Am J Perinatol 2011; 28(8): 651-658
DOI: 10.1055/s-0031-1276740
© Thieme Medical Publishers

Obstructive Sleep Apnea Screening in Pregnancy, Perinatal Outcomes, and Impact of Maternal Obesity

Sofia A. Olivarez1 , Millie Ferres1 , Katherine Antony1 , Amarbir Mattewal2 , 3 , Bani Maheshwari1 , Haleh Sangi-Haghpeykar1 , Kjersti Aagaard-Tillery1
  • 1Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Houston, Texas
  • 2Department of Pulmonary–Critical Care, Baylor College of Medicine, Houston, Texas
  • 3Ben Taub General Hospital, Houston, Texas
Further Information

Publication History

Publication Date:
08 April 2011 (online)

ABSTRACT

We employed accepted, validated symptom-based screening measures to discern attributable risk of obstructive sleep apnea (OSA) to adverse pregnancy outcomes, taking into account potential maternal confounders. Commonly employed OSA screening measures (Berlin and Epworth scales) were performed in the second and third trimesters; maternal and neonatal outcome data were thereafter obtained. The relationship between OSA and outcomes of interest were explored in stratified and multivariate models controlling for potential confounders. The overall prevalence of OSA was 25.4%. Given a nonlinear increase by body mass index (BMI) strata (8.9%, 46%; p < 0.0001), stratified multivariate analysis was subsequently performed. Among nonobese (BMI <30) gravidae, frequency of preeclampsia was significantly higher among women with OSA (adjusted odds ratio = 6.58, 95% confidence interval = 1.04, 38.51; p = 0.035). Among the obese (BMI ≥30) gravidae, infant birth weight ratio (or birth weight by gestational age) was higher with OSA + screening than OSA − (1.099 versus 1.035; p = 0.04), and this association remained significant after adjustment for potential confounders (p = 0.05). OSA prevalence increases significantly among obese gravidae, raising concerns for the overall validity of commonly employed screening measures in pregnancy. Nevertheless, OSA status continues to exert an independent influence, as obese and nonobese gravidae are at increased risk for a limited number of adverse perinatal outcomes in multivariate models.

REFERENCES

  • 1 Sahin F K, Koken G, Cosar E et al.. Obstructive sleep apnea in pregnancy and fetal outcome.  Int J Gynaecol Obstet. 2008;  100 141-146
  • 2 Sagheer F, Venkata C, Venkateshiah S B. A 26-year-old pregnant woman with fatigue and excessive daytime sleepiness. Moderate obstructive sleep apnea-hypopnea syndrome in pregnancy.  Chest. 2008;  134 637-639
  • 3 Sharma S K, Vasudev C, Sinha S, Banga A, Pandey R M, Handa K K. Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome.  Indian J Med Res. 2006;  124 281-290
  • 4 Netzer N C, Hoegel J J, Loube D Sleep in Primary Care International Study Group et al. Prevalence of symptoms and risk of sleep apnea in primary care.  Chest. 2003;  124 1406-1414
  • 5 Johns M W. Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: failure of the MSLT as a gold standard.  J Sleep Res. 2000;  9 5-11
  • 6 Netzer N C, Stoohs R A, Netzer C M, Clark K, Strohl K P. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome.  Ann Intern Med. 1999;  131 485-491
  • 7 Franklin K A, Holmgren P A, Jönsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus.  Chest. 2000;  117 137-141
  • 8 Loube D I, Poceta J S, Morales M C, Peacock M D, Mitler M M. Self-reported snoring in pregnancy. Association with fetal outcome.  Chest. 1996;  109 885-889
  • 9 Edwards N, Blyton D M, Hennessy A, Sullivan C E. Severity of sleep-disordered breathing improves following parturition.  Sleep. 2005;  28 737-741
  • 10 Yin T T, Williams N, Burton C et al.. Hypertension, fetal growth restriction and obstructive sleep apnoea in pregnancy.  Eur J Obstet Gynecol Reprod Biol. 2008;  141 35-38
  • 11 Champagne K, Schwartzman K, Opatrny L et al.. Obstructive sleep apnoea and its association with gestational hypertension.  Eur Respir J. 2009;  33 559-565
  • 12 Roush S F, Bell L. Obstructive sleep apnea in pregnancy.  J Am Board Fam Pract. 2004;  17 292-294
  • 13 Yinon D, Lowenstein L, Suraya S et al.. Pre-eclampsia is associated with sleep-disordered breathing and endothelial dysfunction.  Eur Respir J. 2006;  27 328-333
  • 14 Namysłowski G, Mrówka-Kata K, Scierski W, Wylezoł M, Pardela M. The nasal airway evaluation in morbid obesity.  J Physiol Pharmacol. 2005;  56 (Suppl 6) 67-75
  • 15 Xu Z, Jiaqing A, Yuchuan L, Shen K. A case-control study of obstructive sleep apnea-hypopnea syndrome in obese and nonobese Chinese children.  Chest. 2008;  133 684-689
  • 16 Kajaste S, Brander P E, Telakivi T, Partinen M, Mustajoki P. A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study.  Sleep Med. 2004;  5 125-131
  • 17 Kansanen M, Vanninen E, Tuunainen A et al.. The effect of a very low-calorie diet-induced weight loss on the severity of obstructive sleep apnoea and autonomic nervous function in obese patients with obstructive sleep apnoea syndrome.  Clin Physiol. 1998;  18 377-385
  • 18 Kajaste S, Telakivi T, Mustajoki P, Pihl S, Partinen M. Effects of a cognitive-behavioural weight loss programme on overweight obstructive sleep apnoea patients.  J Sleep Res. 1994;  3 245-249
  • 19 Maasilta P, Bachour A, Teramo K, Polo O, Laitinen L A. Sleep-related disordered breathing during pregnancy in obese women.  Chest. 2001;  120 1448-1454
  • 20 Li A M, Au C T, Sung R Y et al.. Ambulatory blood pressure in children with obstructive sleep apnoea: a community based study.  Thorax. 2008;  63 803-809
  • 21 Heslehurst N, Simpson H, Ells L J et al.. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis.  Obes Rev. 2008;  9 635-683
  • 22 Burstein E, Levy A, Mazor M, Wiznitzer A, Sheiner E. Pregnancy outcome among obese women: a prospective study.  Am J Perinatol. 2008;  25 561-566
  • 23 Sharma S K, Kumpawat S, Goel A, Banga A, Ramakrishnan L, Chaturvedi P. Obesity, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleep-disordered breathing.  Sleep Med. 2007;  8 12-17
  • 24 Guilleminault C, Palombini L, Poyares D, Takaoka S, Huynh N T, El-Sayed Y. Pre-eclampsia and nasal CPAP: part 1. Early intervention with nasal CPAP in pregnant women with risk-factors for pre-eclampsia: preliminary findings.  Sleep Med. 2007;  9 9-14
  • 25 Uribe Echevarría E M, Alvarez D, Giobellina R, Uribe Echevarría A M. Epworth drowsiness scale value in obstructive sleep apnea syndrome.  Medicina (B Aires). 2000;  60 902-906
  • 26 Hardinge F M, Pitson D J, Stradling J R. Use of the Epworth Sleepiness Scale to demonstrate response to treatment with nasal continuous positive airways pressure in patients with obstructive sleep apnoea.  Respir Med. 1995;  89 617-620
  • 27 Johns M W. A new method for measuring daytime sleepiness: the Epworth sleepiness scale.  Sleep. 1991;  14 540-545
  • 28 Weinreich G, Plein K, Teschler T, Resler J, Teschler H. Is the Berlin questionnaire an appropriate diagnostic tool for sleep medicine in pneumological rehabilitation?.  Pneumologie. 2006;  60 737-742
  • 29 Olivarez S A, Maheshwari B, McCarthy M et al.. Prospective trial on obstructive sleep apnea in pregnancy and fetal heart rate monitoring.  Am J Obstet Gynecol. 2010;  202 552, e1-e7
  • 30 Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable fetal weight standard.  Ultrasound Obstet Gynecol. 1995;  6 168-174
  • 31 Bukowski R, Gahn D, Denning J, Saade G. Impairment of growth in fetuses destined to deliver preterm.  Am J Obstet Gynecol. 2001;  185 463-467
  • 32 Wilcox M A, Johnson I R, Maynard P V, Smith S J, Chilvers C E. The individualised birthweight ratio: a more logical outcome measure of pregnancy than birthweight alone.  Br J Obstet Gynaecol. 1993;  100 342-347
  • 33 Rothman K J. Objectives of epidemiologic studies. In: Rothman K J, ed. Modern Epidemiology. Boston: Little, Brown and Company; 1986: 84-89

Kjersti M Aagaard-TilleryM.D. Ph.D. 

Baylor College of Medicine

1 Baylor Plaza, Jones 314, Houston, TX 77030

Email: aagaardt@bcm.tmc.edu