0697 Improving Detection of Obstructive Sleep Apnea in Pregnant Women Using a Six-Point Screening Tool

Abstract

Abstract Introduction Pregnant patients with obstructive sleep apnea (OSA) are at higher risk for adverse outcomes. There are currently no established screening tools for pregnant women. OSA in pregnancy continues to be underdiagnosed resulting in missed opportunities to prevent possible adverse outcomes. Methods A screening pilot program was implemented at our general obstetrics and maternal fetal medicine (MFM) clinic to improve diagnosis of OSA among pregnant women. Patients were screened by a nurse for snoring/apneas, BMI > 35, essential hypertension, glucose disorders, neck size > 36 cm, and symptoms of excessive daytime sleepiness. If a patient scored 3/6 or greater, a home sleep apnea test (HSAT), and in some cases an in-lab sleep study (PSG), was recommended to test for OSA after discussion of risks and benefits with an obstetrician. Results Since the initiation of the screening program, 302 women screened positive for OSA based on our 6-point screening tool. Average gestational age at the time of screening was 14.34 +/- 7.97 weeks. Of the women who scored ≥3 on the 6-point screening tool, 92 (30.46%) were referred directly to a sleep study and 31 (10.3%) received a referral to see a sleep medicine provider. A total of 78 underwent sleep testing and 58 (74.4%) were diagnosed with OSA with an apnea-hypopnea index (AHI) ≥ 5. Most patient were African American (67.9%) with an average age of 31.49 +/-5.74. The diagnosis of OSA correlated moderately well with the total score of the 6-point screening tool (p<.001), BMI (p=.005), essential hypertension (p=.01), glucose disorders (p=.07), and neck size (p=.039). Only a BMI of >35 was independently associated with a 3.7 increase in odds for OSA (95%CI=1.17, 11.76, p=.026). Conclusion A significant increase in screening for obstructive sleep apnea was achieved with implementation of the new screening protocol. Ease of use makes the six-point screening protocol a useful tool in clinic. More research is needed to test the accuracy of the six-point screening as a testing tool in this population. Additional barriers to screening and testing for OSA in pregnancy, including social and lifestyle factors should be explored in more depth. Support (If Any)