Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Dr. Cynthia D. Connelly, PhD, RN, FAAN, Chairperson Dr. Mary Barger, PhD, CNM, MPH CDR Dennis L. Spence, NC, USN, PhD, CRNA


Facco four variable model, military, pregnancy, screening, sleep disordered breathing, STOP-Bang


Sleep Disordered Breathing (SDB) during pregnancy is associated with maternal and neonatal morbidity, and in-hospital mortality. A recent prevalence study using the Nationwide Inpatient Sample reported an obstructive sleep apnea (OSA) prevalence of 7.3 per 10,000 in 2013, a rate of 24% per year over the last decade. The rise in prevalence mirrors the rise in obesity. Military Treatment Facilities (MTF) have seen an increase in obesity and related co-morbidities with an unknown prevalence of SDB. Most studies have been conducted in high-risk populations; the general prevalence of SDB and its association with adverse pregnancy outcomes in a military population needs exploration.

This prospective, observational study used the Facco Four Variable (FFV) model and STOP-Bang to screen parturients presenting for delivery at a MTF to determine the general prevalence of SDB. Logistic regression on parturient data who screened positive, FFV (score ≥75) and STOP-Bang (score ≥ 3) was used to examine if higher rates of adverse pregnancy outcomes (gestational hypertension, preeclampsia/eclampsia, gestational diabetes, non-elective cesarean delivery, NICU admission, hospital stay >5 days, a composite variable of adverse pregnancy outcomes) were associated with SDB. Demographic and prevalence data were compared between active duty and non-active duty participants.

Of the study population (N=295), the FFV identified 12.3% (n=36) and STOP-Bang 7.1% (n=21) participants at high risk for SDB. Adverse pregnancy outcomes were experienced by 58% women with the FFV and 66% with STOP-Bang. Logistic regression indicated the FFV categorical score (≥75) was not predictive of adverse pregnancy outcomes. Utilizing FFV absolute score, an increased risk of APO was noted (adjusted OR=1.03, 95% CI 1.01-1.05, p=.013). Logistic regression indicated a STOP-Bang score ≥3 was predictive of an adverse pregnancy outcome (adjusted OR=3.26, 95% CI 1.23-8.62, p=.018).

Findings support the need for routine screening for identification of SDB during pregnancy and the opportunity for repeated testing to track progression, treatment, and resolution of SDB. Further research is needed to determine critical points in the development and management of SDB during pregnancy, if and when SDB resolves after delivery, and the long-term health effects for both mother and child.

Document Type

Dissertation: Open Access