CHEST urges greater attention to sleep apnea during pregnancy

Clinical takeaway: Screen pregnant patients for sleep-disordered breathing, confirm suspected obstructive sleep apnea with home or laboratory testing, and initiate positive airway pressure based on apnea severity, symptoms, sequelae, and comorbidities.

The American College of Chest Physicians has issued its first clinical practice guideline dedicated to obstructive sleep apnea (OSA) in pregnancy, addressing a condition that may be overlooked when fatigue, disrupted sleep, and other symptoms are attributed to normal pregnancy. The guideline includes nine conditional recommendations covering screening, diagnosis, treatment, and postpartum follow-up. All are based on very-low-certainty evidence, underscoring the need for individualized, shared decision-making.

CHEST suggests screening pregnant individuals for sleep-disordered breathing using either a pregnancy-specific questionnaire or a standard screening tool. Patients identified as being at risk may undergo either a home sleep test or laboratory-based polysomnography; the guideline does not favor one diagnostic setting over the other.

Positive airway pressure is the recommended first-line treatment. For patients diagnosed during pregnancy, treatment is suggested when the apnea-hypopnea index (AHI) is 5 to less than 15 events per hour and symptoms, OSA-related sequelae, or comorbidities such as hypertension, stroke, or obesity are present. An AHI of at least 15 warrants treatment regardless of symptoms or comorbidities. Auto-titrating positive airway pressure is preferred; patients already using fixed-pressure CPAP before pregnancy should generally be switched to an auto-titrating device to accommodate pregnancy-related physiologic changes. Scheduled naps may also be considered as an initial measure for persistent daytime symptoms.

Patients diagnosed with OSA during pregnancy should be reassessed after delivery because the condition may improve but does not necessarily resolve postpartum. Measures of sleep-disordered breathing have been associated with adverse fetal growth, preterm birth, neonatal intensive care admission, congenital anomalies, and longer hospitalization, although evidence that OSA treatment prevents these outcomes remains limited.

“What I want most from this guideline is to put sleep-disordered breathing on the radar for pregnant patients and their providers,” said lead author Carolyn D’Ambrosio, MD, FCCP. “The guideline also serves as a reminder that not everything goes away postpartum.”

Source: D’Ambosio CM, et al. (2026 July 21) Chest. Obstructive Sleep Apnea (OSA) in Pregnancy - An American College of Chest Physicians Clinical Practice Guideline