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Obstructive sleep apnea in pregnancy: performance of a rapid screening tool

  • Sleep and Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

The Sleep Apnea Symptom Score (SASS) has been commonly used to assess obstructive sleep apnea (OSA). The aim of this study was to examine the psychometric properties of the SASS and the predictive value of SASS incorporating bedpartner-reported information in identifying OSA in pregnant women.

Methods

A cohort of healthy pregnant women completed the SASS and Pittsburgh Sleep Quality Index. Participants underwent overnight laboratory polysomnography (PSG) monitoring. Reliability and validity of the SASS were evaluated. A multivariable predictive model, incorporating the SASS score along with BMI, age, and bedpartner-reported information, was developed to assess the risk for OSA (AHI ≥ 5 events/h). Receiver operating characteristic curves for OSA were constructed to evaluate the sensitivity and specificity of the predictive model.

Results

A total of 126 and 105 participants completed the PSG during the first and third trimester, respectively. The SASS demonstrated adequate validity and acceptable reliability (Cronbach’s α = 0.72 during the third trimester). When the combined model consisting of SASS, age, BMI, and bedpartner-reported information was used, the area under the curve for AHI ≥ 5 for the first and third trimester was 0.781 (95%CI 0.648, 0.914) and 0.842 (95%CI 0.732, 0.952), respectively; the sensitivity/specificity was 76.9%/72.4% and 82.4%/78.0%, respectively.

Conclusions

The SASS alone has acceptable reliability and validity, but limited predictive values. A new tool, combining the SASS and other patient characteristics (i.e., age, BMI, and bedpartner-reported snoring and breathing pauses), demonstrated improved sensitivity and specificity, and thus may have greater utility in clinical practice for predicting OSA in pregnant women.

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Funding

This study was funded by the National Institutes of Health (T32 HL07713 and 5K23HD041465).

Author information

Authors and Affiliations

  1. College of Nursing, University of Illinois at Chicago, Chicago, IL, USA

    Bilgay Izci Balserak

  2. School of Nursing, Shanghai Jiao Tong University, 227 S Chongqing Rd, Shanghai, 200025, China

    Bingqian Zhu

  3. Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA

    Michael A. Grandner

  4. Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Nicholas Jackson

  5. School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Grace W. Pien

Authors
  1. Bilgay Izci Balserak
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  2. Bingqian Zhu
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  3. Michael A. Grandner
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  4. Nicholas Jackson
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  5. Grace W. Pien
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Corresponding author

Correspondence to Bingqian Zhu.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Balserak, B.I., Zhu, B., Grandner, M.A. et al. Obstructive sleep apnea in pregnancy: performance of a rapid screening tool. Sleep Breath 23, 425–432 (2019). https://doi.org/10.1007/s11325-018-1724-5

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  • DOI: https://doi.org/10.1007/s11325-018-1724-5

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