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Study objectivesCompletion of testing during pregnancy for those who screen positive for obstructive sleep apnea (OSA) is imperative for the diagnosis and treatment of OSA, as the latter may reduce the risk of developing hypertensive disorders of pregnancy. To identify potential barriers, we assessed predictors of non-completion of sleep apnea testing by people identified to be at high risk of OSA by screening during pregnancy. We hypothesized that non-completion of sleep apnea testing would be predicted by insurance status and obstetric factors, such as gestational age at time of testing.MethodsWe performed a retrospective analysis of the first 500 people in our sleep pregnancy database which includes both pregnant and preconception patients who screened positive for OSA; those screened preconception were excluded. Multivariable Poisson regression was used to determine which factors were independently associated with non-completion.ResultsOf 445 referred, 214 (48.1%) completed sleep apnea testing. Factors associated with non-completion of testing on univariate analysis included referral in the third trimester, higher parity, one or more living children, history of preterm birth, history of preeclampsia, type 2 diabetes mellitus, non-partnered status, race, and payor. Symptoms of loud snoring or witnessed apneas were associated with increased incidence of sleep apnea testing completion. Multivariable Poisson regression demonstrated that having public insurance predicted non-completion of sleep apnea testing during pregnancy.ConclusionIn this small study, public insurance was an independent predictor of non-completion of sleep apnea testing during pregnancy. These findings aid efforts to improve patient completion of sleep apnea testing during pregnancy.

Introduction Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, diagnosis, and initiation of therapy are all time-sensitive processes during the dynamic progression of gestation. Completion of referral and testing for sleep apnea during pregnancy requires a significant commitment of time and effort on the part of the pregnant patient. We evaluated for predictors of non-completion of sleep apnea testing within our obstetric-sleep referral pipeline, in an effort to inform and optimize future referrals. Methods We performed a retrospective chart-review of 405 pregnant patient referrals for sleep apnea evaluation at the University of Wisconsin-Madison/UnityPoint sleep apnea pregnancy clinic. We used logistic regression analysis to determine predictors of lack of completion of sleep apnea testing. Results The vast majority of referrals (>95%) were triaged directly to home sleep apnea testing with the Alice PDX portable device, rather than a sleep clinic visit. The overall rate of referral non-completion was 59%. Predictors of non-completion of sleep apnea evaluation in our pregnant population included higher gestational age (GA) at referral (1–12 wks GA: 30%, 13–26 wks GA: 31%, and 27–40 wks GA: 57% non-completers, p=0.006) and multiparity with 1 or more living children (65% non-completers if any living children, compared to 45% non-completers if no living children, p=0.002). Age, race, and transportation were not predictors of failure to complete sleep apnea testing. Conclusion We have identified several predictors of pregnant patients’ failure to complete sleep apnea evaluation with objective home sleep apnea testing after referral from obstetrics. Not surprisingly, higher gestational age emerged as a strong negative predictor of referral completion, with >50% of patients referred in the third trimester not completing sleep apnea testing. Early screening and referral for sleep apnea evaluation in pregnancy should be prioritized, given the time-sensitive nature of diagnosis and therapy initiation, and demonstrated reduced completion of referrals in advanced pregnancy. Support (if any) None