Continuous Positive Airway Pressure (CPAP) for Sleep Apnea in Pregnancy

Purpose

A randomized controlled trial of 1,500 women to assess whether treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP) in pregnancy will result in a reduction in the rate of hypertensive disorders of pregnancy.

Conditions

  • Obstructive Sleep Apnea of Adult
  • Preeclampsia
  • Obstetrical Complications

Eligibility

Eligible Ages
Over 18 Years
Eligible Genders
Female
Accepts Healthy Volunteers
No

Inclusion Criteria

  1. Singleton gestation. Twin gestation reduced to singleton, either spontaneously or therapeutically, is not eligible unless the reduction occurred before 14 weeks project gestational age. 2. Gestational age at randomization between 14 weeks 0 days and 21 weeks 6 days based on clinical information and evaluation of the earliest ultrasound. 3. Diagnosis with mild to moderate OSA as defined by an AHI score ≥ 5 and <30.

Exclusion Criteria

  1. Previously prescribed, current or planned therapy for sleep apnea. 2. Age < 18 years, because the rate of sleep apnea in this population is extremely low. 3. Inability to sleep in a stable place with access to the CPAP machine at least 5 nights per week. 4. Asthma requiring systemic steroid therapy for more than 14 days within the past 6 months because this population is expected to be unresponsive to CPAP therapy. 5. Current use of prescribed sleeping pills for insomnia. 6. Chronic medical conditions requiring oxygen supplementation (e.g. pulmonary fibrosis, pulmonary hypertension, cystic fibrosis) because this population is expected to be unresponsive to CPAP therapy. 7. Chronic renal disease with serum creatinine >1.3 mg/dL because the primary outcome would be pre-determined. 8. Antiphospholipid antibody syndrome, because it would compromise the primary outcome diagnosis. 9. History of medical complications such as: 1. Active liver disease (acute hepatitis, chronic active hepatitis, persistently abnormal liver enzymes) 2. Thrombocytopenia with platelet count <100,000 because of the difficulty in assessing the primary outcome. 10. Active vaginal bleeding (more than spotting) at the time of randomization. 11. Known chromosomal, genetic, major malformations or fetal demise, or planned termination of pregnancy because inclusion would compromise evaluation of secondary neonatal outcomes. 12. Known major uterine malformations associated with adverse pregnancy outcomes. 13. Current use of opiates (heroin, methadone, or other daily opioid use) due to inaccuracy of the home sleep test and inefficiency of CPAP. 14. Active drug use, alcohol use, or unstable psychiatric condition. 15. Participation in another interventional study that influences preeclampsia, hypertensive disorders of pregnancy, or GDM. 16. Prenatal care or delivery planned at a non-network center where access to the complete electronic medical record will not be available to research staff. 17. Participation in this trial in a previous pregnancy. Patients who were screened in a previous pregnancy, but not randomized, may be included.

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Intervention Model Description
Women who are between 14 weeks 0 days and 21 weeks 5 days with a singleton gestation and obstructive sleep apnea (OSA) will be randomized to one of two arms at participating MFMU Network clinical center: Autotitrating CPAP with weekly contact, incentives for compliance and initial sleep advice counseling Initial sleep advice counseling alone
Primary Purpose
Prevention
Masking
Double (Investigator, Outcomes Assessor)
Masking Description
This study is an unmasked randomized controlled multi-center clinical trial.

Arm Groups

ArmDescriptionAssigned Intervention
Experimental
Continuous Positive Airway Pressure
Autotitrating CPAP with weekly contact, incentives for compliance and initial sleep advice counseling
  • Device: Continuous Positive Airway Pressure
    Autotitrating CPAP with weekly contact, incentives for compliance and initial sleep advice counseling
    Other names:
    • CPAP
Other
Sleep Advice Control
Initial sleep advice counseling alone
  • Other: Sleep Advice Control
    Initial sleep advice counseling alone

Recruiting Locations

University of Texas Medical Branch
Galveston, Texas 77555
Contact:
Amelia Nounes, MSN, RN
409-747-1758
aanounes@UTMB.EDU

More Details

Status
Recruiting
Sponsor
The George Washington University Biostatistics Center

Study Contact

Rebecca Clifton, PhD
301-881-9260
rclifton@bsc.gwu.edu

Detailed Description

Emerging data support a link between sleep disordered breathing (SDB) and adverse pregnancy outcomes. In particular, women with obstructive sleep apnea (OSA) appear to be at increased risk of both hypertensive disorders of pregnancy and gestational diabetes. In the non-pregnant population, OSA is typically treated with continuous positive airway pressure (CPAP) during sleep and has been shown to reduce blood pressure in hypertensive patients. Unfortunately, data on whether maternal and neonatal outcomes could be improved with treatment of OSA during pregnancy are extremely limited. This study aims to address this knowledge gap. A randomized controlled trial of 1,500 women to assess whether treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP) in pregnancy will result in a reduction in the rate of hypertensive disorders of pregnancy.