We thank Mr Reichmann for his interest in our recent article that demonstrated an association between pregnancy-onset sleep-disordered breathing (SDB) and elevated maternal blood pressure. We agree that, although intervention trials clearly are warranted and we have such a trial currently underway, these should not target hypertensive women exclusively. As in any other population, SDB in pregnant women should be treated. However, whether standard adult criteria for sleep apnea should be used remains unknown. Even in pregnant women without evidence of sleep apnea by standard criteria, airflow limitation is associated with increased systemic arterial blood pressure, which is reduced in response to CPAP treatment. Large trials of both maternal and fetal outcomes are needed to determine the threshold of SDB that requires intervention in this population.

Furthermore, the impact of untreated SDB during pregnancy may extend beyond maternal health. Substantial evidence supports the hypothesis that an adverse in utero environment plays a role in fetal programming and thus the future health of the offspring. It is therefore plausible that maternal SDB may impact not only the newborn infant but also the long-term health of the child. Consequently, the opportunity to treat SDB during pregnancy has the potential to influence the health of the next generation.

We agree with Mr Reichmann that it is a challenge to deliver CPAP to pregnant women in a timely manner. More importantly, before a patient can be treated, she must first be identified, which poses a particular problem because few obstetric health care providers screen women for SDB. Even if all pregnant women were screened for symptoms of SDB, it would not be practical for all snoring women to undergo polysomnography for diagnostic purposes because of the anticipated large number. One key area of future research is therefore to develop a pregnancy-specific screening tool that has high sensitivity and specificity to identify those women who are at the highest risk of adverse pregnancy outcomes.