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A Retrospective Analysis of Pregnant Women Screened for Obstructive Sleep Apnea and Associated Adverse Maternal and Fetal Outcomes FREE TO VIEW

Rupinder Kullar; Sunjay Devarajan; Jennifer Pukish; Laura Parikh; Helain Landy; Cristina Reichner; Richard Waldhorn
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MedStar Georgetown University Hospital, Washington, DC

Chest. 2014;146(4_MeetingAbstracts):942A. doi:10.1378/chest.1990434
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SESSION TITLE: Sleep Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To establish the distribution of OSA risk scores in pregnant women using a modified Sleep Apnea Clinical Score (SACS) screening tool. Scores of >48 in previous studies have been shown to be predictive of moderate/severe OSA (AHI>20) in non pregnant patients. Additionally, correlations between adverse maternal/fetal outcomes were assessed in this study. This review also demonstrates local epidemiologic data pertaining to pregnancy and sleep disordered breathing.

METHODS: Retrospective single center chart review using PeriBirth® of visits to Medstar Georgetown University Hospital Labor & Delivery (L&D) unit from July-December 2012. All women routinely underwent Modified SACS at each visit to L&D. 389 patients (680 visits) during this time interval, with a completed Modified SACS were included in the analysis. Maternal conditions/outcomes examined: age, prepregnancy BMI/diabetes/HTN, gestational diabetes/HTN, chronic anemia, placentation abnormalities, eclampsia/preeclampsia/HELLP syndrome, postpartum hemorrhage, transfer to MICU. Fetal/neonatal outcomes examined: large for gestational age (LGA), small for gestational age (SGA), need for NICU, cord gas results, 5 minute Apgar, birth trauma, stillbirth, and fetal presentation.

RESULTS: Modified SACS ranged from 26 to 50, with a mean of 35.59. 75% of patients had a Modified SACS<37. Statistically significant higher Modified SACS were associated with the following conditions: prepregnancy HTN (N=25, SACS 41.44 present/35.49 absent, p<0.0001), gestational HTN (N=70, SACS 40.18 present/35.18 absent, p<0.0001), mild preeclampsia (N=31, SACS 38.82 present/35.53 absent, p=0.002), thalassemia (N=7, SACS 42.36 present/35.57 absent, p=0.0139), LGA (N=34, SACS 36.84 present/35.63 absent, p=0.0326).

CONCLUSIONS: Statistically significant higher Modified SACS in this study were associated with maternal HTN/gestational HTN, preeclampsia, thalassemia, and fetal LGA.

CLINICAL IMPLICATIONS: This is a preliminary analysis of the data of a non-validated OSA screening tool in pregnancy, which will encompass L&D visits from May 2007 to December 2012. An estimated 3,300+ patients will be included in the final analysis. Adverse maternal/fetal outcomes have been reported in patients with OSA. We will perform a multi-center prospective study using home sleep studies to validate the modified SACS as a screening questionnaire for OSA during pregnancy. A validated questionnaire may have clinical value in identifying patients for further diagnostic testing and treatment.

DISCLOSURE: The following authors have nothing to disclose: Rupinder Kullar, Sunjay Devarajan, Jennifer Pukish, Laura Parikh, Helain Landy, Cristina Reichner, Richard Waldhorn

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