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Obstructive Sleep Apnea in Hypertension Pregnancy: A Wrong Vital Therapeutic Decision

Oana Arghir*, PhD; Mihaela Trenchea, MD; Oana Deleanu, MD
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Constanta General Medicine Faculty, Ovidius University, Constanta, Romania


Chest. 2012;142(4_MeetingAbstracts):1004A. doi:10.1378/chest.1386148
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Abstract

SESSION TYPE: Miscellaneous Global Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Obstructive sleep apnea (OSA) is strongly associated with hypertension [1]. Chronic arterial hypertension pre-existing in pregnancy or new-onset discovered during pregnancy could be complicated by pre-eclampsia or eclampsia [2]. Snoring and obesity, as independent predictive factors for hypertension, are considered risk factors for OSA in pregnant normo or hypertensive. With no prospective population studies, the prevalence of OSA in pregnancy is not known.

CASE PRESENTATION: Young white caucazian woman 32 years aged, with hypertensive mother at young age, Known with obesity first degree (BMI=32Kg/m2), previous untreated arterial hypertension stage III (max. 220/100 mmHg), task with an 8-weeks interrupted by therapeutic abortion due to high blood pressure resistant to antihypertensive treatment and for iminent eclampsia, shows suggestive symptoms for OSA, with an Epworth score =7. Polygraphy results: severe OSA. Holter monitoring revealed elevated systolic-diastolic blood pressure diurnal and nocturnal, with non-dipper pattern.All causes of secondary hypertension's etiology were excluded.

DISCUSSION: Recently studies showed that OSA is an independent risk for onset of hypertension and may contribute to a higher risk of hypertension during pregnancy and doubles the risk for preeclampsia and preterm birth [3]. Snoring increases in frequency during pregnancy. So, any hypertensive pregnant woman with symptoms suggestive for OSA must be investigated by polysomnographia and, if it’s necessary, treated with continuous positive airway pressure (CPAP). Any pregnant hypertensive woman with nocturnal hypoxemia must benefit of CPAP administration in order to control better of arterial hypertension. In the same time, CPAP administration permits to reduce antihypertensive medication doses. Literature review revealed a better control of blood pressure in the third quarter of pregnancy in hypertensive women with associated OSA by CPAP. Even in the cases of pre-eclampsia, CPAP is well tolerated by pregnant women and is effective for both mother and fetus. Future studies are needed to provide answers to questions about hypertensive women at the first prenatal visit for diagnosis and treatment for OSA and prevent fetal complications associated (intrauterine growth retardation, fetal hypotrophy) by placental ischemia secondary intermittent hypoxemia.

CONCLUSIONS: Wrong decision of abortion was determined by insufficient informations about OSA as a possible cause of high resistance to antihypertensive therapy. An earlier diagnosis of OSA and CPAP therapy could saved fetus' life before the onset of preeclampsia.

1) Champagne K,Schwartzman K,Opatrny L,Barriga P,Morin L.Obstructive Sleep Apnoea its association with gestational hypertension.Eur Respir J 2009,33;559-565

2) Kapsimalid F,Kriger M. Obstructive Sleep Apnea in pregnancy.Sleep MedClinic 2(2007) 603-613

3) Pavlova M,Sheikth L.S. Sleep in women.Semin Neurol 2011 Sep;31(4):397-403.

DISCLOSURE: The following authors have nothing to disclose: Oana Arghir, Mihaela Trenchea, Oana Deleanu

No Product/Research Disclosure Information

Constanta General Medicine Faculty, Ovidius University, Constanta, Romania

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