///2016 Abstract Details
2016 Abstract Details2019-07-15T10:10:51-05:00

Association between OSA screening questions, OSA status, and Pregnancy Outcomes

Abstract Number: T-15
Abstract Type: Original Research

Jennifer E Dominguez MD, MHS1 ; Mary Cooter MSc2; Ashraf S. Habib MBBCh, MSc, MHSc, FRCA3

BACKGROUND Recent studies have associated obstructive sleep apnea (OSA) with peripartum complications. However, identifying pregnant women with OSA is difficult given the poor reliability of available OSA screening tools. The purpose of this study is to develop a reliable screening tool to identify pregnant women at risk for OSA, and to study the peripartum outcomes of women with OSA. METHODS Recruitment started in March 2015 and is ongoing. Adult, pregnant subjects, 24-30 weeks GA and BMI > 40 kg.m-2, are recruited. Non-English speaking subjects, those with known OSA or chronic opioid use are excluded. 4 OSA screening tools: the Berlin (BQ) and STOP-BANG; Epworth Sleepiness Scale (ESS); and ASA checklist (ASAC) are collected with demographics and neck circumference (NC). Subjects undergo home polysomnography using ApneaLink Air™(ResMed Corp, Poway, CA, USA). The device reports Apnea-Hypopnea Index (AHI), flow-limited breathing, and oxygen-desaturation index (ODI) among other data. Pregnancy and neonatal outcomes are followed. Descriptive statistics were calculated for each questionnaire’s total score, as well as for each individual question in the study cohort and among those that experienced each event of interest [N (%), mean (SD), and median (Q1,Q3) for total scores]. RESULTS 41 subjects had responses and outcomes. 33/41 subjects had valid sleep studies. Invalid studies or less than 2 hrs were excluded. Mean(SD) age and GA for all subjects was 28.3(5.2) yrs and 29.2(5.2) wks. 27.3% of subjects were at-risk for OSA by home sleep study (AHI ≥ 5). Higher BMI was associated with AHI ≥ 5 (52.7 vs. 47.5 kg.m-2), but ages and GA were similar. Positive responses to OSA questions among women with AHI ≥ 5 vs. AHI < 5 are reported in Table 1. Women who endorsed loud snoring were more likely to develop PIH (25% vs. 13.8%). NC > 40 cm was associated with higher rates of PIH (83% vs. 37.9%). Loud snoring was more common in women with gestational diabetes mellitus (33.3% vs. 14.3%). Those who reported “falling asleep while driving” had a greater proportion of adverse fetal outcomes. CONCLUSIONS This small, observational, prospective study suggests that the incidence of OSA among obese, early third trimester gravidas may exceed 27%, as home studies tend to underestimate AHI. As suggested by others, while total scores may not predict OSA, elements of some of these questionnaires may be useful in predicting women at-risk for OSA, as well as pregnancy complications.

SOAP 2016