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Obstructive sleep apnea in pregnancy: reliability of prevalence and prediction estimates

Journal of Perinatology volume 34, pages 587–593 (2014)Cite this article

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Abstract

Objective:

We sought to ascertain the validity of two screening scales for obstructive sleep apnea (OSA) in pregnancy and to establish the prevalence of OSA in pregnancy.

Study Design:

In this prospective observational study, two screening scales were administered. Screen positive subjects were referred for diagnostic polysomnography (PSG); if admitted for antepartum care, screen positive subjects underwent a modified study with a type 3 device (T3D).

Result:

A total of 1509 subjects underwent OSA screening; 58 completed diagnostic testing. Neither measure was a reliable diagnostic tool for OSA as determined by T3D or PSG (detection rates of 10.3% and 18.0%, respectively). Among screen positive subjects undergoing PSG or T3D testing, 15.5% ultimately met ‘gold standard’ OSA diagnostic criteria for an estimated point prevalence of 4.9%.

Conclusion:

In this prospective trial, screening positive on the Berlin questionnaire or Epworth sleepiness scale was poorly predictive of OSA among gravidae and was associated with a high false referral rate.

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References

  1. Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP . Pathophysiology of sleep apnea. Physiol Rev 2010; 90 (1): 47–112.

    Article  CAS  Google Scholar 

  2. Lurie A . Obstructive sleep apnea in adults: epidemiology, clinical presentation, and treatment options. Adv Cardiol 2011; 46: 1–42.

    Article  Google Scholar 

  3. Iber C, Ancoli-Israel S, Chesson A, Quan SF . The AASM Manual for the Score of Sleep and Associated Events: Rules, Terminology, and Technical Specifications 1st edn Westchester, Illinois: American Academy of Sleep Medicine, 2007.

    Google Scholar 

  4. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP . Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999; 131 (7): 485–491.

    Article  CAS  Google Scholar 

  5. Johns MW . A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14 (6): 540–545.

    Article  CAS  Google Scholar 

  6. Johns MW . Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the epworth sleepiness scale: failure of the MSLT as a gold standard. J Sleep Res 2000; 9 (1): 5–11.

    Article  CAS  Google Scholar 

  7. Sharma SK, Vasudev C, Sinha S, Banga A, Pandey RM, Handa KK . Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome. Indian J Med Res 2006; 124 (3): 281–290.

    CAS  PubMed  Google Scholar 

  8. Olivarez SA, Maheshwari B, McCarthy M, Zacharias N, van den Veyver I, Casturi L et al. Prospective trial on obstructive sleep apnea in pregnancy and fetal heart rate monitoring. Am J Obs Gynecol 2010; 202 (6): 552 e1–552 e7.

    Article  Google Scholar 

  9. Facco FL, Ouyang DW, Zee PC, Grobman W A . Development of a pregnancy-specific screening tool for sleep apnea. J Clin Sleep Med 2012; 8 (4): 389–394.

    PubMed  PubMed Central  Google Scholar 

  10. Wilson DL, Walker SP, Fung AM, O’Donoghue F, Barnes M, Howard M . Can we predict sleep-disordered breathing in pregnancy? The clinical utility of symptoms. J Sleep Res 2013; 22 (6): 670–678.

    Article  Google Scholar 

  11. Bourjeily G, Raker CA, Chalhoub M, Miller MA . Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing. Eur Respir J. 2010; 36 (4): 849–855.

    Article  CAS  Google Scholar 

  12. Olivarez SAA, Ferres M, Antony K, Mattewal A, Maheshwari B, Sangi-haghpeykar H et al. Obstructive sleep apnea screening in pregnancy, perinatal outcomes, and impact of maternal obesity. Am J Perinatol 2011; 28 (8): 651–658.

    Article  Google Scholar 

  13. Louis JM, Auckley D, Sokol RJ, Mercer BM . Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy. Am J Obs Gynecol 2010; 202 (3): 261 e1–261 e5.

    Article  Google Scholar 

  14. Chen YH, Kang JH, Lin CC, Wang IT, Keller JJ, Lin HC . Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J Obs Gynecol 2012; 206 (2): 136 e1–5.

    Article  Google Scholar 

  15. Sahin FK, Koken G, Cosar E, Saylan F, Fidan F, Yilmazer M et al. Obstructive sleep apnea in pregnancy and fetal outcome. Int J Gynaecol Obstet 2008; 100 (2): 141–146.

    Article  Google Scholar 

  16. Sahota PK, Jain SS, Dhand R . Sleep disorders in pregnancy. Curr Opin Pulm Med 2003; 9 (6): 477–483.

    Article  Google Scholar 

  17. Izci B, Riha RL, Martin SE, Vennelle M, Liston WA, Dundas KC et al. The upper airway in pregnancy and pre-eclampsia. Am J Respir Crit Care Med 2003; 167 (2): 137–140.

    Article  Google Scholar 

  18. Pilkington S, Carli F, Dakin MJ, Romney M, De Witt KA, Dore CJ et al. Increase in Mallampati score during pregnancy. Br J Anaesth 1995; 74 (6): 638–642.

    Article  CAS  Google Scholar 

  19. Rosenthal LD, Dolan DC . The Epworth sleepiness scale in the identification of obstructive sleep apnea. J Nerv Ment Dis 2008; 196 (5): 429–431.

    Article  Google Scholar 

  20. Guilleminault C, Kreutzer M, Chang JL . Pregnancy, sleep disordered breathing and treatment with nasal continuous positive airway pressure. Sleep Med 2004; 5 (1): 43–51.

    Article  Google Scholar 

  21. Connolly G, Razak AR, Hayanga A, Russell A, McKenna P, McNicholas WT . Inspiratory flow limitation during sleep in pre-eclampsia: comparison with normal pregnant and nonpregnant women. Eur Respir J. 2001; 18 (4): 672–676.

    Article  CAS  Google Scholar 

  22. Nigro CA, Serrano F, Aimaretti S, Gonzalez S, Codinardo C, Rhodius E . Utility of ApneaLink for the diagnosis of sleep apnea-hypopnea syndrome. Med (B Aires) 2010; 70 (1): 53–59.

    Google Scholar 

  23. Antony KM, Agrawal A, Arndt ME, Murphy AM, Alapat PM, Guntupalli KK et al. Association of adverse perinatal outcomes with screening measures of obstructive sleep apnea. J Perinatol Press 2014; 28: 651–658.

    Google Scholar 

  24. Pepe MS, Etzioni R, Feng Z, Potter JD, Thompson ML, Thornquist M et al. Phases of biomarker development for early detection of cancer. J Natl Cancer Inst 2001; 93 (14): 1054–1061.

    Article  CAS  Google Scholar 

  25. Franklin KA, Holmgren PA, Jonsson F, Poromaa N, Stenlund H, Svanborg E . Snoring, pregnancy-induced hypertension, and growth retardation of the fetus. Chest 2000; 117 (1): 137–141.

    Article  CAS  Google Scholar 

  26. Facco FL, Kramer J, Ho KH, Zee PC, Grobman WA . Sleep disturbances in pregnancy. Obs Gynecol 2010; 115 (1): 77–83.

    Article  Google Scholar 

  27. Hutchison BL, Stone PR, McCowan LME, Stewart AW, Thompson JMD, Mitchell E a . A postal survey of maternal sleep in late pregnancy. BMC Pregnancy and Childbirth 2012; 12 (1): 144.

    Article  Google Scholar 

  28. Schiza SE, Bouloukaki I, Mermigkis C, Bourjeily G, El Sabbagh R, Sawan P et al. Epworth sleepiness scale scores and adverse pregnancy outcomes. Sleep Breath 2013; 17 (4): 1125–1126.

    Article  Google Scholar 

  29. Edwards N, Blyton DM, Kirjavainen TT, Sullivan CE . Hemodynamic responses to obstructive respiratory events during sleep are augmented in women with preeclampsia. Am J Hypertens 2001; 14 (11 Pt 1): 1090–1095.

    Article  CAS  Google Scholar 

  30. Guilleminault C, Palombini L, Poyares D, Takaoka S, Huynh NT, El-Sayed Y . Pre-eclampsia and nasal CPAP: part 1. Early intervention with nasal CPAP in pregnant women with risk-factors for pre-eclampsia: preliminary findings. Sleep Med 2007; 9 (1): 9–14.

    Article  Google Scholar 

  31. Poyares D, Guilleminault C, Hachul H, Fujita L, Takaoka S, Tufik S et al. Pre-eclampsia and nasal CPAP: part 2. Hypertension during pregnancy, chronic snoring, and early nasal CPAP intervention. Sleep Med 2007; 9 (1): 15–21.

    Article  Google Scholar 

  32. Oktay B, Rice TB, Atwood CW Jr., Passero M Jr., Gupta N, Givelber R et al. Evaluation of a single-channel portable monitor for the diagnosis of obstructive sleep apnea. J Clin Sleep Med 2011; 7 (4): 384–390.

    PubMed  PubMed Central  Google Scholar 

  33. Ralls FM, Grigg-Damberger M . Roles of gender, age, race/ethnicity, and residential socioeconomics in obstructive sleep apnea syndromes. Curr Opin Pulm Med 2012; 18 (6): 568–573.

    Article  Google Scholar 

  34. O’Brien LM, Bullough AS, Shelgikar A V, Chames MC, Armitage R, Chervin RD . Validation of Watch-PAT-200 against polysomnography during pregnancy. J Clin Sleep Med 2012; 8 (3): 287–294.

    PubMed  PubMed Central  Google Scholar 

  35. Louis J, Auckley D, Miladinovic B, Shepherd A, Mencin P, Kumar D et al. Perinatal outcomes associated with obstructive sleep apnea in obese pregnant women. Obs Gynecol 2012; 120 (5): 1085–1092.

    Google Scholar 

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Acknowledgements

We thank Lata Casturi, RPGST at Baylor College of Medicine; ResMed for the use of the ResMed ApneaLink devices; and staff and nurses at Casa de Amigos, People’s Health Center and Ben Taub General Hospital Obstetrics Clinic and Antepartum Unit. KM Aagaard was supported by a DP2 award (DP21DP2OD001500-01 NIH Director New Innovator Award). This study was financially supported by the Baylor College of Medicine Department of Obstetrics and Gynecology Resident Research Grant 2011-2012 (to KM Antony). ResMed donated single-use nasal cannulas and oximeter sensors for this study.

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Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA

    K M Antony, M E Arndt, A M Murphy & K M Aagaard

  2. School of Medicine, University of Texas Health Science Center, Houston, TX, USA

    A Agrawal

  3. Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA

    P M Alapat & K K Guntupalli

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  1. K M Antony
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Correspondence to K M Aagaard.

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Antony, K., Agrawal, A., Arndt, M. et al. Obstructive sleep apnea in pregnancy: reliability of prevalence and prediction estimates. J Perinatol 34, 587–593 (2014). https://doi.org/10.1038/jp.2014.48

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