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Obstructive sleep apnea in pregnant women with chronic hypertension: A prospective observational cohort study
Abstract Number: F3D-459
Abstract Type: Original Research
BACKGROUND: Chronic hypertension (cHTN) is an important co-morbidity for obstructive sleep apnea (OSA). OSA is also associated with peripartum complications. Identifying pregnant women with OSA is difficult given the poor reliability of OSA screening tools. The purpose of this on-going study is to determine if pregnant women with cHTN are at significantly higher risk of having undiagnosed OSA than BMI-matched normotensive pregnant controls. Our secondary aim is to examine the predictive value of the OSA prediction score proposed by Facco et al.(1), the Berlin questionnaire, and the Epworth Sleepiness Scale in this cohort of second trimester pregnant women.
METHODS: After IRB approval, recruitment began in May 2017 and is ongoing. Two groups of adult gravidas between 10-20 weeks gestation are being recruited: 1) those with cHTN (on medication or elevated blood pressures documented on two clinic visits); 2) those with normal blood pressure, no treatment for/history of cHTN, and matched for BMI with the cHTN group (± 3 kg.m-2) to control for the effect of obesity on OSA diagnosis and cHTN. Target enrollment is 50 subjects/group. Exclusion criteria include: OSA therapy; opioid or alpha-blockers use (can interfere with the home sleep test); secondary HTN; or non-English speaking. Following informed consent, subjects answered a set of self-reported sleep questions and were followed for pregnancy outcomes. Subjects undergo home sleep testing using an FDA-approved WatchPAT™ device (Itamar Medical Ltd., Caesarea, Israel) during one night of sleep.
RESULTS: As of this time, 79 subjects have undergone home sleep testing (41 cHTN, 38 controls). All 79 subjects had valid sleep studies of more than 2 hours. Patient demographics, screening questionnaires, and home sleep test data are summarized in the Table. The prevalence of OSA among gravidas with cHTN is high compared to BMI-matched controls (63% vs. 34%). Among women with OSA, 58% of the cHTN group had moderate to severe OSA vs. 8% of the normotensive group.
CONCLUSIONS: Preliminary data from this ongoing, observational, prospective study suggest that cHTN is an important independent risk factor for OSA in pregnant women, and that OSA may be more severe when co-morbid with cHTN. We expect to present the completed study with statistical analysis at the SOAP meeting.
1. Facco FL, Ouyang DW, Zee PC, Grobman WA. Development of a pregnancy-specific screening tool for sleep apnea. J Clin Sleep Med. 2012;8(4):389-394.