Augusta University, Department of Obstetrics and Gynecology, Augusta, Georgia.
Wake Forest School of Medicine, Department of Anesthesiology, Winston Salem, North Carolina.
J Clin Sleep Med. 2018 Apr 15;14(4):549-555. doi: 10.5664/jcsm.7042.
To measure prevalence and severity of third trimester obstructive sleep apnea and evaluate postpartum resolution. To assess a novel biomarker for screening for obstructive sleep apnea in pregnancy.
This prospective observational study was performed at Wake Forest School of Medicine obstetrics clinics between April 2014 and December 2015. Fractional exhaled nitric oxide measurements and sleep studies were obtained and compared at 32 0/7 to 35 6/7 weeks gestation and postpartum. Exhaled nitric oxide and risk factors for the development of gestational sleep apnea were evaluated for predictive ability independently and in screening models.
Of 76 women enrolled, 73 performed valid sleep studies in pregnancy and 65 had an additional valid study 6 to 15 weeks postpartum. Twenty-four women (37%) had gestational sleep apnea compared with 23 (35%) with postpartum sleep apnea ( > .99). Eight of 11 women (73%) retested 6 to 8 months postpartum had persistent sleep apnea. Exhaled nitric oxide had moderate discrimination screening for sleep apnea in pregnancy (area under the receiver operating characteristic curve = 0.64). A model utilizing exhaled nitric oxide, pregnancy-specific screening, and Mallampati score improved ability to identify women at risk for gestational sleep apnea (sensitivity = 46%, specificity = 91% and likelihood ratio = 5.11, area under receiver operating characteristic curve = 0.75).
Obstructive sleep apnea is common in the early postpartum period and often persisted at least 6 months. Exhaled nitric oxide as a sole biomarker to screen for sleep apnea in pregnancy has only modest discrimination. Combined with additional parameters sensitivity and specificity improved.
Registry: ClinicalTrials.gov, Identifier: NCT02100943, Title: Exhaled Nitric Oxide as a Biomarker of Gestational Obstructive Sleep Apnea and Persistence Postpartum, URL: https://clinicaltrials.gov/ct2/show/NCT02100943.
测量妊娠晚期阻塞性睡眠呼吸暂停的患病率和严重程度，并评估产后缓解情况。评估一种用于妊娠筛查阻塞性睡眠呼吸暂停的新型生物标志物。
这项前瞻性观察性研究于 2014 年 4 月至 2015 年 12 月在维克森林医学院妇产科诊所进行。在妊娠 32 0/7 至 35 6/7 周时获得并比较呼出气一氧化氮测量值和睡眠研究结果，并在产后 6 至 15 周时再次进行。评估呼出气一氧化氮和导致妊娠睡眠呼吸暂停发展的危险因素的独立预测能力，并在筛查模型中进行评估。
在 76 名入组的女性中，73 名女性在妊娠期间进行了有效的睡眠研究，65 名女性在产后 6 至 15 周时进行了另外一项有效的睡眠研究。24 名女性（37%）患有妊娠睡眠呼吸暂停，23 名女性（35%）患有产后睡眠呼吸暂停（>.99）。11 名女性中有 8 名（73%）在产后 6 至 8 个月时重复测试，结果仍有睡眠呼吸暂停。呼出气一氧化氮对妊娠睡眠呼吸暂停具有中等的筛查鉴别能力（接受者操作特征曲线下面积=0.64）。利用呼出气一氧化氮、妊娠特异性筛查和马兰巴蒂评分的模型可提高识别有妊娠睡眠呼吸暂停风险的女性的能力（敏感性=46%，特异性=91%，似然比=5.11，接受者操作特征曲线下面积=0.75）。
阻塞性睡眠呼吸暂停在产后早期很常见，并且至少有 6 个月持续存在。呼出气一氧化氮作为妊娠睡眠呼吸暂停筛查的单一生物标志物，其鉴别能力仅为中等。与其他参数相结合，可提高敏感性和特异性。
注册号：ClinicalTrials.gov，识别码：NCT02100943，标题：呼出气一氧化氮作为妊娠阻塞性睡眠呼吸暂停和产后持续存在的生物标志物，网址：https://clinicaltrials.gov/ct2/show/NCT02100943。
