Sleep Disorders During Pregnancy: Mechanisms, Maternal-Fetal Outcomes, and Clinical Approach
Abstract
Introduction: Sleep disorders are highly prevalent during pregnancy and include alterations in sleep duration, quality, and continuity, as well as specific conditions such as insomnia, obstructive sleep apnea, and restless legs syndrome. Their prevalence increases throughout pregnancy and may adversely affect both maternal and fetal health through multiple biological mechanisms.
Objective: To summarize current scientific evidence regarding the pathophysiological mechanisms, epidemiology, maternal-fetal outcomes, clinical assessment, and management of sleep disorders during pregnancy.
Methods: A narrative review was conducted following SANRA quality criteria. Literature published between 2019 and 2026 was retrieved from PubMed, Web of Science, Scopus, and SciELO, including systematic reviews, meta-analyses, prospective cohorts, multicenter studies using polysomnography, intervention protocols, and clinical reviews. Evidence was synthesized according to sleep physiology, epidemiology, specific sleep disorders, obstetric and perinatal outcomes, mental health, and prenatal care recommendations.
Results: Current evidence indicates that sleep fragmentation, intermittent hypoxia, sympathetic activation, systemic inflammation, endothelial dysfunction, and insulin resistance are plausible mechanisms linking sleep disorders with gestational diabetes, gestational hypertension, preeclampsia, cesarean delivery, preterm birth, and perinatal depression. Evidence regarding low birth weight and fetal growth restriction remains inconsistent. Screening using validated instruments, combined with non-pharmacological interventions and cognitive behavioral therapy for insomnia, represents the preferred first-line management approach.
Conclusions: Sleep disorders are common and clinically important during pregnancy and represent potentially modifiable risk factors. Routine sleep screening during prenatal care, together with timely diagnosis and individualized management, may improve maternal and neonatal outcomes. Additional longitudinal studies, particularly in Latin American populations, are warranted.
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References
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