August 26, 2026 | Academies & Associations, Obstructive Sleep Apnea

The American College of Chest Physicians (CHEST) has released a new clinical practice guideline addressing obstructive sleep apnea (OSA) and sleep-disordered breathing (SDB) during pregnancy.

The guideline provides nine evidence-based recommendations covering screening, diagnosis, treatment, and postpartum reassessment. It is intended to provide clinicians with more specific guidance. Previously, evidence and clinical recommendations in this area have been limited.

Key Takeaways

• The guideline provides nine recommendations for the management of OSA in pregnant patients.

• It addresses screening, diagnostic testing, treatment, and postpartum reassessment of sleep-disordered breathing.

• SDB during pregnancy has been associated with adverse outcomes affecting both the pregnant patient and fetus, including preterm birth, abnormal fetal growth, longer hospital stays, and increased neonatal intensive care admission.

• Because available evidence remains limited, all nine recommendations are conditional and based on very low-certainty evidence.

• The guideline emphasizes that sleep-disordered breathing should not simply be attributed to normal pregnancy-related symptoms and should remain on the radar of both patients and healthcare providers.

The full guideline, titled “Obstructive Sleep Apnea (OSA) in Pregnancy – An American College of Chest Physicians Clinical Practice Guideline,” was published in the journal CHEST.

According to the guideline authors, there has been a need for clearer clinical direction on identifying and managing SDB during pregnancy. This need includes when and how patients should be screened, which diagnostic approaches should be used, when treatment should be initiated, and whether patients should be reassessed after delivery.

“What I want most from this guideline is to put sleep-disordered breathing on the radar for pregnant patients and their providers,” said Carolyn D’Ambrosio, MD, FCCP, lead author of the guideline.

D’Ambrosio also emphasized that symptoms occurring during pregnancy may sometimes be dismissed as temporary consequences of pregnancy. However, sleep-disordered breathing can have important consequences for both the parent and fetus. She noted that some problems may also persist after delivery rather than automatically resolving postpartum.

Potential Pregnancy-Related Risks

The guideline notes that measures of sleep-disordered breathing have been associated with several adverse pregnancy and neonatal outcomes.

These include:

• Abnormal fetal growth

• Increased risk of neonatal intensive care unit admission

• Longer maternal hospital stays

• Congenital anomalies

• Preterm birth

However, the guideline also makes clear that the evidence supporting these associations and the recommended interventions remains limited. Consequently, each of the nine recommendations is classified as conditional, with a very low level of certainty in the available evidence.

The Nine Recommendations

1. Adjusting PAP therapy during pregnancy

For pregnant individuals who were already using CPAP for OSA before pregnancy, CHEST suggests using auto-adjusting positive airway pressure (APAP) rather than continuing fixed-pressure CPAP.

2. Screening for sleep-disordered breathing

The guideline suggests that pregnant individuals should be screened for sleep-disordered breathing.

3. Choice of screening tool

For pregnant individuals undergoing screening, CHEST suggests using either a pregnancy-specific screening tool or a standard sleep-disordered breathing screening tool.

4. Diagnostic testing

For pregnant individuals being evaluated for OSA, the guideline suggests that either home-based diagnostic testing or laboratory-based diagnostic testing may be used.

5. When treatment should be offered

For pregnant individuals diagnosed with OSA during pregnancy, treatment is suggested when the apnea-hypopnea index (AHI) is 5–15 events per hour. This applies if symptoms, consequences, comorbidities, or additional risk factors are present.

When the AHI is greater than 15 events per hour, PAP therapy is recommended regardless of whether symptoms or comorbidities are present.

6. PAP versus no treatment

When treatment is indicated, CHEST suggests using some form of positive airway pressure (PAP) therapy rather than no treatment.

7. PAP versus alternatives

For pregnant individuals with OSA for whom treatment is recommended, the guideline suggests PAP therapy rather than alternative treatment approaches.

8. Managing residual sleepiness

For pregnant individuals receiving PAP therapy for OSA diagnosed during pregnancy who continue to experience excessive sleepiness, the guideline suggests using scheduled naps whenever possible.

Stimulant medications should be considered only on an as-needed basis after scheduled naps have failed to adequately address the sleepiness.

9. Reassessment after delivery

For individuals who were diagnosed with OSA during pregnancy, CHEST suggests reassessment for sleep-disordered breathing during the postpartum period.

Why the Guideline Matters

Pregnancy produces substantial physiological changes that can affect breathing during sleep. Additionally, symptoms such as fatigue, daytime sleepiness, snoring, and disrupted sleep can easily be attributed to pregnancy itself.

The new CHEST guideline highlights the importance of considering sleep-disordered breathing when these symptoms occur and provides clinicians with a framework for deciding when screening, diagnostic evaluation, treatment, and follow-up may be appropriate.

At the same time, the very low certainty of evidence behind all nine recommendations is important. The guideline represents current expert guidance in an area where high-quality pregnancy-specific research remains limited.

The recommendation for postpartum reassessment is particularly significant. A diagnosis of OSA made during pregnancy should not necessarily be assumed to disappear after delivery. Continued or recurrent sleep-disordered breathing may warrant further evaluation and management.

Overall, the guideline brings greater attention to a potentially underrecognized condition during pregnancy and reinforces the importance of identifying and appropriately managing sleep-disordered breathing to support the health of both the pregnant patient and the developing fetus.