title: Epworth sleepiness scale scores and adverse pregnancy outcomes.
abstract: OBJECTIVE
  Snoring is associated with adverse pregnancy outcomes including gestational hypertensive disorders, gestational diabetes, and Cesarean deliveries. The purpose of this study was to assess whether excessive daytime sleepiness (EDS) assessed by Epworth Sleepiness Scale (ESS) increases the risk of these complications further.
  
  
  METHODS
  Following institutional review board approval and informed consent, English-speaking women in the immediate postpartum period were systematically selected and recruited. Women answered a survey that included questions regarding symptoms of sleep-disordered breathing (SDB) using the multivariable apnea prediction index and excessive daytime sleepiness using ESS. Pregnancy and fetal outcomes were collected by review of medical records. Standard statistical analysis with multivariable logistic regression was performed. ESS was evaluated both as a continuous variable and with various cutoffs given that pregnant women are likely more sleepy at baseline than the general population.
  
  
  RESULTS
  In patients who underwent planned Cesarean delivery, mean ESS was significantly higher than in those with uncomplicated vaginal delivery, even after adjusting for confounders (adjusted odds ratio (aOR), 1.08; 95 % CI, 1.01-1.15; p = 0.02). There was no significant association between EDS (defined as ESS of >10) and gestational diabetes or gestational hypertensive disorders in snorers or non snorers. However, a significant association with gestational diabetes was found in patients with an ESS of >16 compared to those with an ESS of ≤16, even after multiple adjustments (aOR, 6.82; 95 % CI, 1.19-39.27), but the number of subjects in an ESS of >16 category was small.
  
  
  CONCLUSIONS
  There is an increased association between women with higher ESS and planned Cesarean delivery. Severe EDS was associated with gestational diabetes in pregnant women in a small sample size. Future studies in larger samples need to confirm the association of severe EDS and gestational diabetes and elucidate potential mechanisms of the links with adverse outcomes.
authors: Department of Medicine, The Miriam Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA, ghada_bourjeily@brown.edu.
authors: Ghada
authors: G
authors: Bourjeily
authors: Rana
authors: R
authors: El Sabbagh
authors: Peter
authors: P
authors: Sawan
authors: Christina
authors: C
authors: Raker
authors: Carren
authors: C
authors: Wang
authors: Beth
authors: B
authors: Hott
authors: Mariam
authors: M
authors: Louis
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000209:etiology; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis / Q000453:epidemiology; D007231:Infant, Newborn; D008875:Middle Aged; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000209:etiology; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D012913:Snoring / Q000175:diagnosis / Q000453:epidemiology; D013223:Statistics as Topic; D011795:Surveys and Questionnaires