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Predictors of sleep-disordered breathing in pregnancy
Open accessAbstract
BACKGROUND Sleep‐disordered breathing (SDB) is common in pregnancy, but there are limited data on predictors. OBJECTIVES The objective of this study was to develop predictive models of sleep‐disordered breathing during pregnancy. STUDY DESIGN Nulliparous women completed validated questionnaires to assess for symptoms related to snoring, fatigue, excessive daytime sleepiness, insomnia, and restless leg syndrome. The questionnaires included questions regarding the timing of sleep and sleep duration, work schedules (eg, shift work, night work), sleep positions, and previously diagnosed sleep disorders. Frequent snoring was defined as self‐reported snoring ≥3 days per week. Participants underwent in‐home portable sleep studies for sleep‐disordered breathing assessment in early (6–15 weeks gestation) and mid pregnancy (22–31 weeks gestation). Sleep‐disordered breathing was characterized by an apnea hypopnea index that included all apneas, plus hypopneas with ≥3% oxygen desaturation. For primary analyses, an apnea hypopnea index ≥5 events per hour was used to define sleep‐disordered breathing. Odds ratios and 95% confidence intervals were calculated for predictor variables. Predictive ability of the logistic models was estimated with area under the receiver‐operating‐characteristic curves, along with sensitivities, specificities, and positive and negative predictive values and likelihood ratios. RESULTS Among 3705 women who were enrolled, data were available for 3264 and 2512 women in early and mid pregnancy, respectively. The corresponding prevalence of sleep‐disordered breathing was 3.6% and 8.3%, respectively. At each time point in gestation, frequent snoring, chronic hypertension, greater maternal age, body mass index, neck circumference, and systolic blood pressure were associated most strongly with an increased risk of sleep‐disordered breathing. Logistic regression models that included current age, body mass index, and frequent snoring predicted sleep‐disordered breathing in early pregnancy, sleep‐disordered breathing in mid pregnancy, and new onset sleep‐disordered breathing in mid pregnancy with 10‐fold cross‐validated area under the receiver‐operating‐characteristic curves of 0.870, 0.838, and 0.809. We provide a supplement with expanded tables, integrated predictiveness, classification curves, and an predicted probability calculator. CONCLUSION Among nulliparous pregnant women, logistic regression models with just 3 variables (ie, age, body mass index, and frequent snoring) achieved good prediction of prevalent and incident sleep‐disordered breathing. These results can help with screening for sleep‐disordered breathing in the clinical setting and for future clinical treatment trials.
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“Other studies have identified similar risk factors for gestational OSA.1005,1006”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1005]
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Metadata
- Authors
- Louis, J. M., Koch, M. A., Reddy, U. M., Silver, R. M., Parker, C. B., Facco, F. L., Redline, S., Nhan-Chang, C.-L., Chung, J. H., Pien, G. W., Basner, R. C., Grobman, W. A., Wing, D. A., Simhan, H. N., Haas, D. M., Mercer, B. M., Parry, S., Mobley, D., Carper, B., Saade, G. R., Schubert, F. P., & Zee, P. C.
- Affiliations
- Case Western Reserve University (US)
- RTI International (US)
- National Institutes of Health (US)
- University of Utah (US)
- University of Pittsburgh (US)
- Harvard University (US)
- Johns Hopkins University (US)
- Columbia University (US)
- Northwestern University (US)
- University of California, Irvine (US)
- Indiana University Indianapolis (US)
- University of Pennsylvania (US)
- Brigham and Women's Hospital (US)
- The University of Texas Medical Branch at Galveston (US)
- Corresponding author
- Louis, Judette M.
- ORCID
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2018-05
- Volume
- 218
- Issue
- 5
- Pages
- 521.e1-521.e12
- ISSN
- 0002-9378 (ISSN-L)
- PMC
- PMC5916044
- OpenAlex
- W2789139446
- Semantic Scholar
- 75a7f620e130a5f5d19e14c9af31b3ad786dbb0c
- Cited by
- 106
- References
- 40
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 10 · 2023: 11 · 2022: 18 · 2021: 14 · 2020: 15 · 2019: 18 · 2018: 4
- FWCI
- 8.77
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- RTI International
- National Heart, Lung, and Blood Institute
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD063053, U10HD063046, U10HD063020, U10HD063072, U10HD063048, U10HD063041, U10HD063047, U10HD063036, U10HD063037, UG1HD040512)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- sleep-disordered breathing, pregnancy, snoring, body mass index, maternal age, chronic hypertension, neck circumference, apnea-hypopnea index, sleep apnea screening, risk factors, nulliparous women, home sleep monitoring, insomnia, restless legs syndrome, excessive daytime sleepiness, shift work, sleep duration, sleep position, body mass index calculator
- MeSH terms
- Adolescent, Adult, Blood Pressure, Female, Humans, Hypertension, Maternal Age, Pregnancy, Pregnancy Complications, Risk Factors, Sleep Apnea Syndromes, Snoring, Body Mass Index, Prevalence, Polysomnography, Young Adult
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