title: Excessive daytime sleepiness in late pregnancy may not always be normal: results from a cross-sectional study.
abstract: OBJECTIVE
  Many changes that normally occur during pregnancy disrupt sleep and may lead to excessive daytime sleepiness (EDS). However, given that pregnancy may also predispose to the development of sleep-disordered breathing (SDB), we sought to investigate whether EDS may be associated with snoring, gasping, or apneas, further suggesting SDB.
  
  
  METHODS
  A cross-sectional survey of women in the immediate postpartum period was conducted. Participants answered questions from the multivariable apnea prediction index regarding snoring, gasping, and witnessed apneas in the last 3 months of pregnancy. Participants were also asked to answer Epworth Sleepiness Scale (ESS) questions, and a score 0-24 was calculated (>10 considered abnormal). Medical history and medication use were obtained both by history and review of the medical record.
  
  
  RESULTS
  Out of 1,000 women recruited, 990 women answered the ESS questionnaire completely. Mean prepregnancy body mass index (BMI) was 26.1 ± 6.2 with 21.7 % of the sample having a prepregnancy BMI ≥30. Mean ESS score was 7.1 ± 3.9, and 1.7 % of the total sample scored 16 or greater. ESS increased significantly with age, BMI, and neck circumference. All three symptoms of SDB were associated with higher mean ESS scores. In a multiple linear regression analysis, loud snoring, gasping, and apneas were statistically significant independent predictors of mean ESS score.
  
  
  CONCLUSIONS
  EDS measured by ESS is a common finding in pregnancy. Snoring, gasping, and apneas appear to be independent predictors of mean ESS scores.
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, Women's Medicine Collaborative of Lifespan, The Miriam Hospital, The Warren Alpert Medical School of Brown University, 146 West River Street, Suite 11 C, Providence, RI 02904, USA. ghada_bourjeily@brown.edu
authors.forename: Ghada
authors.initials: G
authors.lastname: Bourjeily
authors.forename: Christina
authors.initials: C
authors.lastname: Raker
authors.forename: Michel
authors.initials: M
authors.lastname: Chalhoub
authors.forename: Margaret
authors.initials: M
authors.lastname: Miller
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology; D011263:Pregnancy Trimester, Third; D012237:Rhode Island; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires