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Dominguez JE, Cantrell S, Habib AS, Izci-Balserak B, Lockhart E, Louis JM, Miskovic A, Nadler JW, Nagappa M, O'Brien LM, Won C, Bourjeily G. Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy. Obstet Gynecol 2023; 142:403-423. [PMID: 37411038 PMCID: PMC10351908 DOI: 10.1097/aog.0000000000005261] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 07/08/2023]
Abstract
The Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology tasked an expert group to review existing evidence and to generate recommendations on the screening, diagnosis, and treatment of patients with obstructive sleep apnea during pregnancy. These recommendations are based on a systematic review of the available scientific evidence and expert opinion when scientific evidence is lacking. This guideline may not be appropriate for all clinical situations and patients, and physicians must decide whether these recommendations are appropriate for their patients on an individual basis. We recognize that not all pregnant people may identify as women. However, data on non-cisgendered pregnant patients are lacking, and many published studies use gender-binary terms; therefore, depending on the study referenced, we may refer to pregnant individuals as women. This guideline may inform the creation of clinical protocols by individual institutions that consider the unique considerations of their patient populations and the available resources.
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Affiliation(s)
- Jennifer E Dominguez
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
| | - Sarah Cantrell
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Ashraf S Habib
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Bilgay Izci-Balserak
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Ellen Lockhart
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Judette M Louis
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Alice Miskovic
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Jacob W Nadler
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Mahesh Nagappa
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Louise M O'Brien
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Christine Won
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Ghada Bourjeily
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
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Foroughinia S, Hessami K, Asadi N, Foroughinia L, Hadianfard M, Hajihosseini A, Pirasteh N, Vossoughi M, Vafaei H, Faraji A, Kasraeian M, Doroudchi M, Rafiee Monjezi M, Roozmeh S, Bazrafshan K. Effect of Acupuncture on Pregnancy-Related Insomnia and Melatonin: A Single-Blinded, Randomized, Placebo-Controlled Trial. Nat Sci Sleep 2020; 12:271-278. [PMID: 32494210 PMCID: PMC7231755 DOI: 10.2147/nss.s247628] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/27/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of the current study is to evaluate the efficacy and safety of acupuncture on sleep quality and overnight melatonin secretion, measured as urinary 6-sulfatoxymelatonin, in pregnant women. PATIENTS AND METHODS This randomized, parallel, single-blinded (participant), controlled trial was conducted on 72 pregnant women with insomnia. Study participants were randomly assigned to either the intervention, 10 sessions of acupuncture treatment over a 3-week period, or control group by block randomization (1:1). Patients in both groups were evaluated at baseline and post-treatment (third week) using the Pittsburgh Sleep Quality Index (PSQI) score (as the primary outcome) and urinary 6-sulfatoxymelatonin. RESULTS Fifty-five of 72 participants completed the study. There was no statistically significant difference regarding PSQI score and 6-sulfatoxymelatonin level between intervention and control groups at the baseline (P=0.169 and P=0.496). At the end of the study period, treatment with acupuncture significantly improved the PSQI score (P<0.001) with a large effect size of 3.7, as well as 6-sulfatoxymelatonin level (P=0.020) with a medium effect size of 0.6 as compared to the control group. No adverse effects were noted during acupuncture sessions and follow-up visits. CONCLUSION Acupuncture was shown to significantly improve the sleep quality in pregnant women, possibly through increasing melatonin secretion, and could be recommended as a low-cost and low-risk alternative treatment to pharmacological therapies.
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Affiliation(s)
- Saeedeh Foroughinia
- Obstetrics and Gynecology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Asadi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammadjavad Hadianfard
- Physical Medicine and Rehabilitation Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azadeh Hajihosseini
- Physical Medicine and Rehabilitation Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Pirasteh
- Physical Medicine and Rehabilitation Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Vossoughi
- Oral and Dental Disease Research Center, Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Homeira Vafaei
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azam Faraji
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Kasraeian
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnoosh Doroudchi
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Shohreh Roozmeh
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khadije Bazrafshan
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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