The Challenge of Screening for Obstructive Sleep Apnea in Pregnancy

Malhamé, Isabelle; Bublitz, Margaret H.; Bourjeily, Ghada

doi:10.1513/annalsats.201907-507ed

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…Commonly used screening tools for SDB in the general population (e.g., Berlin Questionnaire, STOP-BANG, and Epworth Sleepiness Scale) do not accurately identify SDB in women during pregnancy. [35][36][37] These tools, based primarily on symptoms typical in men (e.g., excessive daytime sleepiness), include items likely not predictive of SDB in women and exclude symptoms commonly reported by women, such as fatigue, anxiety, and depression. A few studies have aimed to develop a predictive screening tool in pregnancy.…”

Section: Mechanisms Contributing To Sdb In Pregnancymentioning

confidence: 99%

Sleep-Disordered Breathing and Pregnancy-Related Cardiovascular Disease

Laposky

Pemberton

2021

Journal of Women's Health

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Sleep-disordered breathing (SDB) is a serious medical condition characterized by intermittent episodes of airflow limitation, intermittent hypoxia, and sleep disturbance triggering a pattern of autonomic dysfunction associated with hypertension, diabetes, and other adverse health conditions. SDB incidence is two to three times higher during pregnancy and is associated with an increased risk of cardiometabolic complications, including pre-eclampsia and gestational diabetes. Treatments to protect breathing during sleep are available, pointing to SDB as a potential therapeutic target to reduce maternal cardiometabolic morbidity. However, in clinical practice, the majority of SDB cases in pregnancy are undiagnosed, indicating a need to improve screening for SDB risk factors and referral for diagnostic testing. Furthermore, definitive clinical trials are needed to determine the extent to which SDB intervention reduces the risk of adverse cardiovascular and neonatal outcomes in pregnancy. This review article discusses an accumulation of research pointing to SDB as a prevalent risk factor for gestational cardiometabolic disease, as well as a potential therapeutic target to reduce cardiometabolic morbidity.

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Section: Mechanisms Contributing To Sdb In Pregnancymentioning

confidence: 99%

Sleep-Disordered Breathing and Pregnancy-Related Cardiovascular Disease

Laposky

Pemberton

2021

Journal of Women's Health

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“…These findings suggest that symptoms of frequent snoring and somnolence are associated with depressive symptoms in early pregnancy, but SDB symptoms may not exacerbate risk for worsening depressive symptoms over gestation. Notably, questionnaires have yet to be validated for SDB screening in pregnancy [ 32 ], and most women in our sample (77%) were categorized as high-risk for OSA on the Berlin Questionnaire in early pregnancy despite having AHI values below the diagnostic criteria for OSA. In addition, a recent study that also evaluated the Berlin Questionnaire by category reported that positive scores on category 3 (BMI and high blood pressure) predicted adverse obstetric outcomes whereas scores on the other categories did not [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Sleep Disordered Breathing Measures in Early Pregnancy Are Associated with Depressive Symptoms in Late Pregnancy

et al. 2021

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Sleep disordered breathing (SDB) and depression are both common complications of pregnancy and increase risk for adverse maternal and neonatal outcomes. SDB precedes onset of depression in non-pregnant adults; however, the longitudinal relationship has not been studied in pregnancy. The present research examined temporal associations between SDB and depressive symptoms in 175 pregnant women at risk for SDB (based on frequent snoring and obesity), but without an apnea hypopnea index of ≥5 events per hour at enrollment. Women completed a self-report assessments of depressive symptoms using PHQ-9 and in-home level III sleep apnea monitoring at approximately 12- and 32-weeks’ gestation. We also assessed the risk for SDB using the Berlin Questionnaire in early pregnancy. Results revealed that measures of SDB in early pregnancy as assessed by in-home sleep study, but not by self-reported SDB, predicted elevated depressive symptoms in late pregnancy. SDB in late pregnancy was not associated with depressive symptoms. To conclude, these findings suggest that SDB may increase the risk for elevated depressive symptoms as pregnancy progresses.

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“…Prediction of risk of SDB in pregnancy has been challenging, and there is an interest in the field to develop algorithms to identify pregnant women at risk of SDB in order to maximize identification while minimizing demands on diagnostic resources and patient burden, such as polysomnography or in-home sleep apnea testing. 47 As fetal sex is now being identified earlier in pregnancy than in the past, given the advent of cell free DNA as a screening test, it is possible to examine whether the addition of fetal sex to management decisions for screening for SDB and to identify women at highest risk of perinatal complications of SDB.…”

Section: Discussionmentioning

confidence: 99%

Exploring Fetal Sex as a Risk Factor for Sleep Disordered Breathing and Its Complications in Pregnancy

Bublitz

Salameh

Sanapo

et al. 2020

Gender and the Genome

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Sleep disordered breathing (SDB) is a common, yet under-recognized and undertreated condition in pregnancy. Sleep disordered breathing is associated with pregnancy complications including preeclampsia, gestational diabetes, preterm birth, as well as severe maternal morbidity and mortality. The identification of risk factors for SDB in pregnancy may improve screening, diagnosis, and treatment of SDB prior to the onset of pregnancy complications. The goal of this study was to determine whether fetal sex increases risk of SDB in pregnancy. A cohort of singleton (N = 991) pregnant women were recruited within 24 to 48 hours of delivery and answered questions regarding SDB symptoms by questionnaire. Women who reported frequent loud snoring at least 3 times a week were considered to have SDB. Hospital records were reviewed to extract information on fetal sex and pregnancy complications including preeclampsia, pregnancy-induced hypertension, gestational diabetes, preterm delivery, and low birth weight. Women carrying male fetuses were significantly more likely to have SDB (β = .37, P = .01, OR: 1.45 [95% CI: 1.09-1.94]). Fetal sex was associated with increased risk of hypertensive disorders of pregnancy (defined as preeclampsia and/or pregnancy-induced hypertension) among women with SDB in pregnancy (β = .41, P = .02, OR: 1.51 [95% CI: 1.08-2.11]). Fetal sex did not increase risk of preterm birth, low birth weight, or gestational diabetes among women with SDB in pregnancy. Women carrying male fetuses were approximately 1.5 times more likely to report SDB in pregnancy compared to women carrying female fetuses, and women with pregnancy-onset SDB carrying male fetuses were 1.5 times more likely to have hypertensive disorders of pregnancy compared to women with SDB carrying female fetuses. Confirmation of fetal sex as a risk factor may, with other risk factors, play a role in identifying women at highest risk of SDB complications in pregnancy.

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The Challenge of Screening for Obstructive Sleep Apnea in Pregnancy

Cited by 8 publications

References 16 publications

Sleep-Disordered Breathing and Pregnancy-Related Cardiovascular Disease

Sleep-Disordered Breathing and Pregnancy-Related Cardiovascular Disease

Sleep Disordered Breathing Measures in Early Pregnancy Are Associated with Depressive Symptoms in Late Pregnancy

Exploring Fetal Sex as a Risk Factor for Sleep Disordered Breathing and Its Complications in Pregnancy

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