Incidence of Obstructive Sleep Apnea in Pregnancy
Condition: Obstructive Sleep Apnea; Pregnancy
MeSH terms: Apnea; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
Study type: Observational

Summary: 
      Obstructive sleep apnea is a condition characterized by obstruction of the upper airways and
      episodes of apnea and hypopnea during sleep. It is associated with significant adverse health
      effects. The incidence of obstructive sleep apnea in the general female population is
      approximately 2% but the incidence of obstructive sleep apnea in pregnancy is unknown. There
      is some evidence that pregnancy precipitates or at least exacerbates this condition and that
      there may be a relationship between intrauterine fetal growth retardation and maternal
      preeclampsia. In addition, there are several anesthetic implications that are concern for the
      patient with obstructive sleep apnea. These include: exquisite 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; arterial hypercarbia; polycythemia; hypertension; pulmonary hypertension and
      cardiac failure. All of these conditions pose significant anesthetic risk for the patient,
      and this risk may be increased further by pregnancy.
    

Detailed description: 
      All patients presenting to the Prentice Women's Hospital's (PWH) Labor and Delivery Unit for
      spontaneous labor, induction of labor and scheduled cesarean delivery are routinely
      interviewed by a member of the anesthesia team to obtain a detailed history and physical
      examination and to discuss labor analgesia options. Immediately following this usual and
      customary preanesthetic evaluation the member of the anesthesia team performing the
      preanesthetic consultation (anesthesiology attending, resident physician, or nurse) used a
      standard verbal consent script to obtain verbal consent from the subject for study
      participation. Study participants were asked to complete a written validated survey, the
      Berlin Questionnaire, evaluating self-reported snoring and daytime sleepiness as well as
      basic demographic data (age, height, current weight and pregnancy weight gain). Survey
      completion time was 1 to 2 minutes.

      The survey was available in English and Spanish. It did not contain any subject personal
      health information. The survey sheet remained in the labor and delivery room with the
      subject's usual anesthesia medical record paperwork until the patient was discharged from the
      unit. At the time of discharge, the infant's birthweight and APGAR scores were recorded on
      the survey and the survey collected.

      All female patients, ages 18 - 45, presenting to the PWH Operating Room for elective
      gynecologic surgery, and all female patients, ages 18 - 45, presenting to the Northwestern
      Memorial Hospital (NMH) Ambulatory Surgery Center were interviewed by a member of the
      anesthesia team to obtain a routine preoperative history and physical examination and to
      discuss the anesthesia options. Immediately following this usual and customary preanesthetic
      evaluation the member of the anesthesia team performing the preanesthetic consultation
      (anesthesiology attending, resident physician, or certified registered nurse anesthetist)
      used a standard verbal consent script to obtain verbal consent from the subject for study
      participation. Study participants were asked to complete a written validated survey, the
      Berlin Questionnaire, evaluating self-reported snoring and daytime sleepiness as well as
      basic demographic data (age, height, and weight). The survey was available in English and
      Spanish. Survey completion time was 1-2 minutes. The survey did not contain any patient
      identifying information and was collected after completion.
    

Intervention name(s): Survey: Berlin questionnaire
Intervention type(s): Procedure
Intervention description(s): Completion of questionnaire
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Pregnant females spontaneously laboring, scheduled for induction of labor or scheduled for
        a cesarean delivery, and non-pregnant females presenting for outpatient surgery between the
        ages of 18-45.
      
Keywords: Obstructive Sleep Apnea; Pregnancy; Berlin Questionnaire