Sleep physiology in late pregnancy: A video-based, multi-night, in-home, level 3 sleep apnea study of pregnant participants and their bed partners

We completed a video-based, four-night, in-home, level 3 sleep apnea study of healthy, low-risk pregnant participants and their bed partners in order to characterize sleep physiology in the third trimester of pregnancy. Demographic, anthropometric, and baseline sleep health characteristics were recorded, and the NightOwl home sleep apnea test device was used to measure sleep breathing, posture, and architecture parameters. Symptoms of restless legs syndrome were elicited in the exit interview. Forty-one pregnant participants and 36 bed partners completed the study. Bed partners had a significantly higher prevalence of sleep apnea than their pregnant co-sleepers (31% vs. 5.9%). Bed partners also had more severe sleep apnea than their pregnant co-sleepers, and this persisted on an adjusted analysis for baseline differences in factors known to increase risk of sleep apnea. In pregnant participants, increasing gestational age was found to be protective against mild respiratory events but not more severe events. While the correlation between STOP-Bang score and measures of sleep apnea severity was weak, an affirmative response to the "witnessed apneas" item on the STOP-Bang questionnaire was a strong predictor of more severe sleep apnea for all participants. Smoking history also increased sleep apnea risk. Pregnant participants had lower sleep efficiency and longer self-reported sleep onset latency. Restless legs syndrome was experienced by 39.5% of the pregnant participants but no bed partners. From a sleep breathing perspective, people with healthy, low-risk pregnancies have better sleep than their bed partners despite lower sleep efficiency and higher rates of restless legs syndrome. Clinical Study RegistrationSleep in Late Pregnancy - Artificial Intelligence Development for the Detection of Disturbances and Disorders (SLeeP AID4), https://clinicaltrials.gov/study/NCT05376475, registration ID NCT05376475. Statement of SignificancePregnancy negatively impacts sleep, and poor sleep in pregnancy negatively impacts maternal and fetal health. Pregnancy represents a unique challenge to sleep breathing physiology and, thus, an opportunity to test for sleep apnea. Sleep apnea however, while increased in pregnancy, is more common in males. This novel study tested healthy people with low-risk pregnancies and their bed partners for sleep apnea in the comfort of their home over four nights in late pregnancy. Sleep apnea was more common and worse in the bed partners. Advancing gestational age was protective against mild but not severe sleep apnea, and a critical remaining knowledge gap is this interplay in high-risk pregnancies. Future sleep in pregnancy research should make efforts to include high-risk pregnancies.