Guideline recommends screening pregnant women at high risk for sleep apnea

Key takeaways:

• Women with obesity, hypertension or diabetes are at high risk for sleep apnea and should be screened during pregnancy.
• It is not recommended to screen older pregnant women with no other risk factors.

A new consensus guideline recommend screening women during pregnancy who have high risk for obstructive sleep apnea, such as those with obesity, hypertension or diabetes.

“There are not enough studies that guide the treatment of sleep apnea in pregnancy; hence, treatment is not aimed at reducing the risk for preeclampsia or gestational diabetes since studies are scarce in this area, but rather should follow the indications for nonpregnant individuals,” Ghada Bourjeily, MD, guideline committee co-chair, professor of medicine at Brown University and research director of the Women’s Medicine Collaborative at Lifespan, told Healio. “Women with obesity, hypertension or diabetes who are anticipating pregnancy or are in early pregnancy should be screened for symptoms of sleep apnea, and those with symptoms should be referred for further testing and management.”

The Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology had an expert taskforce conduct a systematic review of existing literature from MEDLINE, Embase, CINAHL Complete and Scopus from database inception to August 2020. The taskforce identified 192 studies related to screening, diagnosing, treating and managing obstructive sleep apnea (OSA) in pregnancy. Its recommendations are published in Obstetrics & Gynecology.

The taskforce developed the following recommendations for guidance on screening pregnant women for OSA:

• Screen pregnant women with obesity with a BMI of 30 kg/m² or higher.
• Screen pregnant women with hypertensive disorders of pregnancy or diabetes.
• Screen pregnant women at high OSA risk in their first or second trimesters.
• Pregnancy-specific OSA screening criteria — the sum of age, prepregnancy BMI and 15 points each for chronic hypertension and frequent snoring — may be considered a screening tool for pregnant women but is suboptimal among high-risk groups.
• Pregnancy-specific OSA screening criteria, including maternal age, BMI and frequent snoring, should be further validated.
• The BMI, age and tongue enlargement (BATE) screening model may be useful in OSA prediction in pregnant women but requires clinical training and further validation.

However, the taskforce does not recommend the following:

• universal screening of all pregnant women for OSA;
• screening of pregnant women with advanced maternal age and no other risk factors; and
• utilization of the Berlin questionnaire, the STOP-BANG questionnaire, the Epworth Sleepiness Scale or the American Society of Anesthesiologists (ASA) checklist as screening tools for pregnant women.

In addition, the taskforce noted that home sleep testing may be a reasonable tool for diagnosing OSA in pregnant women, but laboratory testing may be required if there is high clinical suspicion and the home sleep test is negative.

“We need research to better understand whether treatment of sleep apnea can improve pregnancy-specific outcomes in addition to improving symptoms,” Bourjeily said. “We also need strategies to implement timely screening, diagnosis and management of sleep apnea in this population given the finite duration of pregnancy but the significant association of sleep apnea with cardiovascular and metabolic outcomes and severe maternal morbidity.”

For more information:

Ghada Bourjeily, MD, can be reached at ghada_bourjeily@brown.edu.