treatment result.