Antepartum obstructive sleep apnea screening and its association with postpartum respiratory depression: a retrospective cohort study (2020-2025).

BACKGROUND

Obstructive sleep apnea is not routinely screened for in the peripartum population, and its association with postpartum respiratory depression remains unclear. We evaluated positive antepartum obstructive sleep apnea screening and its association with postpartum respiratory outcomes.

METHODS

We conducted a single-center retrospective cohort study of parturients undergoing routine antepartum obstructive sleep apnea STOP screening (loud snoring, daytime tiredness, observed apnea, high blood pressure) from July 2020 to June 2025. Delivery encounters with at least one STOP response were included. Positive STOP screening was defined as ≥2 criteria. Postpartum respiratory outcomes included bradypnea, oxygen desaturation, and naloxone administration. Associations of positive STOP screening, individual STOP components, and self-reported obstructive sleep apnea with postpartum respiratory outcomes were evaluated using logistic regression.

RESULTS

Among 19,250 delivery encounters, 608 (3.2%) screened positive and 182 (1.0%) reported obstructive sleep apnea. Bradypnea occurred in 2.8% (532/19,237) and oxygen desaturation in 2.4% (356/14,723). Positive STOP screening was associated with desaturation (adjusted OR 1.86, 95% CI 1.21-2.88; P = 0.005), but not bradypnea. Preeclampsia or a hypertensive diagnosis was associated with bradypnea (OR 1.64, 95% CI 1.14-2.35) and desaturation (OR 2.88, 95% CI 2.06-4.03). Self-reported obstructive sleep apnea was associated with bradypnea (OR 2.01, 95% CI 1.06-3.84) and desaturation (OR 2.72, 95% CI 1.46-5.08). Snoring, tiredness, and observed apnea were associated with desaturation but not bradypnea.

CONCLUSION

Positive antepartum STOP screening was associated with postpartum desaturation but not bradypnea. Preeclampsia or a hypertensive diagnosis may be an important screening question for postpartum respiratory depression.