Obstructive sleep apnea screening in pregnancy, perinatal outcomes, and impact of maternal obesity

We employed accepted, validated symptom-based screening measures to discern attributable risk of obstructive sleep apnea (OSA) to adverse pregnancy outcomes, taking into account potential maternal confounders. Commonly employed OSA screening measures (Berlin and Epworth scales) were performed in the second and third trimesters; maternal and neonatal outcome data were thereafter obtained. The relationship between OSA and outcomes of interest were explored in stratified and multivariate models controlling for potential confounders. The overall prevalence of OSA was 25.4%. Given a nonlinear increase by body mass index (BMI) strata (8.9%, 46%; p<0.0001), stratified multivariate analysis was subsequently performed. Among nonobese (BMI <30) gravidae, frequency of preeclampsia was significantly higher among women with OSA (adjusted odds ratio=6.58, 95% confidence interval=1.04, 38.51; p=0.035). Among the obese (BMI 30) gravidae, infant birth weight ratio (or birth weight by gestational age) was higher with OSA+screening than OSA(1.099 versus 1.035; p=0.04), and this association remained significant after adjustment for potential confounders (p=0.05). OSA prevalence increases significantly among obese gravidae, raising concerns for the overall validity of commonly employed screening measures in pregnancy. Nevertheless, OSA status continues to exert an independent influence, as obese and nonobese gravidae are at increased risk for a limited number of adverse perinatal outcomes in multivariate models.