Abstract
<title>Abstract</title> <p>Obstructive sleep apnea (OSA) has been associated with adverse metabolic and obstetric outcomes during pregnancy, but prospective evidence from Middle Eastern populations remains limited. This prospective cohort study investigated the association between OSA and maternal and neonatal outcomes among young pregnant women in Oman. Omani women aged ≤ 35 years with singleton low-risk pregnancies were recruited before 24 weeks' gestation from Sultan Qaboos University Hospital and Ministry of Health primary healthcare centres between January 2021 and April 2024. OSA was assessed using level III home sleep apnea testing and classified according to the apnea–hypopnea index (AHI). Daytime sleepiness was evaluated using the Epworth Sleepiness Scale, and participants were followed until delivery. Maternal and neonatal outcomes were extracted from medical records and analysed using multivariable regression models. Among 429 women who completed the study, 42.2% had OSA (AHI ≥ 5 events/hour). Gestational diabetes mellitus (GDM) occurred in 28.2% of participants and was the only pregnancy outcome significantly associated with OSA (p = 0.031). No significant associations were found between OSA and gestational hypertension, preterm birth, fetal growth restriction, cesarean delivery, low birth weight, Apgar score, or neonatal intensive care unit admission. Third-trimester body mass index and AHI independently predicted HbA1c levels (F = 4.199, p = 0.006; R² = 0.030). OSA was common and independently associated with GDM, supporting consideration of OSA screening during pregnancy, particularly among women at increased risk of GDM.</p>