title: Screening of obstructive sleep apnea during pregnancy: differences in predictive values of questionnaires across trimesters.
abstract: OBJECTIVE
  Evaluation of Berlin and Stop-Bang questionnaires in detecting obstructive sleep apnea (OSA) across trimesters of pregnancy.
  
  
  METHODS
  Pregnant women from a high-risk pregnancy clinic were recruited to complete sleep evaluations including Berlin and Stop-Bang Questionnaires. Overnight testing with Watch-PAT200 for diagnosis of OSA (cutoff point of apnea-hypopnea index ≥5 events/h) was performed.
  
  
  RESULTS
  Seventy-two singleton pregnant women participated in the study. Enrollment consisted of 23, 24, and 25 women during first, second, and third trimesters, respectively. Of 72 pregnancies, 23 patients (31.9%) had OSA. Prevalence of OSA classified by trimesters from first to third was 30.4%, 33.33%, and 32.0%, respectively. Overall predictive values of Berlin and Stop-Bang questionnaires were fair (ROC area under curve, AUC 0.72 for Berlin, p = 0.003; 0.75 for Stop-Bang, p = 0.001). When categorized according to trimesters, predictive values substantially improved in second (AUC: 0.84 for Berlin; 0.78 for Stop-Bang) and third trimesters (AUC: 0.81 for Berlin; 0.75 for Stop-Bang), whereas performances of both questionnaires during first trimester were poorer (AUC: 0.49 for Berlin; 0.71 for Stop-Bang). Multivariate analyses show that pre-pregnancy body mass index (BMI) in first trimester, snore often in second trimester, and weight gain and pregnancy BMI in third trimester were significantly associated with OSA.
  
  
  CONCLUSIONS
  In high-risk pregnancy, Berlin and Stop-Bang questionnaires were of limited usefulness in the first trimester. However their predictive values are acceptable as pregnancy progresses, particularly in second trimester. OSA in pregnancy seems to be a dynamic process with different predictors association during each trimester.
authors.affiliation: Ramathibodi Hospital Sleep Disorder Center, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandL: Division of Pulmonary and Critical Care Unit, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Visasiri
authors.initials: V
authors.lastname: Tantrakul
authors.affiliation: Division of Pulmonary and Critical Care Unit, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand: Chiangrai Prachanukoh Hospital, Chiang Rai, Thailand.
authors.forename: Piyaporn
authors.initials: P
authors.lastname: Sirijanchune
authors.affiliation: Division of Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Panyu
authors.initials: P
authors.lastname: Panburana
authors.affiliation: Ramathibodi Hospital Sleep Disorder Center, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Janejira
authors.initials: J
authors.lastname: Pengjam
authors.affiliation: Ramathibodi Hospital Sleep Disorder Center, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Worakot
authors.initials: W
authors.lastname: Suwansathit
authors.affiliation: Division of Pulmonary and Critical Care Unit, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Viboon
authors.initials: V
authors.lastname: Boonsarngsuk
authors.affiliation: Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, CA.
authors.forename: Christian
authors.initials: C
authors.lastname: Guilleminault
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D017286:Polysomnography / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D015203:Reproducibility of Results; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis*; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: Berlin questionnaire; Obstructive sleep apnea; Screening questionnaire; Stop-Bang questionnaire; pregnancy