0501 Sleep Medicine Referrals in a High-Risk Obstetrics Population

Abstract Introduction Obstructive sleep apnea (OSA) has traditionally been underdiagnosed and undertreated in pregnancy. Untreated OSA has been associated with adverse peripartum outcomes, such as hypertensive disorders of pregnancy, diabetes, cesarean delivery and NICU admissions. In August 2023, a taskforce from the Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology published recommendations that pregnant patients with obesity, gestational or pre-existing diabetes, or hypertensive disorders of pregnancy be screened for OSA. Currently, our Maternal-Fetal Medicine (MFM) group only screens for OSA in the obese pregnant population on a conditional basis. It is unknown how many of these patients are screened for OSA and/or referred to sleep medicine for follow-up. Methods This is a cross-sectional retrospective study to characterize the 19,439 pregnancies from January 1, 2012-December 31, 2022 at a rural health system with five labor and delivery units that would meet criteria for screening for OSA and a sleep medicine referral. Patients were included if they were over 18, pregnant and had at least a hypertensive disorder of pregnancy, diabetes (pre-existing or gestational) or were obese. The Cochrane-Armitage trend test was used to evaluate the rates over the time-period. Results In the initial data review, we found that between 2012 and 2022, the practice grew considerably; there was an increase in the proportion of women with gestational diabetes (16.9-31.2%, p 0.01), obesity (75.0-75.2%, p 0.01) and a hypertensive disorder of pregnancy (22.9-25.8%, p 0.01). Despite the increase in sleep medicine referrals during pregnancy (0.4-1.1%, p 0.01) over the years, the overall referral rate to sleep medicine regardless of the selected peripartum co-morbidity remained low at 0.5-0.9%. Conclusion Less than 1% of patients at high-risk for OSA in pregnancy are being screened or tested for OSA. Based on the guidelines published in August 2023, these results establish a wide practice gap in our center. It is likely that this knowledge is generalizable to centers around the country. We conclude that there is a large opportunity to improve our maternal outcomes by connecting these at-risk patients with sleep medicine referrals to be screened and treated for OSA. Support (if any)