Predictors of sleep-disordered breathing in pregnancy

Judette M. Louis, Matthew A. Koch, Uma M. Reddy, Robert M. Silver, Corette B. Parker, Francesca L. Facco, Susan Redline, Chia Ling Nhan-Chang, Judith H. Chung, Grace W. Pien, Robert C. Basner, William A. Grobman, Deborah A. Wing, Hyagriv N. Simhan, David M. Haas, Brian M. Mercer, Samuel Parry, Daniel Mobley, Benjamin Carper, George SaadeFrank P. Schubert, Phyllis C. Zee

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)521.e1-521.e12
JournalAmerican Journal of Obstetrics and Gynecology
Volume218
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Sleep Apnea Syndromes
Pregnancy
Snoring
Logistic Models
Sleep
Apnea
Body Mass Index
ROC Curve
Blood Pressure
Restless Legs Syndrome
Aptitude
Maternal Age
Sleep Initiation and Maintenance Disorders
Fatigue
Pregnant Women
Appointments and Schedules
Neck
Odds Ratio
Clinical Trials
Confidence Intervals

Keywords

  • home sleep test
  • prediction
  • pregnancy
  • sleep-disordered breathing

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Louis, J. M., Koch, M. A., Reddy, U. M., Silver, R. M., Parker, C. B., Facco, F. L., ... Zee, P. C. (2018). Predictors of sleep-disordered breathing in pregnancy. American Journal of Obstetrics and Gynecology, 218(5), 521.e1-521.e12. https://doi.org/10.1016/j.ajog.2018.01.031

Predictors of sleep-disordered breathing in pregnancy. / Louis, Judette M.; Koch, Matthew A.; Reddy, Uma M.; Silver, Robert M.; Parker, Corette B.; Facco, Francesca L.; Redline, Susan; Nhan-Chang, Chia Ling; Chung, Judith H.; Pien, Grace W.; Basner, Robert C.; Grobman, William A.; Wing, Deborah A.; Simhan, Hyagriv N.; Haas, David M.; Mercer, Brian M.; Parry, Samuel; Mobley, Daniel; Carper, Benjamin; Saade, George; Schubert, Frank P.; Zee, Phyllis C.

In: American Journal of Obstetrics and Gynecology, Vol. 218, No. 5, 01.05.2018, p. 521.e1-521.e12.

Research output: Contribution to journalArticle

Louis, JM, Koch, MA, Reddy, UM, Silver, RM, Parker, CB, Facco, FL, Redline, S, Nhan-Chang, CL, Chung, JH, Pien, GW, Basner, RC, Grobman, WA, Wing, DA, Simhan, HN, Haas, DM, Mercer, BM, Parry, S, Mobley, D, Carper, B, Saade, G, Schubert, FP & Zee, PC 2018, 'Predictors of sleep-disordered breathing in pregnancy', American Journal of Obstetrics and Gynecology, vol. 218, no. 5, pp. 521.e1-521.e12. https://doi.org/10.1016/j.ajog.2018.01.031
Louis JM, Koch MA, Reddy UM, Silver RM, Parker CB, Facco FL et al. Predictors of sleep-disordered breathing in pregnancy. American Journal of Obstetrics and Gynecology. 2018 May 1;218(5):521.e1-521.e12. https://doi.org/10.1016/j.ajog.2018.01.031
Louis, Judette M. ; Koch, Matthew A. ; Reddy, Uma M. ; Silver, Robert M. ; Parker, Corette B. ; Facco, Francesca L. ; Redline, Susan ; Nhan-Chang, Chia Ling ; Chung, Judith H. ; Pien, Grace W. ; Basner, Robert C. ; Grobman, William A. ; Wing, Deborah A. ; Simhan, Hyagriv N. ; Haas, David M. ; Mercer, Brian M. ; Parry, Samuel ; Mobley, Daniel ; Carper, Benjamin ; Saade, George ; Schubert, Frank P. ; Zee, Phyllis C. / Predictors of sleep-disordered breathing in pregnancy. In: American Journal of Obstetrics and Gynecology. 2018 ; Vol. 218, No. 5. pp. 521.e1-521.e12.
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abstract = "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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T1 - Predictors of sleep-disordered breathing in pregnancy

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AU - Koch, Matthew A.

AU - Reddy, Uma M.

AU - Silver, Robert M.

AU - Parker, Corette B.

AU - Facco, Francesca L.

AU - Redline, Susan

AU - Nhan-Chang, Chia Ling

AU - Chung, Judith H.

AU - Pien, Grace W.

AU - Basner, Robert C.

AU - Grobman, William A.

AU - Wing, Deborah A.

AU - Simhan, Hyagriv N.

AU - Haas, David M.

AU - Mercer, Brian M.

AU - Parry, Samuel

AU - Mobley, Daniel

AU - Carper, Benjamin

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AU - Schubert, Frank P.

AU - Zee, Phyllis C.

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N2 - 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.

AB - 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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KW - prediction

KW - pregnancy

KW - sleep-disordered breathing

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