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- Title
Can we predict sleep-disordered breathing in pregnancy? The clinical utility of symptoms.
- Authors
Wilson, Danielle L.; Walker, Susan P.; Fung, Alison M.; O'Donoghue, Fergal; Barnes, Maree; Howard, Mark
- Abstract
Sleep-disordered breathing ( SDB) is reported commonly during pregnancy and is associated with an increased risk of adverse maternal and fetal outcomes, but the majority of these data are based upon self-report measures not validated for pregnancy. This study examined the predictive value of screening questionnaires for SDB administered at two time-points in pregnancy, and attempted to develop an 'optimized predictive model' for detecting SDB in pregnancy. A total of 380 women were recruited from an antenatal clinic in the second trimester of pregnancy. All participants completed the Berlin Questionnaire and the Multivariable Apnea Risk Index ( MAP Index) at recruitment, with a subset of 43 women repeating the questionnaires at the time of polysomnography at 37 weeks' gestation. Fifteen of 43 (35%) women were confirmed to have a respiratory disturbance index ( RDI) > 5 h−1. Prediction of an RDI > 5 h−1 was most accurate during the second trimester for both the Berlin Questionnaire (sensitivity 0.93, specificity 0.50, positive predictive value 0.50 and negative predictive value 0.93), and the MAP Index [area under the receiver operating characteristic ( ROC) curve of 0.768]. A stepwise selection model identified snoring volume, a body mass index ( BMI)≥32 kg m−2 and tiredness upon awakening as the strongest independent predictors of SDB during pregnancy; this model had an area under the ROC curve of 0.952. We conclude that existing clinical prediction models for SDB perform inadequately as a screening tool in pregnancy. The development of a highly predictive model from our data shows promise for a quick and easy screening tool to be validated for future use in pregnancy.
- Subjects
SLEEP apnea syndromes; POLYSOMNOGRAPHY; MEDICAL screening; SENSITIVITY (Personality trait); IMMUNOSPECIFICITY; PREGNANT women
- Publication
Journal of Sleep Research, 2013, Vol 22, Issue 6, p670
- ISSN
0962-1105
- Publication type
Article
- DOI
10.1111/jsr.12063