CHEST Releases Pregnancy Guideline on Sleep-Disordered Breathing

Glencove, IL — The American College of Chest Physicians (CHEST) has issued a new clinical practice guideline addressing obstructive sleep apnea (OSA) during pregnancy, aiming to standardize how clinicians screen, diagnose, treat, and reassess sleep-disordered breathing (SDB) in pregnant patients. The guideline appears in CHEST®, delivering nine evidence-based, practice-oriented recommendations intended to improve consistency and decision-making in prenatal care.

OSA is increasingly linked with meaningful maternal and fetal morbidity, yet clinicians have lacked detailed guidance for managing SDB across pregnancy. This publication responds directly to that evidence gap by offering a structured approach that can be integrated into obstetric and sleep medicine workflows.

“This guideline puts sleep-disordered breathing on the radar for pregnant patients and their providers,” said Carolyn D’Ambrosio, MD, FCCP, lead author. She emphasized that pregnancy symptoms are sometimes dismissed as transient, even though disordered breathing can carry serious consequences for both parent and fetus—and may not resolve automatically after delivery.

The guideline notes that physiologic measures of SDB have been associated with adverse fetal growth outcomes, higher risk of neonatal intensive care unit (NICU) admission at birth, longer hospital stays, congenital anomalies, and preterm birth. These associations strengthen the clinical rationale for earlier identification and targeted management when indicated.

Because the supporting evidence is limited, all nine recommendations are conditional and rated at a very low level of certainty. Even so, the recommendations provide a practical framework for care, with clinicians encouraged to individualize decisions based on symptom burden and comorbid risk.

Key highlights include screening pregnant individuals for SDB, tailoring OSA treatment to severity thresholds (including an AHI range of 5–15 when symptoms or sequelae and relevant comorbidities are present, or AHI >15 alone), and performing postpartum reassessment in individuals previously diagnosed with OSA during pregnancy.

The full recommendation set is available through the CHEST Journal website in the article titled “Obstructive Sleep Apnea (OSA) in Pregnancy – An American College of Chest Physicians Clinical Practice Guideline.”