By Alpna Agrawal, Ph.D., MS II
As a medical student in the Scholarly Concentration program (Clinical Safety, Quality, and Evidence-based Medicine) at the Medical School, I presented a poster at the annual meeting of American College of Obstetricians and Gynecologists (ACOG) in Chicago on developing a short-form screening tool for sleep apnea during pregnancy.
Dr. David Marshak, my research adviser and professor of neurobiology and anatomy, encouraged me to submit the poster in order to gain experience presenting research at a clinical conference and to learn more about the field of Ob/Gyn.
Examining 1,153 pregnant women, my co-authors and I identified a four-item scale on sleep disturbance during pregnancy. The items asked pregnant women whether they snored often, if their snoring bothered others, if anyone had noticed that they stopped breathing during their sleep, and whether they fell asleep while driving. The scale demonstrated good reliability and validity and was associated with preeclampsia. Specifically, the odds of developing preeclampsia were 1.5 times higher for women with a higher scale score compared with women with a lower scale score.
Preeclampsia is a multi-system disorder characterized by new onset hypertension and either proteinuria or end-organ dysfunction after 20 weeks of gestation. It affects 3-6% of pregnancies in the United States and is linked to maternal and/or fetal mortality as well as morbidities such as intrauterine growth restriction for infants and increased lifetime risk of cardiovascular disease for mothers.
Advantages of this screening tool are that it is markedly shorter than standard measures and demonstrates that even among normal weight women, screening positive on items related to abnormal sleep patterns increases their risk of preeclampsia. Previous studies suggest continuous positive airway pressure (CPAP) among pregnant women with sleep apnea decreased the rate of preeclampsia. Further research is needed on the clinical efficacy of this screening tool in early detection of women at risk for preeclampsia.
The poster was a part of a larger project led by Dr. Kathleen Antony, maternal fetal medicine fellow, and Dr. Kjersti Aagaard, associate professor, Baylor College of Medicine. Results from the project were recently published as two papers in the Journal of Perinatology, describing the prevalence of sleep apnea during pregnancy and its associated maternal and neonatal risks. Mentorship in the Scholarly Concentration Program and this cross-institutional collaboration in the Texas Medical Center make me even more excited about a career in clinical medicine. Thank you to my mentors and collaborators for this opportunity!
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