Dr. Chapa’s Clinical Pearls, September 18, 2025

Episode: OB? Get Your ZZZZs: Insomnia’s Effects on Pregnancy

Episode Overview

This episode dives into the impact of insomnia and sleep disorders, especially in the context of pregnancy. Dr. Chapa discusses a new JAMA Network Open publication highlighting the associations between sleep disturbances—particularly insomnia and obstructive sleep apnea (OSA)—and a spectrum of adverse maternal and fetal outcomes. The focus is on practical screening strategies, interpreting the clinical implications of recent data, and sharing actionable tips for improving sleep hygiene among pregnant patients.

Target Audience: Medical students, residents, and healthcare providers in women’s health.

Key Discussion Points & Insights

Importance of Sleep in Pregnancy

• Emphasizes that adults require 7–9 hours of restorative sleep; lack of sleep impedes physical and mental health (00:48).
• Sleep allows the brain and body to reset and decompress; chronic deprivation leads to dysfunction and stress.

Background on Sleep Disorders in Pregnancy

• Historical context: Two years ago (May 2023), the podcast covered OSA in pregnancy and its screening importance, particularly in patients with high BMI (03:20).
  • Quote: “We should potentially ask about obstructive sleep apnea, especially in high risk patients, meaning those with an obese BMI.” (05:10)
• Cites consensus guidelines (July 2023) advocating CPAP as safe in pregnancy, though evidence is mixed on its ability to reduce adverse obstetrical outcomes (06:54).
  • Quote: “CPAP, even though we don’t have a lot of data, definitely advised for obstructive sleep apnea in pregnancy.” (07:55)
• Stresses that no validated OSA screening tool exists specifically for pregnancy; recommends using clinical history and partner reports as practical approaches (11:21).
  • Quote: “Ask, what do people say about you when you’re sleeping? That’s the easiest way.” (11:34)

The New Study on Insomnia’s Impact

• Publication: "Ischemic Placental Disease and Severe Morbidity in Pregnant Patients with Sleep Disorders," JAMA Network Open, Sept 16, 2025.
• Study Type: Retrospective, cross-sectional, data mining using ICD-9/10 codes in California; focus on singleton births (15:08, 17:47).
• Limitations: Coding errors, selection and recall bias, and lack of placental pathology data (15:08).
  • Quote: “It’s a data bank search using ICD codes… a lot of selection bias and recall bias and incorrect coding that goes into this.” (15:08)

Key Findings: Associations with Insomnia and OSA

• Both insomnia and OSA are linked with increased risk for adverse pregnancy outcomes:
  • Adjusted Relative Risks (ARR):
    • Insomnia: ARR for any placental insufficiency: 1.42
    • OSA: ARR for any placental insufficiency: 1.57 (18:24)
  • For severe specific morbidities, insomnia alone associated with striking relative risks (though with small absolute risk increases):
    • Disseminated intravascular coagulation: 2.38
    • Cerebrovascular disorder: 4.23
    • Sepsis: 2.6
    • Shock: 3.61
    • Thrombotic embolism: 3.72
    • Hysterectomy: 3.02 (18:50)
  • Quote: “Even insomnia, guys, is not benign.” (19:44)

Contextualizing Night Shift Work

• Though not addressed in the current publication, Dr. Chapa discusses meta-analyses linking night shift work (altered circadian rhythm) to a mild-to-moderate rise in adverse outcomes (gestational hypertension, preeclampsia, SGA, preterm birth) (13:27).
  • Odds ratios for night shift work typically in the 1.2–1.3 range (20–30% increase), but no universal recommendation against night shift for pregnant workers (13:45).
  • Quote: “If you are a G4 P3 and… all preterm… and you’re working night shift, that’s potentially a modifiable issue.” (14:09)
  • Personalized risk assessment is key (14:18).

Take-Home Recommendations for Clinicians

• Three Key Steps:
  1. Ask about sleep hygiene (15:44)
  2. Screen for OSA, especially in high-BMI patients
  3. Inquire about insomnia and night shift work, and stress self-care to patients (15:53)
• “Sleep hygiene is a big deal.” (15:59)

Actionable Insomnia Management

• Melatonin: Generally safe for brief, occasional use (with some concerns if overused regarding fetal neurodevelopment) (26:06).
• Cognitive behavioral therapy (CBT) specific for insomnia is effective and safe.
• Relaxation techniques, including magnesium/Epsom salt baths, promote rest and are pregnancy-safe (26:22).
  • Quote: “All of those things are perfectly safe, as is melatonin when used correctly.” (26:34)

Notable Quotes & Memorable Moments

• “Every good, well-designed machine needs its downtime… same thing with the body and the brain.” (01:23)
• “Obstructive sleep apnea is, without a question, linked to adverse pregnancy outcomes… because the body is under this chronic oxidative stress.” (05:38)
• “Insomnia, according to this brand new publication, not just obstructive sleep apnea, but even insomnia just by itself is also linked to some increased perinatal morbidity.” (09:07)
• “There is insufficient evidence to recommend universal restriction of night shift work in pregnancy, but individualization of risk assessment is warranted.” (14:18, citing 2019 Gray Journal meta-analysis)
• “Compared with patients without either sleep disorder, the adjusted risk ratio was higher for patients with insomnia than it was for obstructive sleep apnea [for certain outcomes].” (20:02)
• “Ask patients about sleep. Ask patients about obstructive sleep apnea… have appropriate time to recoup that rest so their body can try to reset.” (25:00)
• “Ways to treat insomnia… melatonin can be useful… relaxation technique seems to help… cognitive behavioral therapy… magnesium sulfate bath… all perfectly safe.” (26:06–26:34)

Segment Timestamps

• [00:48] – Introduction: The necessity of restorative sleep
• [03:20] – Recap: Past episodes on OSA and screening guidelines
• [09:07] – Breaking news: New study on insomnia and pregnancy outcomes
• [11:21] – Practical OSA screening tips in pregnancy
• [13:27] – Night shift work, circadian rhythm, and pregnancy: The additional risk context
• [15:08] – Study deep-dive: Study methods, results, and limitations
• [18:24] – Key findings: Relative risks for insomnia and OSA
• [19:44] – Detailed relative risk numbers for specific morbidities
• [25:00] – Author conclusions and clinical takeaways
• [26:06] – Safe strategies for managing insomnia in pregnancy

Summary Table: Sleep Disorders in Pregnancy and Associated Risks

| Sleep Disturbance | ARR (Any Placental Insufficiency) | Notable Severe Risks (Relative Risk) | |-----------------------|-----------------------------------|--------------------------------------------------------------------------------------------------------| | Night Shift Work | 1.2–1.3 (meta-analysis) | SGA, preterm birth, gestational hypertension (mild-moderate risk) | | Insomnia | 1.42 | DIC (2.38), CVD (4.23), Sepsis (2.6), Shock (3.61), Thromboembolism (3.72), Hysterectomy (3.02) | | Obstructive Sleep Apnea| 1.57 | Similar/adverse outcomes, but highest overall risk among the three disorders discussed |

Practical Takeaways (Clinician Focus)

• Screen all pregnant patients—not just for OSA, but also for insomnia and discuss night shift work.
• Remember risk continuum: Night shift (mild) → Insomnia (moderate) → OSA (most problematic).
• Promote sleep hygiene and recovery time for all, especially night shift workers and those with poor sleep.
• Management: Melatonin in moderation, relaxation, CBT, and behavioral approaches are safe in pregnancy.

Conclusion

Dr. Chapa reiterates that sleep disorders in pregnancy—particularly insomnia and OSA—deserve attention as potential contributors to obstetric morbidity. While absolute risks remain low, relative hazards are meaningful enough to advocate for regular screening, patient education, and individualized interventions. In sum: “OB, you need your Z’s!” (09:13), and so do your patients.

End of Summary
(All timestamps MM:SS are approximate based on transcript extract.)