Scientific Investigations
Development of a Pregnancy-Specific Screening Tool for Sleep Apnea
http://dx.doi.org/10.5664/jcsm.2030
Francesca L. Facco, M.D.1; David W. Ouyang, M.D.2; Phyllis C. Zee, M.D., Ph.D.3; William A. Grobman, M.D., M.B.A.1
1Northwestern University, Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, IL; 2NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, Department of Obstetrics and Gynecology, Evanston, IL; 3Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, IL
Study Objective:
The Berlin Questionnaire and Epworth Sleepiness Scale (ESS) are commonly used to screen for sleep apnea in non-pregnant populations. We sought to evaluate the Berlin and ESS in pregnancy and to determine whether an alternative screening approach could better detect sleep apnea in pregnant women.
Methods:
Pregnant women at high risk for sleep apnea (women with chronic hypertension, pre-gestational diabetes, obesity, and/or a prior history of preeclampsia) completed a sleep survey composed of the Berlin and ESS, and participated in an overnight sleep evaluation with the Watch-PAT100 (WP100), a wrist-mounted device designed to diagnose sleep apnea, defined as an apnea hypopnea index ≥ 5. Using multivariable statistics, demographic, clinical, and subjective symptoms that were independently associated with sleep apnea were determined and a prediction rule for the presence of sleep apnea was developed. The predictive capacity of this newly developed system was compared to that of the Berlin and ESS using receiver-operating curve (ROC) statistics.
Results:
Of the 114 women who participated and had a valid WP100 study, 100 completed the Berlin and 96 the ESS. The Berlin and ESS did not accurately predict sleep apnea in this high-risk pregnancy cohort, with ROC area under the curves (AUC) of 0.54 (p = 0.6) and 0.57 (p = 0.3), respectively. Conversely, a model incorporating frequent snoring, chronic hypertension, age, and body mass index performed significantly better (AUC 0.86, p > 0.001).
Conclusion:
The Berlin and ESS are not appropriate tools to screen for sleep apnea in high-risk pregnant women. Conversely, our four-variable model more accurately predicts sleep apnea in pregnancy.
Citation:
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.
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