Jamillet Flores was used to feeling sleepy, a side-effect of medication she takes.
But a nurse observing her during a routine visit to Tampa General Hospital noticed the signs of what would turn out to be far more serious: Obstructive sleep apnea that stopped her breathing at least 100 times a night.
It's a condition most often associated with overweight men who snore so badly they keep their partners up. But obstructive sleep apnea can be an issue at any age, and either gender.
It's particularly serious when it happens to women like Flores, 34, who was four months pregnant when she was diagnosed in December after a sleep study.
New research from the University of South Florida has found that pregnant women with obstructive sleep apnea are five times more likely to die in the hospital during and shortly after pregnancy, compared with women without the disorder. The study also found that pregnant women with apnea also were more likely to suffer the severe complications of pregnancy, including severe high blood pressure, an enlarged heart and pulmonary blood clots.
The USF study is the first large-scale analysis of the association between sleep apnea and maternal deaths. Researchers reviewed hospital discharge data from 55 million pregnant women from 1998 to 2009.
Lead author Dr. Judette Louis said the common apnea warning signs in women like snoring, excessive daytime sleepiness, difficulty concentrating, depression and anxiety are often dismissed as normal during pregnancy, so the women seldom seek treatment.
"Had she not been in the hospital for that other condition (a blood disorder that sent her to Tampa General for treatment), she may not have been diagnosed and treated for apnea," said Louis, a researcher and assistant professor of obstetrics and gynecology at the USF Health Morsani College of Medicine. "Apnea is generally under-diagnosed in young, pregnant women. It's still thought of by many people as a disease of older, obese men. But it's not limited to them and it can be a very serious condition, particularly in pregnant women."
In the study, published in the journal Sleep, Louis and her team focused on women with a diagnosis of sleep apnea and pregnancy-related health complications. Of the three major causes of death during pregnancy, two are worsened by apnea — blood clots and pre-eclampsia, serious high blood pressure that can lead to seizures.
"The data is out there and it's very clear in the general population that if you have sleep apnea you are more likely to have heart disease, heart attacks, strokes, and are more likely to die early," said Louis. "We just never knew until now the true impact of apnea on young, pregnant women."
Louis hopes the study will encourage people to take sleep apnea seriously and get treatment, especially during pregnancy. She also hopes more physicians who care for pregnant women will talk with their patients about apnea.
For women who think they don't have time for a conventional sleep study, Louis noted that studies can be conducted at home so patients don't have to be away from their families overnight. Also, if a patient needs a CPAP (continuous positive airway pressure) machine for apnea, there is an alternative to the traditional mask that covers the mouth and nose; newer models sit in front of the nostrils.
She noted, though, that not a great deal is known about apnea during pregnancy .
"We know that in non-pregnant people CPAP saves lives,'' Louis said. "We don't know that yet for pregnant women because it hasn't been specifically studied, but we can say that more women with sleep apnea die while pregnant than those who don't have apnea."
CPAP, the gold standard apnea treatment, keeps airways open by blowing air through a hose connected to a face mask. As soon as she had her diagnosis, Flores started using a CPAP machine faithfully, even when napping during the day.
"It gave me peace of mind knowing I was getting proper oxygen for myself and for the baby," said Flores, who lives near Orlando.
Jonah was born on April 28 and spent several days in the neonatal intensive care unit at Tampa General because he had jaundice, a result of his mother's blood disorder. But now he's doing well, and his mother credits her medical team for recognizing her apnea.
"When it was time to go to the hospital for the delivery, the CPAP machine was one of the first things I put in the car,'' she said. "It has made such a difference."
Irene Maher can be reached at firstname.lastname@example.org.