title: Performance of screening questionnaires for obstructive sleep apnea during pregnancy: A systematic review and meta-analysis.
abstract: This review aims to evaluate the performance of obstructive sleep apnea (OSA) screening questionnaires during pregnancy. A systematic review and meta-analysis was performed using MEDLINE Scopus, CINAHL, and the Cochrane library. A bivariate meta-analysis was applied for pooling of diagnostic parameters. Six of the total 4719 articles met the inclusion criteria. The Berlin questionnaire (BQ, N = 604) and Epworth sleepiness scale (ESS, N = 420) were the most frequently used screening tools during pregnancy. The pooled prevalence of OSA during pregnancy was 26.7% (95%CI: 16.9%, 34.4%, I2= 83.15%). BQ performance was poor to fair with pooled sensitivity and specificity of 0.66 (95%CI: 0.45, 0.83; I2= 78.65%) and 0.62 (95%CI: 0.48, 0.75; I2= 81.55%), respectively. BQ performance was heterogeneous depending on type of reference test and pregnancy. Sensitivity increased if diagnosis was based on polysomnography (0.90), and respiratory disturbance index (0.90). However, sensitivity decreased if screening was performed in early pregnancy (≤20 weeks gestation: 0.47), and high-risk pregnancy (0.44). Performance of ESS was poor with pooled sensitivity and specificity of 0.44 (95%CI: 0.33, 0.56; I2= 32.8%) and 0.62 (95%CI: 0.48, 0.75; I2= 81.55%), respectively. In conclusion, BQ and ESS showed poor performance during pregnancy, hence a new OSA screening questionnaire is needed. Registration: PROSPERO registration CRD42015025848.
authors.affiliation: Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Ramathibodi Hospital Sleep Disorder Center and Division of Pulmonary and Critical Care, Medicine Department, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Visasiri
authors.initials: V
authors.lastname: Tantrakul
authors.affiliation: Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address: pawin.num@mahidol.ac.th.
authors.forename: Pawin
authors.initials: P
authors.lastname: Numthavaj
authors.affiliation: Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, CA, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Guilleminault
authors.affiliation: Hunter Medical Research Institute and School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: McEvoy
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: Department of Preventive and Social Medicine, University of Medicine, Mandalay, Myanmar.
authors.forename: Win
authors.initials: W
authors.lastname: Khaing
authors.affiliation: Hunter Medical Research Institute and School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.affiliation: Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Ammarin
authors.initials: A
authors.lastname: Thakkinstian
mesh_terms: D000328:Adult; D001604:Berlin; D005260:Female; D006801:Humans; D008403:Mass Screening; D017286:Polysomnography / Q000379:methods; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Berlin questionnaire; Epworth sleepiness scale; Obstructive sleep apnea; Pregnancy; Systematic review