Sleep health predicted glucose metabolism among pregnant women: A prospective cohort study.

AIMS: To examine whether sleep health in the first trimester could predict glucose metabolism in the second trimester. METHODS: Pregnant women (N = 127) during the first trimester were recruited (August 2022 to March 2023). Overall sleep health was assessed by the Sleep Health Index. Various dimensions of sleep health were measured using a 7-day sleep diary and questionnaires. The outcomes, including diagnosis of gestational diabetes mellitus (GDM) and HbA1c, were obtained from the medical records in the second trimester. Poisson regression analysis and multiple linear regression were used for data analysis. RESULTS: The average age of the participants was 32.6 years. The incidence of GDM was 28.3 % and the mean HbA1c was 5.2 % (33 mmol/mol). Sleep duration regularity (RR = 1.808; 95 %CI 1.023, 3.196) was associated with GDM after controlling for confounders. SHI total score (ß = -0.278; 95 %CI -0.022, -0.005) and sleep duration regularity (ß = 0.243; 95 %CI 0.057, 0.372) were associated with HbA1c. CONCLUSIONS: Worse sleep health, particularly lower sleep regularity, predicted worse glucose metabolism among pregnant women. Healthcare professional may consider adding sleep-related assessment to prenatal care. Maintaining regular sleep should be encouraged. Studies examining the impact of sleep intervention on glucose metabolism among pregnant women are warranted.

Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy.

The Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology tasked an expert group to review existing evidence and to generate recommendations on the screening, diagnosis, and treatment of patients with obstructive sleep apnea during pregnancy. These recommendations are based on a systematic review of the available scientific evidence and expert opinion when scientific evidence is lacking. This guideline may not be appropriate for all clinical situations and patients, and physicians must decide whether these recommendations are appropriate for their patients on an individual basis. We recognize that not all pregnant people may identify as women. However, data on non-cisgendered pregnant patients are lacking, and many published studies use gender-binary terms; therefore, depending on the study referenced, we may refer to pregnant individuals as women. This guideline may inform the creation of clinical protocols by individual institutions that consider the unique considerations of their patient populations and the available resources.

The Relationship Between Sleep and Brain Function in Older Adults With Chronic Kidney Disease and Self-Identified Cognitive Impairment.

Older adults with chronic kidney disease (CKD) are at risk for cognitive impairment and sleep disturbances. The purpose of the current study was to investigate the relationship between sleep and brain structure/function in older adults with CKD and self-identified cognitive impairment. The sample (N = 37) had a mean age of 68 years (SD = 4.9 years), estimated glomerular filtration rate of 43.7 mL/min/1.73m2 (SD = 10.98), median sleep time of 7.4 hours, and was 70% female. Sleeping <7.4 hours, compared to ≥7.4 hours, was associated with better attention/information processing (ß = 11.46, 95% confidence interval [CI] [3.85, 19.06]) and better learning/memory (ß = 2.06, 95% CI [0.37, 3.75]). Better sleep efficiency was associated with better global cerebral blood flow (ß = 3.30, 95% CI [0.65, 5.95]). Longer awake length after sleep onset was associated with worse fractional anisotropy of the cingulum (ß = -0.01, 95% CI [-0.02, -0.003]). Sleep duration and continuity may be related to brain function in older adults with CKD and self-identified cognitive impairment. [Journal of Gerontological Nursing, 49(7), 31-39.].

Cross-cultural adaptation and validation of the Chinese version of the Sleep Health Index.

OBJECTIVE: To generate the Chinese Sleep Health Index (SHI-C) in Mandarin with cross-cultural adaptations and test its psychometric properties. METHODS: This study used a cross-sectional design. Health science students were included (N = 271) and a sub-set (n = 74) was invited for the re-test. Cross-cultural adaptation of the SHI-C was performed prior to formal validation. The SHI-C, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Bedtime Procrastination Scale, and Sleep Hygiene Index were used to measure variables of interest. Exploratory factor analysis was used to evaluate the structure validity. Bivariate analyses were used to evaluate the construct validity. RESULTS: Exploratory factor analysis identified 3 factors (ie, sleep quality, sleep duration, and disordered sleep) accounting for 55.6% of the total variance. The SHI-C total and sleep quality sub-index scores were significantly associated with both PSQI global score (r = -0.132, p < .05; r = -0.182, p < .01, respectively) and ISI score (r = -0.655, p < .05; r = -0.820, p < .05, respectively). SHI-C total, sleep quality sub-index, and sleep duration sub-index scores were significantly associated with Bedtime Procrastination Scale and Sleep Hygiene Index scores (r = -0.238 to -0.368, p < .05). Students with insomnia (ISI > 9) or poor sleep quality (PSQI > 5) had significantly lower SHI-C scores than those without (73.5 vs. 89.0, p < .01; 84.1 vs. 86.7, p < .05, respectively). SHI-C showed good internal consistency (Cronbach's alpha = 0.73) and test-retest reliability (intraclass correlation coefficient = 0.82). CONCLUSIONS: The SHI-C demonstrated good validity and adequate reliability in a Chinese sample of health science students. It could be used to measure sleep health in future research and practice. Psychometric properties of the SHI-C among other Chinese populations remain to be confirmed.

Infant feeding type and maternal sleep during the postpartum period: a systematic review and meta-analysis.

The aim of this meta-analysis was to examine the associations among infant feeding types, sleeping habits, and maternal sleep postpartum. Databases including Cumulative Index of Nursing and Allied-Health Literature (CINAHL), PubMed, and Google Scholar were searched in addition to reference lists from selected articles and other key references. A critical review of relevant articles from the data sources was conducted with attention to the infant feeding types and maternal night-time sleep. The methodological quality was assessed systematically. The pooled mean difference was calculated. Narrative summaries were also used. A total of 6,472 participants from seven studies were included in the meta-analysis. A random-effects model demonstrated a significantly higher maternal night-time sleep in breastfeeding mothers than non-breastfeeding mothers with a pooled standardized mean difference of 0.24 h (95% confidence interval 0.03-0.46, p = 0.026). Co-sleeping with infants during the night also increased the sleeping hours in breastfeeding mothers. Homogeneity was observed with a Tau2 of 0.0308 and I2 of 44.3%. Funnel plots, Egger's and Begg's tests revealed no evidence of publication bias. This systematic review and meta-analysis demonstrated that breastfeeding may be associated with a longer night-time sleep postpartum and the synthesis of the literature suggested that co-sleeping with the infant was associated with longer sleep duration in breastfeeding women. Further research into factors involving maternal decisions on infant feeding types and their effects on maternal sleep is needed to better understand the mothers' attitude toward infant feeding and their own sleep.

Special Issue: The Diagnosis and Management of OSA.

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing (SDB) and is demonstrating an increasing prevalence worldwide [...].

Evening blue-light exposure, maternal glucose, and infant birthweight.

Maternal-fetal consequences of exposure to blue-wavelength light are poorly understood. This study tested the hypothesis that evening blue-light exposure is associated with maternal fasting glucose and infant birthweight. Forty-one pregnant women (body mass index = 32.90 ± 6.35 kg/m2 ; 24-39 years old; 16 with gestational diabetes mellitus [GDM]) wore actigraphs for 7 days, underwent polysomnography, and completed study questionnaires during gestational week 30 ± 3.76. Infant birthweight (n = 41) and maternal fasting glucose (n = 30; range = 16-36 weeks) were recorded from the mothers' medical charts. Blue-light exposure was obtained from Actiwatch-Spectrum recordings. Adjusted and unadjusted linear regression analyses were performed to determine sleep characteristics associated with maternal fasting glucose and infant-birthweight. The mean fasting mid- to late-gestation glucose was 95.73 ± 24.68 mg/dl and infant birthweight was 3271 ± 436 g. In unadjusted analysis, maternal fasting glucose was associated with blue-light exposure (ß = 3.82, p = 0.03). In the final model of multiple linear regression for fasting glucose, evening blue-light exposure (ß = 4.00, p = 0.01) remained significant after controlling for gestational weight gain, parity, sleep duration, and GDM. Similarly, blue-light exposure was associated with infant birthweight (69.79, p = 0.006) in the unadjusted model, and remained significant (ß = 70.38, p = 0.01) after adjusting for weight gain, wakefulness after sleep onset, gestational age at delivery, and GDM. Higher blue-light exposure in pregnancy is associated with higher fasting glucose and infant birthweight. Reduced use of electronic devices before bedtime is a modifiable behavior.

Independent associations between sleep duration, gamma gap, and cognitive function among older adults: Results from the NHANES 2013-2014.

This study examined whether gamma gap mediated the association between sleep and cognitive function. Data from NHANES 2013-2014 were used. Three tests were used to measure cognitive function. Sleep was measured by three single questions. Gamma gap was calculated by subtracting albumin from total protein. Participants were 1392 older adults (53.2% females). Approximately 12% reported being told having sleep disorder, 1/3 reported having trouble sleeping, 25.9% had short sleep, and 12.5% had long sleep. Sleep disorders and sleep quality were not associated with cognitive function. Long sleep duration was an independent risk factor of reduced cognitive function on immediate recall, delayed recall, and executive function. Elevated gamma gap was also an independent risk factor of lower cognitive function. In a representative sample of older adults in the US, gamma gap and sleep duration were independent predictors of cognitive function. This study highlights the need for sleep assessment among older adults.

Feasibility of sleep extension and its effect on cardiometabolic parameters in free-living settings: a systematic review and meta-analysis of experimental studies.

AIMS: Inadequate sleep is a global health issue and has been associated with an increased risk for cardiovascular diseases. As a part of sleep hygiene, intentional lengthening of night-time sleep duration (i.e. sleep extension) might be a behavioural intervention to improve cardiometabolic health. To examine the feasibility of sleep extension and its effects on cardiometabolic parameters in free-living settings. METHODS AND RESULTS: This review was registered in PROSPERO (CRD42019146174). Five databases were searched. Only experimental studies conducted in adults without a diagnosis of sleep disorder were included. The pooled mean difference was calculated by the inverse variance method. Narrative summaries were also used. Thirteen studies from 11 trials were included. The intervention ranged from 3 days to 6 weeks. Sleep extension increased total sleep time by 51 min [95% confidence interval (CI) 39-63]. Overall, sleep extension did not result in significant changes in blood pressure. However, sub-group analysis revealed that when 24 h mean blood pressure was obtained among those with pre-hypertension or Stage 1 hypertension, sleep extension reduced systolic (weighted mean difference = -7.8 mm/Hg; 95% CI -10.6 to -4.9), and diastolic blood pressure (weighted mean difference = -4.2 mm/Hg; 95% CI -6.7 to -1.8). The pooled effects on fasting glucose and insulin resistance were not significant. The effect of sleep extension on other parameters (e.g. heart rate) was not consistent. CONCLUSION: Sleep extension is feasible and could increase sleep in free-living settings. Sleep extension shows promise for reducing 24 h mean blood pressure among those with pre-hypertension or hypertension. More large-scale studies are needed to examine its long-term effects.

Associations between Diet and Sleep Duration in Different Menopausal Stages.

This study aimed to determine which dietary factors were associated with habitual sleep duration in pre/peri- and post-menopausal women. Data from the 2007-2008 National Health and Nutrition Examination Survey were used (N = 1,783). Habitual sleep duration was categorized as very short (<5 h), short (5-6 h), normal (7-8 h), and long (≥9 h). Diet assessment was performed following validated procedures. In pre/peri-menopausal women (n = 1,116), controlling for the confounders, fewer number of foods, less intake of protein, carbohydrates, thiamin (B1), food folate, total choline, phosphorus, sodium, potassium, and selenium were significantly associated with a higher risk for very short sleep. Being on a low-salt diet was related to a lower risk for long sleep. In comparison, in post-menopausal women (n = 667), controlling for the confounders, more sugar intake, less intake of phosphorus and zinc were related to a higher risk for short sleep. There were novel associations between diet and sleep duration, particularly among pre/peri-menopausal women. Future research is needed to confirm those causal relationships.

Using Research Electronic Data Capture for Longitudinal Assessment Among Older Adults With Diabetes Enhances Real-Time Data Collection.

The aim of this study was to provide evidence on the application of Research Electronic Data Capture for collecting repeated data during a 7-day period among older adults. Fifty-seven adults (≥50 years) with type 2 diabetes were recruited. Participants completed one sleep diary upon awaking and one self-care diary before going to bed each day for 7 days. The diaries were administered via the Research Electronic Data Capture Web-based system and were completed via participants' own electronic devices. Objective compliance rate, time used to complete each diary, and participant experience were described. Approximately 80% (n = 45) of the participants used Research Electronic Data Capture. Among these participants, the noncompliance rate ranged between 0% and 8.9% for the sleep diary and 0% and 13.1% for the self-care diary. Participants spent 4.2 to 8.7 minutes on the sleep diary and 3.5 to 7.1 minutes on the self-care diary. It took the participants a longer time to complete the diaries during the first day than during the following 6 days. Few participants reported technical issues or felt inconvenient or stressful with completing the Research Electronic Data Capture diaries. Overall, the compliance rates were high. Completing the diaries was not time-consuming and participants were largely satisfied with the Research Electronic Data Capture data collection. Research Electronic Data Capture has aided the longitudinal data collection. With adequate training, Research Electronic Data Capture is an efficient tool to collect repeated data among older adults and thus is recommended for future research.

Fatigue and Sleep Quality Predict Eating Behavior Among People With Type 2 Diabetes.

BACKGROUND: People with Type 2 diabetes frequently report increased fatigue and sleep disturbance. These symptoms might put them at a higher risk for unhealthy eating behavior-detrimental to diabetes control. OBJECTIVES: The aim of the study was to examine the effect of fatigue and sleep on eating behavior in people with Type 2 diabetes by using a daily diary approach. METHODS: Data from 56 patients were collected during a baseline interview and an 8-day ambulatory assessment period in the free-living setting. Each day, participants completed one diary upon awakening to assess their sleep duration and sleep quality during the previous night and morning fatigue. They also completed one diary before going to bed to assess their eating behavior during the day (e.g., uncontrolled eating, cognitive restraint, emotional eating, and snacking). Data from 7 days were analyzed using generalized estimating equations. RESULTS: During the 7 days, controlling for age, gender, and body mass index, between-person fatigue was a significant predictor of uncontrolled eating, emotional eating, and snacking. Similarly, controlling for the covariates, between-person sleep quality was a significant predictor of uncontrolled eating and emotional eating. No associations were found between sleep duration and eating behavior. DISCUSSIONS: At the between-person level, reporting higher fatigue or poorer sleep quality was associated with higher levels of unhealthy eating behavior. Patients with Type 2 diabetes with high fatigue or poor sleep quality may require additional attention to support their healthy eating.

Relationships between objective sleep parameters and inflammatory biomarkers in pregnancy.

We examined the relationships between sleep and inflammatory biomarkers during late pregnancy. Seventy-four women underwent an overnight sleep assessment by polysomnography. Blood samples were collected before bedtime and again within 1 h upon awakening to measure C-reactive protein (CRP), interleukin (IL)-6, and IL-6 soluble receptor. Sleep parameters included variables characterizing sleep architecture and sleep continuity. The participants were 32.2 (SD = 4.1) years old, and the average gestational age was 32.8 (3.5) weeks. Controlling for covariates, evening CRP was negatively associated with N3 sleep (ß = -0.30, P = 0.010). N3 sleep was also negatively associated with morning CRP (ß = -0.26, P = 0.036), with a higher percentage of N3 sleep associated with a lower level of morning CRP. Contrarily, there was a tendency for a positive association between stage N2 sleep and morning CRP (ß = 0.23, P = 0.065). Stage N1 sleep was associated with morning IL-6 (ß = 0.28, P = 0.021), with a higher percentage of N1 sleep associated with a higher morning IL-6. No significant associations were found between morning inflammatory biomarkers and sleep continuity parameters. In conclusion, increased light sleep was associated with increased inflammatory biomarkers, whereas more deep sleep was associated with decreased inflammatory biomarkers. These findings further support the interactions between sleep and the immune system during late pregnancy.

Obstructive Sleep Apnea Is Associated with Newly Diagnosed Gestational Diabetes Mellitus.

Rationale: Sleep-disordered breathing (SDB) is associated with increased risk of adverse pregnancy outcomes, including gestational diabetes mellitus (GDM). GDM is a significant cause of maternal and infant morbidities. Assessing these risk factors concurrently may facilitate both the identification of women at GDM risk and the initiation of GDM prevention strategies.Objectives: To investigate whether SDB events, including SDB in rapid eye movement (REM) sleep and other sleep parameters, are associated with increased risk of GDM and to evaluate the performance of the models investigating associations between breathing and sleep parameters and GDM risk.Methods: In this case-control study, 46 women with newly diagnosed GDM and 46 healthy control subjects, who were individually matched for age, gestational age, body mass index, race, and parity, completed overnight polysomnographic studies and sleep questionnaires after being screened for GDM during the late-second to mid-third trimesters. Conditional logistic regression analysis was used to identify models investigating associations between risk factors and GDM risk. The Bayesian information criterion (BIC) was employed to compare models; the model with the lowest BIC is preferred.Results: Obstructive sleep apnea (OSA; defined as an apnea-hypopnea index [AHI] >5 events/h) was present in 22% of subjects with GDM and 9% of control subjects (P < 0.001). Women with OSA had a higher GDM risk (odds ratio [OR], 4.71; 95% confidence interval [CI], 1.05-21.04). In individual models, GDM risk was also significantly higher among women with higher overall AHI (events/h OR, 1.81; 95% CI, 1.01-3.27), higher AHI in REM (events/h OR, 2.09; 95% CI, 1.02-4.31), higher oxygen desaturation index greater than or equal to 4% (ODI4; events/h OR, 2.21; 95% CI, 1.03-4.73), and higher Sleep Apnea Symptom Score (OR, 2.72; 95% CI, 1.11-6.69). The percentage of non-REM sleep was significantly associated with decreased risk of GDM (percentage of non-REM sleep OR, 0.88; 95% CI, 0.78-0.99). The BIC supports the conclusion that there is a strong association between AHI in REM and GDM risk compared with the other significant models.Conclusions: SDB events, including REM-related OSA, are linked to increased GDM risk. GDM risk is also influenced by intercorrelated sleep variables.

A Screening Algorithm for Obstructive Sleep Apnea in Pregnancy.

Rationale: Obstructive sleep apnea (OSA) is common in pregnancy and associated with maternal and fetal complications. Early detection of OSA may have important implications for maternal-fetal well-being. A screening tool combining several methods of assessment may better predict OSA among pregnant women compared with tools that rely solely on self-reported information.Objectives: To develop a screening tool combining subjective and objective measures to predict OSA in pregnant women.Methods: This study is a secondary analysis using data collected from a completed cohort of pregnant women (n = 121 during the first and n = 87 during the third trimester). Participants underwent full polysomnography and completed the Multivariable Apnea Prediction Questionnaire. The Obstructive Sleep Apnea/Hypopnea Syndrome Score and Facco apnea predictive model were obtained. Logistic regression analysis and area under the curve (AUC) were used to identify models predicting OSA risk.Results: Participants' mean age was 27.4 ± 7.0 years. The prevalence of OSA during the first and third trimester was 10.7% and 24.1%, respectively. The final model predicting OSA risk consisted of body mass index, age, and presence of tongue enlargement. During the first trimester, the AUC was 0.86 (95% confidence interval [CI], 0.76-0.96). During the third trimester, the AUC was 0.87 (95% CI, 0.77-0.96). When the first-trimester data were used to predict third-trimester OSA risk, the AUC was 0.87 (95% CI, 0.77-0.97). This model had high sensitivity and specificity when used during both trimesters. The negative posttest probabilities (probability of OSA given a negative test result) ranged from 0.03 to 0.07.Conclusions: A new model consisting of body mass index, age, and presence of tongue enlargement provided accurate screening of OSA in pregnant women, particularly African-Americans. This tool can be easily and rapidly administered in busy clinical practices without depending on patients' awareness of experiencing apnea symptoms.

Objective sleep in pregnant women: a comparison of actigraphy and polysomnography.

OBJECTIVES: To compare different actigraphy scoring settings with polysomnography (PSG) for 1 night of total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep onset latency (SOL) in healthy pregnant women between 6 and 7 months of gestation. DESIGN: Secondary analysis using data from a case-control study. SETTING: A large university-affiliated hospital in the Midwestern United States. PARTICIPANTS: A total of 78 pregnant women were recruited, among which 38 healthy women with uncomplicated pregnancies were included for this analysis. MEASUREMENTS: Participants had an overnight PSG assessment at a sleep center while simultaneously wearing an actigraph (Minimitter; Philips Respironics, Andover, MA). Sleep parameters from both devices included TST, SE, WASO, and SOL. Four scoring settings were used to obtain these parameters from actigraphy. Bland-Altman tests were used to evaluate the agreement between sleep variables scored independently from actigraphy and PSG. RESULTS: The default scoring setting (10-by-40) yielded significantly different results from the PSG (P < .01). The 10 immobile/mobile minutes for sleep onset/end with an activity threshold of 10 (10-by-10) produced estimations of TST, SE, and WASO closest to those produced by PSG. When this setting was used, the mean differences between PSG- and actigraphy-assessed TST, SE, and WASO were -1.9 minutes, -0.4%, and 7.4 minutes. When the 10 and 15 immobile/mobile minutes for sleep onset/end were used, the difference between PSG- and actigraphy-assessed SOL was approximately 4 to 5 minutes. CONCLUSIONS: Findings from this study do not support the use of default actigraph settings in pregnant women. In contrast, the 10-by-10 scoring setting provided the greatest agreement and least bias in comparison with PSG for sleep measurements. The 10-by-10 scoring setting is recommended to be used in studies consisting of pregnant women.

Changes in Sleep Characteristics and Breathing Parameters During Sleep in Early and Late Pregnancy.

STUDY OBJECTIVES: Few studies have objectively evaluated sleep characteristics during pregnancy or investigated the relationship between altered spectral electroencephalogram (EEG) bands and sleep-disordered breathing (SDB). The study aimed to describe changes in sleep as measured by polysomnography (PSG) and spectral EEG bands during pregnancy and to examine the relationship between delta power in non-rapid eye movement (NREM) sleep and SDB. METHODS: This is a secondary analysis of a prospective study. One hundred twenty-three women underwent full PSG in early pregnancy, and 97 repeated PSG in late pregnancy. Spectral analysis of the EEG in NREM sleep was performed. We used linear and logistic mixed-model regression to analyze the sleep measures and linear regression to explore the association between delta power and apnea-hypopnea index (AHI) changes during pregnancy. RESULTS: In late pregnancy, women had shorter sleep duration, poorer sleep efficiency, more awakenings, more stage N2 sleep, less slow wave sleep, less REM sleep, higher AHI, and higher periodic limb movement index compared to early pregnancy. The percentage of stage N1 sleep, sleep latency, REM sleep latency, and arousal index frequency did not change. Regarding EEG-spectra, delta and theta powers decreased, but beta-2 power increased during pregnancy. In multivariable analyses, greater reduction of delta power was associated with larger increases in AHI (ß [95% confidence interval] = -0.038 [-0.073, -0.002], P = .040). Estimates suggest that each one-unit increase in AHI reduces delta power by 4% in late pregnancy. CONCLUSIONS: PSG-measured sleep characteristics change during pregnancy. Delta power decreases when the severity of SDB increases during pregnancy. COMMENTARY: A commentary on this article appears in this issue on page 1095.

Social and Behavioral Determinants of Perceived Insufficient Sleep.

Insufficient sleep is associated with cardiometabolic disease and poor health. However, few studies have assessed its determinants in a nationally representative sample. Data from the 2009 behavioral risk factor surveillance system were used (N = 323,047 adults). Insufficient sleep was assessed as insufficient rest/sleep over 30 days. This was evaluated relative to sociodemographics (age, sex, race/ethnicity, marital status, region), socioeconomics (education, income, employment, insurance), health behaviors (diet, exercise, smoking, alcohol), and health/functioning (emotional support, BMI, mental/physical health). Overall, insufficient sleep was associated with being female, White or Black/African-American, unemployed, without health insurance, and not married; decreased age, income, education, physical activity; worse diet and overall health; and increased household size, alcohol, and smoking. These factors should be considered as risk factors for insufficient sleep.

Sleep disordered breathing in pregnancy.

KEY POINTS: Sleep disordered breathing (SDB) is common and the severity increases as pregnancy progresses.Frequent snoring, older age and high pre-pregnancy body mass index (>25 kg⋅m(-2)) could be reliable indicators for SDB in early pregnancy.SDB screening tools, including questionnaires, used in the nonpregnant population have poor predictive ability in pregnancy.Accumulating evidence suggests that SDB during pregnancy may be associated with increased risk of adverse pregnancy outcomes, including gestational diabetes and pre-eclampsia. However, the results should be interpreted cautiously because several studies failed to adjust for potential maternal confounders and have other study limitations.There are no pregnancy-specific practice guidelines for SDB treatment. Many clinicians and practices follow recommendations for the treatment in the general population. Women with pre-existing SDB might need to be reassessed, particularly after the sixth month of pregnancy, because symptoms can worsen with nasal congestion and weight gain. EDUCATIONAL AIMS: To highlight the prevalence and severity of sleep disordered breathing (SDB) in the pregnant population.To inform readers about risk factors for SDB in pregnancy.To explore the impact of SDB on adverse maternal and fetal outcomes, and biological pathways for associated adverse maternal and fetal outcomes.To introduce current management options for SDB in pregnancy, including medical and behavioural approaches. Sleep disordered breathing (SDB) is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancy-related changes affecting the severity of SDB, the epidemiology and the risk factors of SDB in pregnancy, the association of SDB with adverse pregnancy outcomes, and screening and management options specific for this population.