Screening methods for obstructive sleep apnoea in severely obese pregnant women

Abstract

Obstructive sleep apnoea (OSA) is an often-overlooked diagnosis, more prevalent in the obese population. Screening method accuracy, uptake and hence diagnosis is variable. There is limited data available regarding the obese pregnant population; however, many studies highlight potential risks of apnoeic episodes to mother and foetus, including hypertension, diabetes and preeclampsia. A total of 162 women with a body mass index (BMI) ≥ 35 were recruited from a tertiary referral hospital in the northwest of England. They were invited to attend three research antenatal clinics, completing an Epworth Sleepiness Scale (ESS) questionnaire at each visit. A monitor measuring the apnoea hypopnoea index (AHI) was offered at the second visit. Data taken from consent forms, hospital notes and hospital computer records were collated and anonymized prior to statistical analysis. A total of 12.1% of women had an ESS score of >10, suggesting possible OSA. Rates increased throughout pregnancy, although unfortunately, the attrition rate was high; 29.0% of women used the RUSleeping (RUS) meter, and only one (2.1%) met pre-specified criteria for OSA (AHI ≥ 15). This individual had OSA categorized as severe and underwent investigations for preeclampsia, eventually delivering by emergency caesarean section due to foetal distress. The accuracy of the ESS questionnaire, particularly the RUS monitor, to screen for OSA in the pregnant population remains unclear. Further research on a larger sample size using more user-friendly technology to confidently measure AHI would be beneficial. There are currently no guidelines regarding screening for OSA in the obese pregnant population, yet risks to both mother and foetus are well researched.

Health Technologies for Detecting High Risk Conditions in Pregnancy: A Systematic Review

“…To detect OSA, the researcher can use the Epworth sleepiness scale (ESS) questionnaire. The National Institute of Clinical Excellence (NICE) recommends the ESS questionnaire as a screening tool for non-pregnant populations too, with referral recommendation if symptoms are added to an ESS score of> 10 (Longworth et al, 2017). Pregnant women with obesity, have risks for various problems or diseases, so it should be considered and detected early.…”

Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy

“…9,35,36 The prevalence of OSA (apnea–hypopnea index of five or more events per hour) among pregnant people with obesity ranges from 2% to 24% in available studies. 9,35–41…”

“…9,35,36 The prevalence of OSA (apnea-hypopnea index of five or more events per hour) among pregnant people with obesity ranges from 2% to 24% in available studies. 9,[35][36][37][38][39][40][41] The evidence from studies of people with hypertensive disorders of pregnancy is more difficult to interpret given the heterogeneity of inclusion criteria (chronic hypertension, gestational hypertension, and preeclampsia) and timing of OSA testing during pregnancy. However, there is substantial evidence that people with hypertensive disorders of pregnancy are at higher risk of OSA.…”

Obstructive sleep apnea in pregnant women

“…The prevalence of OSA among obese pregnant women has been reported in several, small prospective studies and has ranged from 2% to 50%. Studies have been consistent in showing that OSA incidence increases with BMI and in the presence of other comorbidities 1–3,13,24,29–38…”

“…Studies have been consistent in showing that OSA incidence increases with BMI and in the presence of other comorbidities. [1][2][3]13,24,[29][30][31][32][33][34][35][36][37][38]…”