Clinical application of a previously validated pregnancy-specific screening tool for sleep apnea in a cohort with a high prevalence of obesity

Sakshi Bajaj; A Lauren Rice; Payden White; Abigail M Wiedmer; Natalie M Jacobson; Nathan R Jones; Mihaela H Bazalakova; Kathleen M Antony

doi:10.1016/j.sleepx.2023.100061

Clinical application of a previously validated pregnancy-specific screening tool for sleep apnea in a cohort with a high prevalence of obesity

Sleep Med X. 2023 Jan 8:5:100061. doi: 10.1016/j.sleepx.2023.100061. eCollection 2023 Dec.

Authors

Sakshi Bajaj¹, A Lauren Rice^{1

2

3}, Payden White^{1

4}, Abigail M Wiedmer^{1

2

3}, Natalie M Jacobson^{2

3}, Nathan R Jones⁵, Mihaela H Bazalakova³, Kathleen M Antony¹

Affiliations

¹ Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, 1010 Mound Street, Madison, WI, USA.
² Department of Biology, University of Wisconsin-Madison, Madison, WI, USA.
³ Department of Neurology, Wisconsin Sleep, Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA.
⁴ School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
⁵ University of Wisconsin Survey Center, University of Wisconsin-Madison, Madison, WI, USA.

Abstract

Objective: The purpose of this project was to determine the positive predictive value of existing obstructive sleep apnea (OSA) screening tools in clinical use, in a real-world clinical population of gravidae, and to explore the development of a new questionnaire for screening for OSA during pregnancy.

Methods: Pregnant people were administered sleep screening questionnaires as part of routine clinical care. These included Facco's four variable OSA screening tool, the STOP-BANG, and the Epworth Sleepiness Scale. Those who screened positive were referred for diagnostic sleep testing, typically with a type III home monitoring device. Here we analyzed the screening responses used by those who completed diagnostic testing to determine the positive predictive value of the existing tools.

Results: 159 pregnant people completed diagnostic OSA testing and were included in this analysis. The positive predictive value of Facco's four variable sleep screening tool was 74.3%, STOP-BANG was 75.3%, and the Epworth Sleepiness Scale was 69.8%. Our sample size was insufficient to create a new screening tool.

Conclusions: Here we calculated the positive predictive value of Facco's 4 variable screening tool for screening for OSA in pregnancy in a real-world pregnant population. While we were not able to generate a new screening tool for screening for OSA during pregnancy, both STOP-BANG and Facco's four variable tool had positive predictive values over 70% in our population which was characterized by high BMI and advanced maternal age. Increased clinical use of the pregnancy-specific tool may be warranted.

Keywords: Obesity; Pregnancy; Screening tools; Sleep apnea; Sleep apnea screening.