Validation of obstructive sleep apnea questionnaires in high-risk pregnancy

Obstructive sleep apnea (OSA) is an underrecognized risk factor for pregnancy complications. Sleep questionnaires vary in their ability to predict pregnant patients at risk for OSA. We aimed to assess the fidelity of the DoISnorePreg questionnaire, compare its performance with the Berlin Questionnaire, and assess the impact of the Epworth Sleepiness Scale in high-risk obstetric patients.

Patients without history of preeclampsia or gestational diabetes were recruited from a high-risk obstetric clinic, completed sleep questionnaires, and underwent a home sleep apnea test at 28 weeks of gestation. Patients were followed through pregnancy to assess maternal and neonatal outcomes. The predictive value of the questionnaires for OSA was assessed using C-statistics.

Thirty-nine percent of participants had an apnea-hypopnea index ≥ 5, among whom 29% had moderate or severe OSA. Patients with OSA had higher body mass indexes, older ages, higher sleepiness scores, more profound oxygen desaturations, longer postpartum lengths of stay, and newborns with increased neonatal intensive care unit admissions. DoISnorePreg outperformed the Berlin Questionnaire with an area under the receiver operating curve of 0.74 vs 0.58. The Epworth Sleepiness Scale did not enhance the performance of either questionnaire. A threshold of ≥ 4 positive responses on DoISnorePreg best predicted patients at risk for OSA with 89% sensitivity and 43% specificity (P < .01).

Prevalence of OSA among high-risk obstetric patients is high. Clinical implications of oxygen desaturations, longer hospital stays, and neonatal intensive care unit admissions highlight the need for screening. DoISnorePreg is a valid predictive tool that helps fill a gap in screening this high-risk population.

Sheehan KN, Xiang KR, Rowland CL, et al. Validation of obstructive sleep apnea questionnaires in high-risk pregnancy. J Clin Sleep Med. 2025;21(12):2155-2163.