0577 Sleep Apnea in Pregnancy: What We Have Learned From the Sleep Pregnancy Clinic

Abstract

Introduction: Evidence is rapidly accumulating of the prevalence of obstructive sleep apnea (OSA) and associated adverse pregnancy outcomes in the obstetrical population. We have established a cross-disciplinary collaborative Sleep Pregnancy Clinic at the University of Wisconsin Madison/Meriter Hospital, which offers streamlined screening, testing, and treatment of gestational OSA (gOSA). We performed restrospective analysis of our patient population to evaluate completion of referrals, prevalence of sleep apnea, and follow through with OSA positive airway pressure treatment (PAP). Method(s): All pregnant patients evaluated at the obstetrical clinics complete a STOP-Bang questionnaire at their first prenatal visit. Frequent (>3 days per week) or loud snoring (15 points), chronic hypertension (15 points), age, and body mass index (BMI) (absolute numbers) are used to calculate a composite score, with scores>75 mandating objective evaluation for OSA per clinical protocol, using the Alice PDX 4-channel home device. Patients meeting diagnostic criteria of respiratory disturbance index (RDI) RDI3% or 4% of 5 events/hour or greater are offered PAP therapy. We have initiated a retrospective analysis of our patient population. Result(s): Referral completion was 46%, with 49 out of 105 patients referred for gOSA evaluation completing objective sleep testing. 63% (31 out of 49 patients tested), met diagnostic criteria for gOSA with RDI3% or 4% > 5/hr. Ten percent (5/49), met 3% but not 4% diagnostic criteria. 77% had mild (RDI 5-15), 13% moderate (RDI 15-30), and 10% severe (RDI>30) gOSA, with only one patient in the mild category by 4% but moderate severity by 3%. 48% of patients meeting diagnostic criteria chose to start PAP. Conclusion(s): Completion of objective sleep testing is low at 46% in a real-world pregnant cohort. However prevalence of gOSA was high at 63%. Close to 50% of diagnosed women opted in for PAP therapy, suggesting good motivation and opportunity for therapeutic intervention in those who complete testing. Further analyses of patient characteristics and pregnancy outcomes in the group with versus without gOSA and opting for or against PAP are ongoing.