Obstructive Sleep Apnea Screening: An Overlooked Aspect of Routine Prenatal Care
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Resident PGY 4
Henry Ford Hospital
Introduction: There is no single screening measure developed to measure the severity of OSAS in pregnancy. Furthermore, the parturient population usually bypasses the pre-operative optimization clinic further decimating the chances of providing optimum intervention for OSAS. Pregnancy and the physiological changes that accompany it may precipitate or at least exacerbate the co-existing OSAS and there may be a correlation between OSAS and development of pre-eclampsia, gestational diabetes, intra-uterine growth retardation, etc. Besides the intrapartum effects of OSAS, there are anesthetic implications such as increased sensitivity to all central nervous system depressant drugs and the potential for upper airway obstruction or apnea with even minimal drug doses, difficult mask ventilation, difficult intubation, arterial hypoxemia, pulmonary hypertension and cardiac failure. Study design: Retrospective cohort analysis. Objectives: Primary: The prevalence of pre-eclampsia between a high & low risk of OSAS patient based on Berlin questionnaire. Secondary: The prevalence of gestational diabetes and other maternal and neonatal outcomes between a high and low risk of OSAS patient, based on Berlin Questionnaire and Stop-Bang screening test. Results: A total of 699 charts were analyzed retrospectively, the prevalence of high- risk for OSAS was 35.5% and it was significantly associated with high maternal BMI (p=0.003). High-risk OSA subjects were associated with a higher likelihood of pregnancy-induced hypertension and pre-eclampsia (adjusted OR 2.3, 95% CI 1.4-4.0), gestational diabetes (adjusted OR 2.1, 95% CI 1.3-3.4) and unplanned Caesarean deliveries (adjusted OR 2.1, 95% CI 1.4-3.2) after multivariable regression analysis. Conclusions: OSAS is associated with adverse perinatal outcomes. Our long-term objective is to provide a safe workflow to identify, diagnose and provide optimum intervention for high-risk OSA patients, in order to avoid adverse outcome.
Chauhan, Gaurav; Saeed, Haleema; Attali, Ami; Swain, Monique; Waldman, Brian; and Han, Xiaoxia, "Obstructive Sleep Apnea Screening: An Overlooked Aspect of Routine Prenatal Care" (2019). High Value Care. 1.