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Obstructive sleep apnea in pregnancy: reliability of prevalence and prediction estimates.

Antony KM, Agrawal A, Arndt ME, Murphy AM, Alapat PM, Guntupalli KK, Aagaard KM - J Perinatol (2014)

Bottom Line: A total of 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%.

View Article: PubMed Central - PubMed

Affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.

ABSTRACT

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: A total of 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 Berlin questionnaire or Epworth sleepiness scale was poorly predictive of OSA among gravidae and was associated with a high false referral rate.

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Related in: MedlinePlus

Flow through study. 1509 subjects were eligible for inclusion. 5 subjects did not fully complete either questionnaire. 1048 subjects completed at least one questionnaire and were screen negative for both the BQ and the ESS, including 75 subjects who fully completed one questionnaire but incompletely completed the other. 456 subjects screened positive for OSA on either the BQ, the ESS, or both. All 456 subjects were referred to the Sleep Center for PSG. If admitted to antepartum during gestation, a T3D was performed. 398 subjects did not complete PSG or T3D. 58 subjects completed PSG and/or T3D. Of the 58 subjects who completed sleep testing via PSG or T3D, 15.5% were diagnosed with obstructive sleep apnea.
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Figure 1: Flow through study. 1509 subjects were eligible for inclusion. 5 subjects did not fully complete either questionnaire. 1048 subjects completed at least one questionnaire and were screen negative for both the BQ and the ESS, including 75 subjects who fully completed one questionnaire but incompletely completed the other. 456 subjects screened positive for OSA on either the BQ, the ESS, or both. All 456 subjects were referred to the Sleep Center for PSG. If admitted to antepartum during gestation, a T3D was performed. 398 subjects did not complete PSG or T3D. 58 subjects completed PSG and/or T3D. Of the 58 subjects who completed sleep testing via PSG or T3D, 15.5% were diagnosed with obstructive sleep apnea.

Mentions: The majority of gravid subjects were Hispanic (87.8%) and non-smokers (96.5%), which is consistent with the obstetric population of Harris Health System (Figure 1). Over three-fourths of the subjects were overweight (35.1%) or obese (40.4%). As shown in Figure 1, after excluding the five subjects that did not complete either screening measure, of the 1504 remaining subjects, 456 (30.3%) screened positive on either the BQ or ESS and 1048 (69.4%) screened negative on at least one measure.


Obstructive sleep apnea in pregnancy: reliability of prevalence and prediction estimates.

Antony KM, Agrawal A, Arndt ME, Murphy AM, Alapat PM, Guntupalli KK, Aagaard KM - J Perinatol (2014)

Flow through study. 1509 subjects were eligible for inclusion. 5 subjects did not fully complete either questionnaire. 1048 subjects completed at least one questionnaire and were screen negative for both the BQ and the ESS, including 75 subjects who fully completed one questionnaire but incompletely completed the other. 456 subjects screened positive for OSA on either the BQ, the ESS, or both. All 456 subjects were referred to the Sleep Center for PSG. If admitted to antepartum during gestation, a T3D was performed. 398 subjects did not complete PSG or T3D. 58 subjects completed PSG and/or T3D. Of the 58 subjects who completed sleep testing via PSG or T3D, 15.5% were diagnosed with obstructive sleep apnea.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4117820&req=5

Figure 1: Flow through study. 1509 subjects were eligible for inclusion. 5 subjects did not fully complete either questionnaire. 1048 subjects completed at least one questionnaire and were screen negative for both the BQ and the ESS, including 75 subjects who fully completed one questionnaire but incompletely completed the other. 456 subjects screened positive for OSA on either the BQ, the ESS, or both. All 456 subjects were referred to the Sleep Center for PSG. If admitted to antepartum during gestation, a T3D was performed. 398 subjects did not complete PSG or T3D. 58 subjects completed PSG and/or T3D. Of the 58 subjects who completed sleep testing via PSG or T3D, 15.5% were diagnosed with obstructive sleep apnea.
Mentions: The majority of gravid subjects were Hispanic (87.8%) and non-smokers (96.5%), which is consistent with the obstetric population of Harris Health System (Figure 1). Over three-fourths of the subjects were overweight (35.1%) or obese (40.4%). As shown in Figure 1, after excluding the five subjects that did not complete either screening measure, of the 1504 remaining subjects, 456 (30.3%) screened positive on either the BQ or ESS and 1048 (69.4%) screened negative on at least one measure.

Bottom Line: A total of 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%.

View Article: PubMed Central - PubMed

Affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.

ABSTRACT

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: A total of 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 Berlin questionnaire or Epworth sleepiness scale was poorly predictive of OSA among gravidae and was associated with a high false referral rate.

Show MeSH
Related in: MedlinePlus