Objective-This prospective observational study explored the association of hypertensive disorders of pregnancy and small-for-gestational age (SGA) with obstructive sleep apnea (OSA) as determined by screening measures for OSA and sleep studies.Study Design-Two symptom-based screening questionnaires, the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS), were administered to enroll 1509 gravidae. Screen positive subjects were referred for polysomnography (PSG). The primary outcome was the occurrence of either gestational hypertension or preeclampsia.[a1]Generalized linear models (GLM) were used to estimate the relative risks of associations.Results-1157 subjects were available for outcomes analysis. Screening positive on the BQ was positively associated with hypertensive disorders in GLM models (aRR=1.90, 95%CI 1.52-2.37).Conclusion-In this large prospective trial, GLM modeling suggest that the BQ but not the ESS demonstrated significant association with measured adverse pregnancy outcomes, and specific items predicted these outcomes better than others. However, causative association of BQ with OSA cannot be assumed.

Objective We sought to ascertain the validity of two screening scales for obstructive sleep apnea (OSA) in pregnancy and to establish the prevalence of OSA in pregnancy. Study Design In this prospective observational study, two screening scales were administered. Screen positive subjects were referred for diagnostic polysomnography (PSG); if admitted for antepartum care, screen positive subjects underwent a modified study with a type 3 device (T3D). Result 1509 subjects underwent OSA screening; 58 completed diagnostic testing. Neither measure was a reliable diagnostic tool for OSA as determined by T3D or PSG (detection rates of 10.3% and 18.0%, respectively). Among screen positive subjects undergoing PSG or T3D testing, 15.5% ultimately met ‘gold standard’ OSA diagnostic criteria for an estimated point prevalence of 4.9%. Conclusion In this prospective trial, screening positive on the BQ or ESS was poorly predictive of OSA among gravidae and was associated with a high false referral rate.

Our data suggest that TEG values are significantly different in term, nonlaboring, healthy gravidae compared with nonpregnant reference values. Pooled means and standard deviations shown here may be considered for reference.

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