Elevated upper body position improves pregnancy-related OSA without impairing sleep quality or sleep architecture early after delivery

Sebastian Zaremba, Noomi Mueller, Anne M. Heisig, Christina H. Shin, Stefanie Jung, Lisa R. Leffert, Brian T. Bateman, Lori J. Pugsley, Yasuko Nagasaka, Ingrid Moreno Duarte, Jeffrey L. Ecker, Matthias Eikermann

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Background: During pregnancy, upper airway resistance is increased, predisposing vulnerable women to pregnancy-related OSA. Elevation of the upper body increases upper airway cross-sectional area (CSA) and improves severity of OSA in a subgroup of nonpregnant patients (positional-dependent sleep apnea). We tested the hypothesis that elevated position of the upper body improves OSA early aft er delivery. METHODS: Following institutional review board approval, we conducted a randomized, crossover study on two postpartum units of Massachusetts General Hospital. Women during the first 48 h aft er delivery were included. Polysomnography was performed in nonelevated and 45° elevated upper body position. Upper airway CSA was measured by acoustic pharyngometry in nonelevated, 45° elevated, and sitting body position. Results: Fift y-five patients were enrolled, and measurements of airway CSA obtained. Thirty patients completed polysomnography in both body positions. Elevation of the upper body significantly reduced apnea-hypopnea index (AHI) from 7.7 ± 2.2/h in nonelevated to 4.5 ± 1.4/h in 45° elevated upper body position ( P = .031) during sleep. Moderate to severe OSA (AHI . 15/h) was diagnosed in 20% of postpartum patients and successfully treated by elevated body position in one-half of them. Total sleep time and sleep architecture were not affected by upper body elevation. Change from nonelevated to sitting position increased inspiratory upper airway CSA from 1.35 ± 0.1 cm 2 to 1.54 ± 0.1 cm 2 during wakefulness. Positiondependent increase in CSA and decrease in AHI were correlated ( r = 0.42, P = .022). Conclusions: Among early postpartum women, 45° upper body elevation increased upper airway CSA and mitigated sleep apnea. Elevated body position might improve respiratory safety in women early aft er delivery.

Original languageEnglish (US)
Pages (from-to)936-944
Number of pages9
Issue number4
StatePublished - Oct 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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