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

Abstract

The Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology tasked an expert group to review existing evidence and to generate recommendations on the screening, diagnosis, and treatment of patients with obstructive sleep apnea during pregnancy. These recommendations are based on a systematic review of the available scientific evidence and expert opinion when scientific evidence is lacking. This guideline may not be appropriate for all clinical situations and patients, and physicians must decide whether these recommendations are appropriate for their patients on an individual basis. We recognize that not all pregnant people may identify as women. However, data on non-cisgendered pregnant patients are lacking, and many published studies use gender-binary terms; therefore, depending on the study referenced, we may refer to pregnant individuals as women. This guideline may inform the creation of clinical protocols by individual institutions that consider the unique considerations of their patient populations and the available resources.

Fig. 1.. ACC/AHA recommendation system: applying Class of Recommendation and Level of Evidence to clinical strategies, interventions, treatments, or diagnostic testing in patient care. Reproduced with permission from Halperin JL, Levine GN, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis RG, et al. Further evolution of the ACC/AHA clinical practice guideline recommendation classification system: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2016;133:1426–28. doi: 10.1161/CIR.0000000000000312. ©2016 American Heart Association, Inc. All requests to use this information must come through the American Heart Association.

Fig. 2.. Results of literature search and two-phase reference screening. An experienced medical librarian devised and conducted the literature searches, which were entered into the systematic review software. References were reviewed in a two-phase approach. Two blinded reviewers independently screened references by title and abstract to determine inclusion. A third reviewer blinded to the previous reviewers' decisions resolved disagreements. Next, the included references were screened at the full-text level by two independent, blinded reviewers to determine eligibility. Disagreements were again resolved by a third blinded reviewer. Possible duplications were reviewed, and, if deemed duplicates, one was excluded.

Fig. 3.. We conducted a meta-analysis of three prospective studies that measured the ability of the STOP-BANG tool to detect obstructive sleep apnea in pregnant women and found a pooled sensitivity of 0.58 (95% CI 0.46–0.70) (A) and pooled specificity of 0.82 (95% CI 0.77–0.86) (B).^,, df, degrees of freedom.

Fig. 4.. We performed a meta-analysis on the four studies that applied the Facco et al criteria to their study cohorts (including the derived cohort).^,, We found a pooled sensitivity of 0.74 (95% CI 0.64–0.82) (A) and specificity of 0.64 (95% CI 0.58–0.70) (B). df, degrees of freedom.

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