Obstructive Sleep Apnea (OSA) in Pregnancy - An American College of Chest Physicians Clinical Practice Guideline.

Abstract

Obstructive sleep apnea (OSA) is associated with significant morbidity in pregnancy. There is minimal guidance available on how best to screen, diagnose, treat, and re-evaluate for OSA in pregnant patients. Considering the potentially adverse consequences of OSA in pregnancy if left untreated, we assembled a panel of experts to methodologically review the available literature and make evidence-based recommendations. Rigorous methodology was applied to provide a trustworthy evidence-based guideline and expert panel report. Panelists developed key clinical questions utilizing the PICO (population, intervention, comparator, and outcome) format, addressing specific topics in OSA in pregnant individuals. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature and supplemented by manual searches. References were screened with study evaluation tools to assess for inclusion, extract meaningful data, and grade the level of evidence to support each recommendation or suggestion. PICO questions related to screening, diagnosis, treatment, and follow up of OSA in pregnant patients resulted in nine conditional recommendations, made with the evidence available and with consensus of the expert panel. We recommend screening pregnant patients for OSA, either with a pregnancy specific screening questionnaire or a standard tool. For those at risk of OSA based on screening, either a home sleep test (HST) or in laboratory polysomnogram (PSG) is recommended for diagnosis. We recommend treatment for those with an apnea-hypopnea index (AHI) of 5-15 who have symptoms/sequelae or comorbidities, or those with an AHI ≥ 15 regardless of symptoms or comorbidities, preferably with auto-titrating positive airway pressure (APAP). Additionally, scheduled naps may be beneficial as an initial step in alleviating residual symptoms. Reassessment of OSA in the postpartum period is recommended in some patients. Due to low level of certainty, nine conditional recommendations were made in the screening, testing, and treatment of OSA in pregnancy.