Siriyotha Sukanya, Tantrakul Visasiri, Plitphonganphim Supada, Rattanasiri Sasivimol, Thakkinstian Ammarin
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Medicine Department, Division of Sleep Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Diagnostics (Basel). 2021 Jun 15;11(6):1097. doi: 10.3390/diagnostics11061097.
Gestational obstructive sleep apnea (OSA) is associated with adverse maternal and fetal outcomes. Timely diagnosis and treatment are crucial to improve pregnancy outcomes. Conventional OSA screening questionnaires are less accurate, and various prediction models have been studied specifically during pregnancy.
A systematic review and meta-analysis were performed for multivariable prediction models of both development and validation involving diagnosis of OSA during pregnancy.
Of 1262 articles, only 6 studies (3713 participants) met the inclusion criteria and were included for review. All studies showed high risk of bias for the construct of models. The pooled C-statistics (95%CI) for development prediction models was 0.817 (0.783, 0850), = 97.81 and 0.855 (0.822, 0.887), = 98.06 for the first and second-third trimesters, respectively. Only multivariable apnea prediction (MVAP), and Facco models were externally validated with pooled C-statistics (95%CI) of 0.743 (0.688, 0.798), = 95.84, and 0.791 (0.767, 0.815), = 77.34, respectively. The most common predictors in the models were body mass index, age, and snoring, none included hypersomnolence.
Prediction models for gestational OSA showed good performance during early and late trimesters. A high level of heterogeneity and few external validations were found indicating limitation for generalizability and the need for further studies.
妊娠期阻塞性睡眠呼吸暂停（OSA）与不良母婴结局相关。及时诊断和治疗对于改善妊娠结局至关重要。传统的OSA筛查问卷准确性较低，并且已经专门针对孕期研究了各种预测模型。
对涉及孕期OSA诊断的多变量预测模型进行了系统评价和荟萃分析，包括模型的开发和验证。
在1262篇文章中，只有6项研究（3713名参与者）符合纳入标准并被纳入综述。所有研究均显示模型构建存在高偏倚风险。开发预测模型的合并C统计量（95%CI）在孕早期为0.817（0.783，0.850），I² = 97.81；在孕中晚期为0.855（0.822，0.887），I² = 98.06。只有多变量呼吸暂停预测（MVAP）模型和法科模型进行了外部验证，合并C统计量（95%CI）分别为0.743（0.688，0.798），I² = 95.84和0.791（0.767，0.815），I² = 77.34。模型中最常见的预测因素是体重指数、年龄和打鼾，均未包括嗜睡。
妊娠期OSA的预测模型在孕早期和晚期表现良好。发现存在高度异质性且外部验证较少，表明其普遍性存在局限性，需要进一步研究。
