New algorithm screens for obstructive sleep apnea in gestational diabetes

ORLANDO, Fla. — A decision-tree tool incorporating the Berlin questionnaire for assessing obstructive sleep apnea in the general population plus neck circumference may better predict sleep apnea in women with gestational diabetes than the questionnaire alone, according to researchers from Thailand.

Sirimon Reutrakul, MD, associate professor in the faculty of medicine at Ramathibodi Hospital of Mahidol University in Bangkok and colleagues, assessed 82 women with obesity and gestational diabetes for obstructive sleep apnea (OSA) at 24 to 36 weeks’ gestation. The researchers recorded the women’s neck circumference and administered the Berlin questionnaire about snoring, daytime sleepiness and elevated BMI plus hypertension.

The women also wore a WatchPAT200 home monitoring device overnight, which indicated that 43 (52.4%) of participants had OSA. Those with and those without OSA had similar age, prepregnancy and current BMI, fasting glucose and HbA1c. A similar proportion of each group also was flagged as being at high risk for OSA by the Berlin questionnaire (two of three categories with positive response, 16% vs. 10%), although more of those with OSA than without answered positively for at least one category (74% vs. 49%; P = .017). The women with OSA had significantly larger neck circumference (35 cm) than those without (34.5 cm; P = .018).

“Obese pregnant women with gestational diabetes are at risk of OSA. Having daytime fatigue, snoring, hypertension or BMI at least kg/m², or larger neck circumference may indicate a higher risk,” Reutrakul told Endocrine Today.

She and her colleagues advise health care providers screening for OSA in women with gestational diabetes to first administer the Berlin questionnaire. Women who respond positively to at least one category, or those who have a neck circumference greater than 35.5 cm regardless of questionnaire responses, should be considered at high risk for OSA.

“This tool has an 86% sensitivity and 51% specificity with an overall accuracy of 70%,” Reutrakul said.

She cautioned, though, that study was relatively small and all participants were Thai.

“Whether this finding can be generalized to other ethnic groups or non-obese women remains to be investigated,” she said. – by Jill Rollet

Reference:

Reutrakul S, et al. SAT 594. Presented at: The Endocrine Society Annual Meeting; April 1-4, 2017; Orlando, Fla.

Disclosures: Reutrakul reports serving as a speaker for Medtronic Minimed, Novo Nordisk and Sanofi, and receiving clinical researcher grants from Merck & Co.