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Published on: December 6, 2016
Obstructive sleep apnea in pregnancy: reliability of prevalence and prediction estimates
K M Antony1, A Agrawal2, M E Arndt1
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
Insights
Two common screening scales for obstructive sleep apnea (OSA) in pregnancy were found to be unreliable. These tools led to high false referral rates, indicating poor predictive value for diagnosing OSA in pregnant individuals.
Area of Science:
- Obstetrics and Gynecology
- Sleep Medicine
- Diagnostic Accuracy Studies
Background:
- Obstructive sleep apnea (OSA) is increasingly recognized as a complication during pregnancy.
- Accurate screening tools are needed to identify pregnant individuals at risk for OSA.
- Existing screening scales require validation in the pregnant population.
Purpose of the Study:
- To evaluate the diagnostic validity of two common screening scales for obstructive sleep apnea (OSA) in pregnant individuals.
- To determine the prevalence of OSA in this population.
Main Methods:
- A prospective observational study involving 1509 pregnant individuals screened for OSA.
- Screen-positive participants underwent diagnostic testing using polysomnography (PSG) or a type 3 device (T3D).
- Validity of screening scales was assessed against gold standard diagnostic criteria.
Main Results:
- Neither the Berlin questionnaire nor the Epworth Sleepiness Scale demonstrated reliable diagnostic capability for OSA in pregnancy.
- Detection rates for OSA were low (10.3% with T3D, 18.0% with PSG).
- The point prevalence of OSA among screen-positive individuals was estimated at 4.9%, with 15.5% meeting diagnostic criteria.
Conclusions:
- Screening positive for OSA using the Berlin questionnaire or Epworth Sleepiness Scale is poorly predictive in pregnant individuals.
- These screening tools are associated with a high rate of false referrals.
- Improved diagnostic strategies are needed for OSA in pregnancy.
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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