Dominguez JE, et al. - In a cohort of pregnant women with extreme obesity in mid-pregnancy, researchers examined the established obstructive sleep apnea (OSA) screening tools, a sleepiness scale, and their individual component items using objective testing to determine OSA status, and to describe the prevalence of OSA among women with extreme obesity. Researchers found that 24% of pregnant women who had a body mass index (BMI) ≥ 40 kg.m^-2 and were between 24 and 35 weeks gestation had OSA, which was defined as apnea-hypopnea index (AHI) > 5 events/hour on an overnight, type III home sleep apnea test. The Berlin questionnaire, American Society of Anesthesiologists checklist, STOP-BANG, OSA in pregnancy score by Facco et al., and the Epworth sleepiness scale were not identified as useful screening tools for OSA in this cohort. However, OSA was noted to be associated with age, BMI, neck circumference, frequent witnessed apneas, and likely to fall asleep while driving.

Methods

• Adult women between 24 and 35 weeks gestation who had a BMI ≥ 40 kg.m^-2 completed OSA screening questionnaires (Berlin, American Society of Anesthesiologists checklist, and STOP-BANG) and the Epworth sleepiness scale at the time of study enrollment, and also underwent performed physical examination of the neck, mouth, and airway.
• Researchers calculated the OSA in pregnancy prediction score proposed by Facco et al.
• The results of an overnight, unattended type III home sleep apnea test were used to determine OSA status for each subject.

Results

• On home sleep apnea testing in mid-pregnancy [AHI > 5 events/hour], OSA was identified in 24% of pregnant women with extreme obesity.
• In this cohort, established OSA screening tools performed very poorly in screening for OSA.
• OSA status was noted to be most strongly associated with age, BMI, neck circumference, frequent witnessed apneas, and highly likely to fall asleep while driving in this cohort.