Epidemiology of sleep disorders in pregnant subjects: A questionnaire based survey

There are several changes which occur during the pregnant state that can impact directly or indirectly on breathing. A questionnaire based survey of sleep disorders amongst pregnant subjects attending a tertiary care hospital in New Delhi.

The study was based on a questionnaire. It contained, besides personal identification of the subject, a set of 35 questions. In addition it also had the Epworth Sleep Questionnaire. A validated questionnaire for anxiety and depression was also used. Details of present pregnancy (parity, gravida, last menstrual period, expected date of delivery and period of gestation) was also recorded. The total number of pregnant subjects interviewed was 325. They were selected randomly from those attending the ante-natal clinic of Safdarjang Hospital & Vardhman Mahavir Medical College, New Delhi.

The overall prevalence of snoring was 13.5%. It correlated positively with depression (p<0.075) and gestation period (p<0.016). The overall prevalence of SDB was 9.5%. It correlated positively with gestation period (p<0.042) BMI (p<0.05) and disorders of initiation & maintenance of sleep (DIMS) (p<0.005) and depression (p<0.021). The overall prevalence of DIMS was 47.6%. The prevalence of DIMS was maximum in the third trimester; and it showed a positive correlation with rising gestation period. The overall prevalence of Restless Leg Syndrome (RLS) was 15.7%. It was most prevalent in age group 21–25 years (p<0.045). It showed rising trend with increase in gestation period (p<0.049), increasing parity (p<0.071) and decreasing hemoglobin concentration (p<0.047). The overall prevalence of depression was 11.4%. It correlated positively with increasing parity (p<0.045). The overall prevalence of anxiety was 18.1%. It correlated negatively with increasing age (p<0.057) & BMI (p<0.067) and positively with increasing gestation period (p<0.099). The overall prevalence of excessive daytime sleepiness (EDS) was 30.5%. It correlated negatively, with gestation period (p<0.005) and parity (p<0.001). The overall prevalence of Sleep Deprivation was 11.0%. It correlated with the presence of disorders of initiation and maintenance of sleep (DIMS). Sleep deprivation was also found to the maximally present in the third trimester.

SDB that develops or worsens during pregnancy affects a significant number of pregnant subjects and can predispose them to pre-eclampsia. It can serve as a pointer towards a sinister maternal and/or fetal complication and necessary action may be taken early. In our country, women are less likely than men to report symptoms of snoring/snorting and gasping due to social/cultural reasons. Hence OSA in pregnant women is likely to go undiagnosed. Moreover, symptoms like EDS and nocturnal insomnia are often assumed to be less discriminatory for OSA in pregnant women. Hence a high index of suspicion and vigilance is required. The indications for polysomnography in pregnant women should probably include those with hypertension, previous babies with unexplained IUGR, and persistent sleep-related symptoms (hypersomnia or insomnia) associated with snoring and/or obesity. The prevalence of such complications during pregnancy is significant in our country. In view of these facts, an awareness needs to be created amongst pregnant subjects, their caregivers and the healthcare community at large to detect typical and atypical manifestation of SDB (like anxiety, depression, RLS, DMIS, fatigue) early and undertake remedial measures.