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J Clin Sleep Med. 2015 Jan 15;11(2):157-63. doi: 10.5664/jcsm.4464.

Screening of obstructive sleep apnea during pregnancy: differences in predictive values of questionnaires across trimesters.

Author information

1
Ramathibodi Hospital Sleep Disorder Center, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandL: Division of Pulmonary and Critical Care Unit, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
2
Division of Pulmonary and Critical Care Unit, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand: Chiangrai Prachanukoh Hospital, Chiang Rai, Thailand.
3
Division of Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
4
Ramathibodi Hospital Sleep Disorder Center, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
5
Division of Pulmonary and Critical Care Unit, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
6
Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, CA.

Abstract

STUDY OBJECTIVES:

Evaluation of Berlin and Stop-Bang questionnaires in detecting obstructive sleep apnea (OSA) across trimesters of pregnancy.

METHODS:

Pregnant women from a high-risk pregnancy clinic were recruited to complete sleep evaluations including Berlin and Stop-Bang Questionnaires. Overnight testing with Watch-PAT200 for diagnosis of OSA (cutoff point of apnea-hypopnea index ≥5 events/h) was performed.

RESULTS:

Seventy-two singleton pregnant women participated in the study. Enrollment consisted of 23, 24, and 25 women during first, second, and third trimesters, respectively. Of 72 pregnancies, 23 patients (31.9%) had OSA. Prevalence of OSA classified by trimesters from first to third was 30.4%, 33.33%, and 32.0%, respectively. Overall predictive values of Berlin and Stop-Bang questionnaires were fair (ROC area under curve, AUC 0.72 for Berlin, p = 0.003; 0.75 for Stop-Bang, p = 0.001). When categorized according to trimesters, predictive values substantially improved in second (AUC: 0.84 for Berlin; 0.78 for Stop-Bang) and third trimesters (AUC: 0.81 for Berlin; 0.75 for Stop-Bang), whereas performances of both questionnaires during first trimester were poorer (AUC: 0.49 for Berlin; 0.71 for Stop-Bang). Multivariate analyses show that pre-pregnancy body mass index (BMI) in first trimester, snore often in second trimester, and weight gain and pregnancy BMI in third trimester were significantly associated with OSA.

CONCLUSIONS:

In high-risk pregnancy, Berlin and Stop-Bang questionnaires were of limited usefulness in the first trimester. However their predictive values are acceptable as pregnancy progresses, particularly in second trimester. OSA in pregnancy seems to be a dynamic process with different predictors association during each trimester.

KEYWORDS:

Berlin questionnaire; Obstructive sleep apnea; Screening questionnaire; Stop-Bang questionnaire; pregnancy

PMID:
25406273
PMCID:
PMC4298773
DOI:
10.5664/jcsm.4464
[Indexed for MEDLINE]
Free PMC Article

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