Case Western Reserve University, Cleveland, OH.
RTI International, Research Triangle Park, NC.
Am J Obstet Gynecol. 2018 May;218(5):521.e1-521.e12. doi: 10.1016/j.ajog.2018.01.031. Epub 2018 Feb 2.
Sleep-disordered breathing (SDB) is common in pregnancy, but there are limited data on predictors.
The objective of this study was to develop predictive models of sleep-disordered breathing during pregnancy.
Nulliparous women completed validated questionnaires to assess for symptoms related to snoring, fatigue, excessive daytime sleepiness, insomnia, and restless leg syndrome. The questionnaires included questions regarding the timing of sleep and sleep duration, work schedules (eg, shift work, night work), sleep positions, and previously diagnosed sleep disorders. Frequent snoring was defined as self-reported snoring ≥3 days per week. Participants underwent in-home portable sleep studies for sleep-disordered breathing assessment in early (6-15 weeks gestation) and mid pregnancy (22-31 weeks gestation). Sleep-disordered breathing was characterized by an apnea hypopnea index that included all apneas, plus hypopneas with ≥3% oxygen desaturation. For primary analyses, an apnea hypopnea index ≥5 events per hour was used to define sleep-disordered breathing. Odds ratios and 95% confidence intervals were calculated for predictor variables. Predictive ability of the logistic models was estimated with area under the receiver-operating-characteristic curves, along with sensitivities, specificities, and positive and negative predictive values and likelihood ratios.
Among 3705 women who were enrolled, data were available for 3264 and 2512 women in early and mid pregnancy, respectively. The corresponding prevalence of sleep-disordered breathing was 3.6% and 8.3%, respectively. At each time point in gestation, frequent snoring, chronic hypertension, greater maternal age, body mass index, neck circumference, and systolic blood pressure were associated most strongly with an increased risk of sleep-disordered breathing. Logistic regression models that included current age, body mass index, and frequent snoring predicted sleep-disordered breathing in early pregnancy, sleep-disordered breathing in mid pregnancy, and new onset sleep-disordered breathing in mid pregnancy with 10-fold cross-validated area under the receiver-operating-characteristic curves of 0.870, 0.838, and 0.809. We provide a supplement with expanded tables, integrated predictiveness, classification curves, and an predicted probability calculator.
Among nulliparous pregnant women, logistic regression models with just 3 variables (ie, age, body mass index, and frequent snoring) achieved good prediction of prevalent and incident sleep-disordered breathing. These results can help with screening for sleep-disordered breathing in the clinical setting and for future clinical treatment trials.
睡眠呼吸障碍（SDB）在妊娠中很常见，但关于其预测因素的资料有限。
本研究旨在建立妊娠期间睡眠呼吸障碍的预测模型。
初产妇完成了经过验证的问卷，以评估与打鼾、疲劳、日间嗜睡、失眠和不宁腿综合征相关的症状。问卷包括关于睡眠时间和睡眠持续时间、工作时间表（例如，轮班工作、夜班工作）、睡眠姿势以及先前诊断的睡眠障碍的问题。频繁打鼾定义为每周报告打鼾≥3 天。参与者在家中进行便携式睡眠研究，以评估妊娠早期（6-15 周妊娠）和中期（22-31 周妊娠）的睡眠呼吸障碍。睡眠呼吸障碍的特征是呼吸暂停低通气指数，包括所有呼吸暂停，以及伴有≥3%氧饱和度下降的呼吸暂停。对于主要分析，使用每小时≥5 次呼吸暂停低通气事件来定义睡眠呼吸障碍。计算预测变量的比值比和 95%置信区间。使用受试者工作特征曲线下的面积来估计逻辑模型的预测能力，以及敏感性、特异性、阳性和阴性预测值和似然比。
在纳入的 3705 名女性中，分别有 3264 名和 2512 名女性在妊娠早期和中期获得了数据。相应的睡眠呼吸障碍患病率分别为 3.6%和 8.3%。在妊娠的每个时间点，频繁打鼾、慢性高血压、年龄较大、体重指数、颈围和收缩压与睡眠呼吸障碍风险增加最密切相关。包含当前年龄、体重指数和频繁打鼾的逻辑回归模型预测了妊娠早期的睡眠呼吸障碍、妊娠中期的睡眠呼吸障碍以及妊娠中期的新发睡眠呼吸障碍，10 倍交叉验证的受试者工作特征曲线下面积分别为 0.870、0.838 和 0.809。我们提供了一个补充资料，其中包含扩展表格、综合预测性、分类曲线和预测概率计算器。
在初产妇中，仅使用 3 个变量（即年龄、体重指数和频繁打鼾）的逻辑回归模型就能很好地预测现患和新发的睡眠呼吸障碍。这些结果有助于在临床环境中筛查睡眠呼吸障碍，并为未来的临床治疗试验提供参考。
