Obstructive Sleep Apnea in Pregnancy: Early Lessons From Our Sleep Pregnancy Clinic

Abstract

Problem considered: Obstructive sleep apnea (OSA) is underdiagnosed during pregnancy, but there is strong theoretical and some empiric evidence that treatment may improve obstetric outcomes. Barriers to screening, testing, and treatment are common during pregnancy. The goal of this described intervention was to reduce these barriers and improve detection of OSA in pregnancy.

Methods: Representatives from sleep medicine and perinatology established a cross-disciplinary, collaborative Sleep Pregnancy Clinic offering a streamlined referral process for multimodal screening, testing, and treatment of OSA during pregnancy. This is a retrospective analysis of data from the clinic's first 19 months.

Results: Between June 2017 and December 2018, 134 pregnant women were referred for OSA testing. Sixty-three (47.0%) completed objective sleep testing, and 38 (60.3%) of the women who completed testing met diagnostic criteria for OSA. This intervention resulted in a statistically significant increase in the number of diagnostic sleep apnea tests performed (average 22.4 tests per year pre-intervention, 77 per year post-intervention [P = 0.0012]).

Discussion and conclusions: Despite a streamlined referral pipeline, completion rates of OSA testing in pregnant women remained below 50%. However, the overall number of women referred and who completed testing increased significantly during this time period. Of those who completed testing, the majority were diagnosed with OSA. Since starting this clinic, we have created resources to familiarize patients with the equipment and worked to reduce other barriers. Assessment of these interventions and the impact of treatment on obstetric outcomes is ongoing, as is assessment of reasons women do not complete diagnostic testing.

Figure 1:

Images of a pregnant woman wearing the sleep device (Alice PDX 4 channel system) (A) and auto-continuous positive airway pressure (Auto-CPAP) (B) nasal pillows interface/mask, which are shown to patients during their obstetrical visit if they screen positive for possible sleep apnea, prompting a referral for testing.

Figure 2:

Patient-facing brochure listing the symptoms of OSA and its significance during pregnancy.

Figure 3:

Of 134 women referred for sleep testing, 63 (47.0) completed testing. Of those who completed testing, 60.3% met criteria for obstructive sleep apnea.

Figure 4:

Referrals and sleep studies completed by pregnant women at the Wisconsin Sleep Center from January 2012-October 2019. There was a statistically significant increase in the number of referrals and completed studies performed on pregnant women after the intervention (average 22.4 tests per year before (SD 5.3) and 67 (SD 16.6) after the intervention (p=0.0012)).