Screening Of Sleep-disordered Breathing During The 3rd Trimester Of Pregnancy

Objective: In recent years,many researchers had found that the incidence of sleep-disordered breathing(SDB)in pregnant women is significantly higher than that of non-pregnant women.And we found that pregnant women with markedly overweight and obesity increase often complained of snoring and sleep problems.But because of the lack of relevant screening method and evaluation means,in common obstetrics outpatient,obstetricians can’t identify whether SDB or not,which result in a missed diagnosis is high.Pregnancy itself is one of the high risk factors of SDB,and it is closely connected with the occurrence and development of hypertensive disease and gestational diabetes during pregnancy.With the increase of the severity of hypoxia,the incidence of adverse pregnancy outcomes increased gradually,causing serious harm to maternal and infant health.Obstructive Sleep Apnea(OSA)is the core component of SDB.Diagnosis of OSA depends on polysomnography(PSG),but for women during pregnancy,especially in late pregnancy women.The convenience of PSG is insufficient.And because of lacking adequate resources,not all of the pregnant women who were suspected of suffering SDB had accepted PSG.Therefore,simple and accurate screening tool for SDB during pregnancy is so urgently needed.Currently,the SDB screening method used in general population is a questionnaire survey.Commonly used questionnaires included the Epworth sleepiness scale(ESS),Berlin questionnaire(BQ)and STOP-Bang questionnaire.However,in China,these questionnaires were not used universally in the study of SDB during pregnancy.So,in this reach,we have two main objective: 1.Select a questionnaire that is appropriate for the screening of the SDB during the third trimester of pregnancy.2.To explore further screening of the use of wearable blood oxygen monitoring wristwatch in pregnant women with positive questionnaire screening to improve the effect of SDB screening.Thus,targeted PSG examination was conducted.Early detection of SDB was detected and early intervention to improve prognosis.Methods: 1.Subjects of this study are women who snoring during late pregnancy and would childbirthed in Tianjin Hexi maternity hospital during June 2016 to August 2017.117 cases were inclued,in 56 cases ESS questionnaire,Berlin questionnaire and STOP-Bang questionnaire were completed.In 41 cases,SDB were diagnosed by portable PSG.All the correlation between the questionnaire and PSG was analyzed,and the sensitivity and specificity of screening SDB were evaluated.Finally,the appropriate questionnaire scale is selected according to the actual situation.2.After the questionnaire collection was completed,a wearable blood oxygen monitor was used to monitor the blood oxygen saturation of the subjects throughout the night.The collected data were analyzed and compared with the PSG test results.Select appropriate indicators for SDB screening to guide clinical application.Results: 1.Compare to other questionnaires,the sensitivity(69.56%)and specificity(88.89%)of STOP-Bang is higher in the screening of SDB during late pregnancy.And because of its operation is simple,scoring method is clear,STOP-Bang is more suitable for obstetric clinical use 2.Performance of wearable blood Oxygen monitor is reliable,and Oxygen reduction index(ODI)has good sensitivity(86.96%)and specificity(83.33%).Comparing the correlation between the different truncation values of ODI and the results of PSG,ODI more than 5 /h can be utilized to additional accurate screening.Conclusion: 1.The STOP-Bang questionnaire is more suitable for SDB screening in obstetric clinics.2.The questionnaire combined with blood oxygen monitoring watch showed that ODI more than 5/h as the screening test,and the sensitivity and specificity of the SDB in the late stage of pregnancy were higher,which was not easy to miss.