Development of a Pregnancy-Specific Screening Tool for Sleep Apnea

Study Objective: The Berlin Questionnaire and Epworth Sleepiness Scale (ESS) are commonly used to screen for sleep apnea in non-pregnant populations. We sought to evaluate the Berlin and ESS in pregnancy and to determine whether an alternative screening approach could better detect sleep apnea in pregnant women. Methods: Pregnant women at high risk for sleep apnea (women with chronic hypertension, pre-gestational diabetes, obesity, and/or a prior history of preeclampsia) completed a sleep survey composed of the Berlin and ESS, and participated in an overnight sleep evaluation with the Watch-PAT100 (WP100), a wrist-mounted device designed to diagnose sleep apnea, defined as an apnea hypopnea index >= 5. Using multivariable statistics, demographic, clinical, and subjective symptoms that were independently associated with sleep apnea were determined and a prediction rule for the presence of sleep apnea was developed. The predictive capacity of this newly developed system was compared to that of the Berlin and ESS using receiver-operating curve (ROC) statistics. Results: Of the 114 women who participated and had a valid WP100 study, 100 completed the Berlin and 96 the ESS. The Berlin and ESS did not accurately predict sleep apnea in this high-risk pregnancy cohort, with ROC area under the curves (AUC) of 0.54 (p = 0.6) and 0.57 (p = 0.3), respectively. Conversely, a model incorporating frequent snoring, chronic hypertension, age, and body mass index performed significantly better (AUC 0.86, p > 0.001). Conclusion: The Berlin and ESS are not appropriate tools to screen for sleep apnea in high-risk pregnant women. Conversely, our four-variable model more accurately predicts sleep apnea in pregnancy.