PAP Therapy Promising in Improving Glucose Control in High-Risk Pregnant Women with Sleep Apnea: Meta-Analysis
Brazil – Positive airway pressure (PAP) therapy may play a beneficial role in managing metabolic health among high-risk pregnant women with obstructive sleep apnea (OSA), according to a new meta-analysis published in The Laryngoscope. The study, led by Thamiris D. D. Cabral and colleagues from the Federal Hospital of Bonsucesso, highlights that PAP therapy can significantly improve glucose regulation. However, its impact on broader maternal and neonatal outcomes remains uncertain.
Obstructive sleep apnea is increasingly recognized as a complication in high-risk pregnancies, particularly in women with conditions such as obesity, hypertension, or gestational diabetes. Untreated OSA can contribute to both maternal and fetal complications. PAP therapy, commonly used to treat OSA in the general population, has been proposed as a potential intervention in pregnancy, but its benefits in this setting require more robust evaluation.
For this purpose, the researchers systematically reviewed and analyzed seven clinical studies including 696 pregnant women diagnosed with OSA. Among them, 328 women received PAP therapy, while the remainder were managed with non-PAP strategies such as waitlist monitoring, sham therapy, or nasal dilator strips.
The pooled findings suggested clinically meaningful benefits on maternal glucose metabolism:
- PAP therapy was linked with significantly lower fasting plasma glucose levels (mean difference [MD] −6.50).
- Insulin resistance, measured by the homeostatic model assessment of insulin resistance (HOMA-IR), was also reduced in the PAP group (MD −0.90).
- No significant improvements were observed for hypertensive disorders of pregnancy, cesarean section rates, or preterm delivery.
- Neonatal outcomes—including birth weight, Apgar scores, fetal growth measures, and NICU admissions—remained largely unaffected by PAP therapy.
These results suggest that PAP therapy may have targeted benefits in improving maternal glucose metabolism, but it does not appear to significantly influence other maternal or neonatal health outcomes.
Commenting on the implications, the authors noted, “Our findings indicate that PAP therapy in high-risk pregnancies complicated by OSA may provide specific benefits related to maternal glucose metabolism, but further research is needed to establish its role in improving overall maternal and neonatal health.”
"The study highlights the importance of identifying OSA during pregnancy, particularly in high-risk women, and exploring interventions that can mitigate complications. While PAP therapy shows promise in metabolic regulation, the researchers emphasized that larger clinical trials are needed to confirm these findings and determine whether long-term maternal and child outcomes can also be improved through this approach," they concluded.
Reference:
D. Cabral, T. D., Knoll, R. M., Plane, J., Viana, P., Vecchia Vendramini, B. D., Ponte Conrado, J. E., Caruso, V., & Huyett, P. Positive Airway Pressure Therapy for Obstructive Sleep Apnea in High-Risk Pregnancy: A Meta-Analysis. The Laryngoscope. https://doi.org/10.1002/lary.70009
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