Sleep Apnea Screening Tools Inadequate in Pregnancy

MINNEAPOLIS – Simpler may be better when it comes to screening pregnant women for sleep apnea, a study has shown.

In a cohort of pregnant women who completed a sleep survey and participated in an overnight sleep evaluation, a two-question screening approach yielded more accurate results than did standard screening tools, including the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS), Dr. Francesca L. Facco reported at the annual meeting of the Associated Professional Sleep Societies.

"Using prepregnancy body mass index and self-reported snoring had a much better sensitivity than the conventional methods, without sacrificing much specificity," she said.

To compare the screening approaches, Dr. Facco of the department of ob.gyn. at Northwestern University, Chicago, and her colleagues recruited 86 high-risk pregnant women, including those with chronic hypertension, pregestational diabetes, obesity, or a prior history of pre-eclampsia, to complete the sleep survey, which consisted of the BQ and ESS measures.

The women also underwent an overnight sleep evaluation using Itamar Medical’s Watch-PAT100 (WP100), a wrist-mounted, ambulatory device designed to diagnose sleep apnea. For this study, sleep apnea was defined as an apnea-hypopnea index score of five or more episodes of disturbed sleep per hour. Patients’ prepregnancy BMI and self-reporting snoring status were recorded as well. "Patients with a prepregnancy BMI of 25 [kg/m²] or higher who also reported snoring were considered to be screen positive" for apnea, Dr. Facco said.

The investigators assessed the performance of the BQ, ESS, and two-question measures relative to the data acquired from the WP100 devices using receiver operating characteristic (ROC) curves, and determined that the two-question approach performed better than the BQ alone, the BQ and ESS combined, and the null hypothesis, according to Dr. Facco. The sensitivity of the combined BQ and ESS was 35% and the specificity was 69%, compared with 74% and 59%, respectively, for the two-question approach.

"The results suggest that standard screening tools for sleep apnea, which have a high sensitivity and specificity in nonpregnant individuals, are inadequate for the assessment of sleep apnea in pregnancy," Dr. Facco said. Modifications that take into account the predictive value of prepregnancy BMI and snoring are warranted, she said, stressing that additional studies are needed to design and test the most appropriate measure for sleep apnea screening in pregnancy.

Because sleep apnea may be associated with complications during pregnancy and with adverse pregnancy outcomes, screening for the disorder should be considered for all pregnant women, and particularly those who are considered to be at high risk, Dr. Facco said.

Dr. Facco disclosed no financial conflicts of interest related to this presentation.

MINNEAPOLIS – Simpler may be better when it comes to screening pregnant women for sleep apnea, a study has shown.

In a cohort of pregnant women who completed a sleep survey and participated in an overnight sleep evaluation, a two-question screening approach yielded more accurate results than did standard screening tools, including the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS), Dr. Francesca L. Facco reported at the annual meeting of the Associated Professional Sleep Societies.

"Using prepregnancy body mass index and self-reported snoring had a much better sensitivity than the conventional methods, without sacrificing much specificity," she said.

To compare the screening approaches, Dr. Facco of the department of ob.gyn. at Northwestern University, Chicago, and her colleagues recruited 86 high-risk pregnant women, including those with chronic hypertension, pregestational diabetes, obesity, or a prior history of pre-eclampsia, to complete the sleep survey, which consisted of the BQ and ESS measures.

The women also underwent an overnight sleep evaluation using Itamar Medical’s Watch-PAT100 (WP100), a wrist-mounted, ambulatory device designed to diagnose sleep apnea. For this study, sleep apnea was defined as an apnea-hypopnea index score of five or more episodes of disturbed sleep per hour. Patients’ prepregnancy BMI and self-reporting snoring status were recorded as well. "Patients with a prepregnancy BMI of 25 [kg/m²] or higher who also reported snoring were considered to be screen positive" for apnea, Dr. Facco said.

The investigators assessed the performance of the BQ, ESS, and two-question measures relative to the data acquired from the WP100 devices using receiver operating characteristic (ROC) curves, and determined that the two-question approach performed better than the BQ alone, the BQ and ESS combined, and the null hypothesis, according to Dr. Facco. The sensitivity of the combined BQ and ESS was 35% and the specificity was 69%, compared with 74% and 59%, respectively, for the two-question approach.

"The results suggest that standard screening tools for sleep apnea, which have a high sensitivity and specificity in nonpregnant individuals, are inadequate for the assessment of sleep apnea in pregnancy," Dr. Facco said. Modifications that take into account the predictive value of prepregnancy BMI and snoring are warranted, she said, stressing that additional studies are needed to design and test the most appropriate measure for sleep apnea screening in pregnancy.

Because sleep apnea may be associated with complications during pregnancy and with adverse pregnancy outcomes, screening for the disorder should be considered for all pregnant women, and particularly those who are considered to be at high risk, Dr. Facco said.

Dr. Facco disclosed no financial conflicts of interest related to this presentation.

MINNEAPOLIS – Simpler may be better when it comes to screening pregnant women for sleep apnea, a study has shown.

In a cohort of pregnant women who completed a sleep survey and participated in an overnight sleep evaluation, a two-question screening approach yielded more accurate results than did standard screening tools, including the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS), Dr. Francesca L. Facco reported at the annual meeting of the Associated Professional Sleep Societies.

"Using prepregnancy body mass index and self-reported snoring had a much better sensitivity than the conventional methods, without sacrificing much specificity," she said.

To compare the screening approaches, Dr. Facco of the department of ob.gyn. at Northwestern University, Chicago, and her colleagues recruited 86 high-risk pregnant women, including those with chronic hypertension, pregestational diabetes, obesity, or a prior history of pre-eclampsia, to complete the sleep survey, which consisted of the BQ and ESS measures.

The women also underwent an overnight sleep evaluation using Itamar Medical’s Watch-PAT100 (WP100), a wrist-mounted, ambulatory device designed to diagnose sleep apnea. For this study, sleep apnea was defined as an apnea-hypopnea index score of five or more episodes of disturbed sleep per hour. Patients’ prepregnancy BMI and self-reporting snoring status were recorded as well. "Patients with a prepregnancy BMI of 25 [kg/m²] or higher who also reported snoring were considered to be screen positive" for apnea, Dr. Facco said.

The investigators assessed the performance of the BQ, ESS, and two-question measures relative to the data acquired from the WP100 devices using receiver operating characteristic (ROC) curves, and determined that the two-question approach performed better than the BQ alone, the BQ and ESS combined, and the null hypothesis, according to Dr. Facco. The sensitivity of the combined BQ and ESS was 35% and the specificity was 69%, compared with 74% and 59%, respectively, for the two-question approach.

"The results suggest that standard screening tools for sleep apnea, which have a high sensitivity and specificity in nonpregnant individuals, are inadequate for the assessment of sleep apnea in pregnancy," Dr. Facco said. Modifications that take into account the predictive value of prepregnancy BMI and snoring are warranted, she said, stressing that additional studies are needed to design and test the most appropriate measure for sleep apnea screening in pregnancy.

Because sleep apnea may be associated with complications during pregnancy and with adverse pregnancy outcomes, screening for the disorder should be considered for all pregnant women, and particularly those who are considered to be at high risk, Dr. Facco said.

Dr. Facco disclosed no financial conflicts of interest related to this presentation.