WMJ Vol 120: Obstructive Sleep Apnea in Pregnancy: Early Lessons From Our Sleep Pregnancy Clinic
Problem Considered: Obstructive sleep apnea (OSA) is underdiagnosed during pregnancy, but there is strong theoretical and some empiric evidence that treatment may improve obstetric outcomes. Barriers to screening, testing, and treatment are common during pregnancy. The goal of this described intervention was to reduce these barriers and improve detection of OSA in pregnancy.
Methods: Representatives from sleep medicine and perinatology established a cross-disciplinary, collaborative Sleep Pregnancy Clinic offering a streamlined referral process for multimodal screening, testing, and treatment of OSA during pregnancy. This is a retrospective analysis of data from the clinic’s first 19 months.
Results: Between June 2017 and December 2018, 134 pregnant women were referred for OSA testing. Sixty-three (47.0%) completed objective sleep testing, and 38 (60.3%) of the women who completed testing met diagnostic criteria for OSA. This intervention resulted in a statistically significant increase in the number of diagnostic sleep apnea tests performed (average 22.4 tests per year pre-intervention, 77 per year post-intervention [P = 0.0012]).
Discussion and Conclusions: Despite a streamlined referral pipeline, completion rates of OSA testing in pregnant women remained below 50%. However, the overall number of women referred and who completed testing increased significantly during this time period. Of those who completed testing, the majority were diagnosed with OSA. Since starting this clinic, we have created resources to familiarize patients with the equipment and worked to reduce other barriers. Assessment of these interventions and the impact of treatment on obstetric outcomes is ongoing, as is assessment of reasons women do not complete diagnostic testing.
The target audience for this journal-based activity is healthcare providers caring for the people and communities of Wisconsin and beyond.
As a result of this journal-based activity, learners will be able to:
- Recognize the symptoms of sleep apnea and how the physiologic changes of pregnancy increase the likelihood of these symptoms.
- Describe how sleep apnea during pregnancy is diagnosed with the healthcare team.
- Explain adverse pregnancy outcomes that are independently associated with sleep apnea.
It is the policy of the University of Wisconsin–Madison Interprofessional Continuing Education Partnership (ICEP) to identify, mitigate and disclose all relevant financial relationships with ineligible companies* held by the speakers/presenters, authors, planners, and other persons who may influence content of this accredited continuing education (CE). In addition, speakers, presenters and authors must disclose any planned discussion of unlabeled/unapproved uses of drugs or devices during their presentation.
For this accredited continuing education activity all relevant financial relationships have been mitigated and detailed disclosures are listed below.
|Name of Individual||Individual's Role in Activity|
Name of Commercial Interest &
|Kathleen M. Antony, MD, MSCl||Author||No relevant relationships with ineligible companies to disclose||No|
|Terese Bailey, BS||Accreditation Specialist||No relevant relationships with ineligible companies to disclose||No|
|Mihaela H. Bazalakova, MD, PhD||Author||No relevant relationships with ineligible companies to disclose||No|
|Jensena Carlson, MD||Reviewer||No relevant relationships with ineligible companies to disclose||No|
|Donn Dexter, MD||Reviewer||No relevant relationships with ineligible companies to disclose||No|
|Natalie M. Jacobson, BS||Author||No relevant relationships with ineligible companies to disclose||No|
|Hannah Mourey, BS||Author||No relevant relationships with ineligible companies to disclose||No|
|Roberta Pawlak, PhD, RN, NEA-BC||Reviewer||No relevant relationships with ineligible companies to disclose||No|
|Lauren Rice||Author||No relevant relationships with ineligible companies to disclose||No|
|Sarina B. Schrager, MD||Editor||No relevant relationships with ineligible companies to disclose||No|
|Abigail M. Wiedmer, BS||Author||No relevant relationships with ineligible companies to disclose||No|
*Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on, patients.
The ACCME does not consider providers of clinical services directly to patients to be commercial interests.
|In support of improving patient care, this activity has been planned and implemented by the University of Wisconsin–Madison ICEP and the Wisconsin Medical Journal. The University of Wisconsin–Madison ICEP is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.|
Credit Designation Statements
American Medical Association (AMA)
The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
American Nurses Credentialing Center (ANCC)
The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 ANCC contact hour.
Iowa Board of Nursing accepts ANCC contact hours for nursing continuing education requirements.
Continuing Education Units
The University of Wisconsin–Madison ICEP, as a member of the University Professional & Continuing Education Association (UPCEA), authorizes this program for 0.1 continuing education units (CEUs) or 1 hour.
- 1.00 AMA PRA Category 1 Credit™
- 1.00 ANCC Contact Hours
- 1.00 University of Wisconsin–Madison Continuing Education Hours
- 1.00 Approved for AMA PRA Category 1 Credit™
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