OSA in Pregnancy: An American College of Chest Physicians Clinical Practice Guideline

OSA is associated with significant morbidity in pregnancy. Minimal guidance is available on how best to screen, diagnose, treat, and re-evaluate for OSA in pregnant patients. Considering the potentially adverse consequences of OSA in pregnancy if left untreated, we assembled a panel of experts to review the available literature methodologically and make evidence-based recommendations.

Rigorous methodology was applied to provide a trustworthy evidence-based guideline and expert panel report. Panelists developed key clinical questions using the population, intervention, comparator, and outcome (PICO) format, addressing specific topics in OSA in pregnant individuals. MEDLINE (via PubMed) and the Cochrane Library were searched systematically for relevant literature and were supplemented by manual searches. References were screened with study evaluation tools to assess for inclusion, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion.

PICO questions related to screening, diagnosis, treatment, and follow-up of OSA in pregnant patients resulted in 9 conditional recommendations made with the evidence available and with the consensus of the expert panel. We recommend screening pregnant patients for OSA, either with a pregnancy-specific screening questionnaire or a standard tool. For those at risk of OSA based on screening, either a home sleep test or in-laboratory polysomnography is recommended for diagnosis. We recommend treatment for those with an apnea-hypopnea index (AHI) of 5 to 15 who have symptoms and sequelae or comorbidities, or those with an AHI of ≥ 15 regardless of symptoms or comorbidities, preferably with autotitrating positive airway pressure. Additionally, scheduled naps may be beneficial as an initial step in alleviating residual symptoms. Reassessment of OSA in the postpartum period is recommended in some patients.

Because of the low level of certainty, 9 conditional recommendations were made for the screening, testing, and treatment of OSA in pregnancy.