Apnea, Obstructive Sleep, Obesity
Conditions
Keywords
pregnancy
Brief summary
Obstructive Sleep apnea (OSA) is a common and underdiagnosed condition in obese pregnant women with serious and life-threatening complications to the mother and baby. The investiators propose that a non-invasive method may be used to detect patients at risk of OSA, giving these women access to the necessary treatment to treat this condition. The method is a estimation of body water, which has been shown to be linked to OSA in the non-pregnant population. Body water is estimated by applying surface electrodes to a participant who is lying down by measuring bioimpedance through body tissues by applying a tiny current between the electrodes. The electrical stimulation is not felt by the participant and has no negative effects on mother or baby.
Detailed description
It is already established that the increasingly prevalent condition of obesity is linked to OSA in pregnancy. Obesity is increasingly prevalent This study will evaluate a novel method of screening for OSA in the obese pregnant population, thereby treating this condition reducing the ill effects to mother and fetus. This will be a prospective observational cohort study. Eligible participants will be approached for consent during their third-trimester antenatal all-day clinic visit. Body water will be measured by connecting electrodes to participants hands, feet and neck whilst lying supine for approximately 15 minutes. Data on patient demographics, BMI, medical conditions, water body composition and indicators of OSA (breathing pattern and oxygen levels during sleep) will be collected, as well as data from patients' sleep tests as ordered by their physician.
Interventions
BIA will be used to determine total body water
Sponsors
Samuel Lunenfeld Research Institute, Mount Sinai Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
16 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
* Participants who give written informed consent * Pregnant women in the third trimester of pregnancy * Grade III obesity * Patients who have prior diagnosis of OSA within the last one year, and non-compliant to treatment such as continuous positive airway pressure (CPAP), or dental appliance * Patients suspected to have OSA based on screening questionnaire (see page 2, OSA-Diagnostic tools for further details)
Exclusion criteria
* Fluid overload states including renal disease, liver disease and congestive heart failure * Prior history of vascular surgery in the lower limbs such as varicose vein surgery, vascular by-pass surgery or evidence of venous efficiency. * Patients with metal implants in lower limbs or spine, due to possible interference with the leg impedance signals. 58 * Participants with diagnosed OSA treated with Continuous Positive Airway Pressure (CPAP). * Patients requiring urgent sleep physician referral (within four weeks) due to serious medical conditions or safety critical-occupations according to the 2011 Canadian Thoracic Society (CTS) guideline 59 e.g. unstable ischemic heart disease, recent cerebrovascular disease. * Implantable cardiac devices
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Presence of sleep apnea | 12 hours | The diagnosis of sleep apnea will be made using apnea hypopnea index (AHI). A diagnosis of OSA is present if a person has an AHI ≥5/hour. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mallampati score | Done during initial exam following consent, this exam will take 1-2 minutes | The patient is asked to open their mouth wide and stick out their tongue. Upon observation, the view is classified/scored as Class 1-4. Class one would be least likely to have airway problems and 4 most likely. |
| Thyromental distance (cm) | Done during initial exam following consent, this exam will take 1-2 minutes | The distance between the thyroid notch and the tip of the jaw with the head extended is evaluated. |
| Subluxation of mandible beyond maxilla | Done during initial exam following consent, this exam will take 1-2 minutes | The patient is asked to extend their mandible beyond the top lip if possible. Scoring is yes or no. |
| Neck extension | Done during initial exam following consent, this exam will take 1-2 minutes | The patient is asked to extend their neck, looking upwards and back, as far as comfortably possible. Scoring is yes if movement is possible, no if extension is not possible. |
| Total body water measurement | Following consent, this measurement will be done, and will take approximately 30 minutes | Total body water will be measured using Bioelectrical Impedance Analysis (BIA) |
| Weight (kg) | Done during initial exam following consent, this exam will take 1-2 minutes | Weight measured in kg to calculate Body Mass index (BMI) |
| Neck size | Done during initial exam following consent, this exam will take 1-2 minutes | Circumference around the neck, measured in centimeters. |
| Questionnaire related to snoring | Done during initial exam following consent, this exam will take 1-2 minutes | Patients will be asked if they snore, if others can hear their snoring and if they are bothered by it. Yes or no answers. |
| Questionnaire related to sleep | Done during initial exam following consent, this exam will take 1-2 minutes | Patients will be asked if they wake frequently during sleep, if they wake with a choking sensation, and whether they doze off or fall asleep while sitting/talking. Yes or no answers. |
| Height (cm) | Done during initial exam following consent, this exam will take 1-2 minutes | Height measured in cm to calculate Body Mass index (BMI) |
Countries
Canada
Outcome results
None listed