Determination of the Predictors of Nocturnal Desaturation in Postpartum Women
Condition: Sleep Disordered Breathing; Nocturnal Oxygen Desaturation; Upper Airway Edema
MeSH terms: Sleep Apnea Syndromes
Study type: Interventional

Summary: 
      The primary aim of the study is to evaluate the effect of the method of delivery (vaginal
      delivery vs. cesarean section) on oxygen saturation in the first postpartum night. The
      investigators hypothesize that nocturnal desaturation occurs more frequently in cesarean
      section compared with vaginal delivery, expressed as either the duration of SpO2 below 90% or
      the Oxygen Desaturation Index (ODI). The ODI is defined as number of oxygen desaturations by
      at least 3 % per hour. Furthermore, the investigators expect a higher pulse rate and a lower
      mean and minimum SpO2 in the cesarean section group compared with the vaginal delivery group.

      The secondary aim of the study is to investigate how the upper body position during sleep (45
      degree elevated vs. non-elevated) affects the oxygen saturation during the first postpartum
      night.

      The investigators hypothesize that an upper body elevation to 45 degrees decreases the
      incidence of desaturation events, expressed as either the duration of SpO2 below 90% or the
      ODI , compared with a non-elevated body position within each delivery group (vaginal delivery
      or cesarean section).

      The third aim of the study is to identify independent predictors of nocturnal desaturation in
      postpartum women. To that end, the investigators will administer questionnaires and collect
      demographic and clinical data according to various obstructive sleep apnea screening scores,
      including the P-SAP, STOP-Bang, and Epworth Sleepiness Scale. The investigators will also ask
      the patient to rate the pain during the study night on a verbal numerical rating scale.
    

Detailed description: 
      Sleep-disordered breathing is common in pregnancy, persisting into the early postpartum
      period. Postpartum airway obstruction is a main cause of anesthesia-related maternal death in
      North America. Upper airway edema following labor and delivery may impair pharyngeal anatomy,
      which can lead to increased vulnerability of the airway collapse during sleep.

      This study evaluates whether the kind of delivery (vaginal birth versus cesarean section) has
      an effect on nocturnal desaturation in the first night after delivery. Furthermore, the
      investigators examine if the upper body position during sleep has an effect on the occurrence
      of oxygen desaturation.

      In addition, the investigators evaluate if preexisting conditions, as indicated by a high
      P-SAP or STOP-Bang-score increase the likelihood of nocturnal desaturation.
    

Intervention name(s): Forty-five degrees elevated upper body position; non-elevated upper body position; Noninvasive wrist pulse oximeter (WristOx Model 3150); Stop-Bang questionnaire; Epworth Sleepiness Scale; P-SAP Score; self-reported pain
Intervention type(s): Procedure; Procedure; Device; Other; Other; Other; Other
Intervention description(s): The noninvasive wrist pulse oximeter (WristOx Model 3150) is used to measure the SpO2 and the pulse rate of the patient in the first night after delivery.; The Stop-Bang questionnaire is a well-established clinical tool to quantify the risk factors of Obstructive Sleep Apnea, which can lead to desaturation in the patient. The STOP Bang questionnaire includes snoring, tiredness, observed apneas, blood pressure, Body Mass Index, age, neck circumference and gender.
The investigators will ask the patient to answer the questionnaire and measure the neck circumference.; The Epworth Sleepiness Scale is a well-established clinical tool to quantify daytime sleepiness. It is clinically used for the diagnosis of sleep disorders.
The investigators will ask the patient to complete the questionnaire and will specify that the questionnaire pertains to the patient's pre-admission condition.; The P-SAP Score is a well-established clinical tool to quantify the risk factors of Obstructive Sleep Apnea, which can lead to desaturation in the patient.
The investigators will ask the patient to answer the questionnaire and will assess the Mallampati Score. The investigators will also measure the neck circumference and the Thyromental distance.; A verbal numerical rating scale is used to asses the pain during the study-night.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment