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. 2014 Aug;34(8):587-93.
doi: 10.1038/jp.2014.48. Epub 2014 Mar 27.

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

K M Antony  1 , A Agrawal  2 , M E Arndt  1 , A M Murphy  1 , P M Alapat  3 , K K Guntupalli  3 , K M Aagaard  1
Affiliations

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

K M Antony et al. J Perinatol. 2014 Aug.

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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Conflict of interest statement

Conflict of Interest: The authors report no conflict of interest.

Figures

Figure 1
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.
Figure 2
Figure 2
Item-test correlations and percent of subjects who screened positive on the sleep measure screening positive on the listed item The bar graph shows the percent of screen positive subjects on the Berlin Questionnaire or Epworth Sleepiness Scale, respectively, who tested positive on the listed item. The item-test correlation for each item is shown to the right of the bar. Cronbach's α for BQ items was 0.62, and itemized correlation ranged from 0.30 to 0.66. Cronbach's α for ESS items was 0.82, and itemized correlations ranged from 0.55 to 0.74.
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