A Randomized Controlled Trial of Sleep Study Surveillance with Targeted APAP Therapy for Obstructive Sleep Apnea in Pregnancy

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by Healthday
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To determine effects of targeted autoregulated positive airway pressure (APAP) in women at risk for obstructive sleep apnea (OSA) on adverse pregnancy outcomes (APOs), cost, and natural history of OSA.
Pregnant women at high risk for OSA were randomized to a sleep study screening group with possible initiation of APAP compared to women not screened for OSA, receiving standard obstetric care (control). Women in the sleep study screened group received a sleep study at two points during pregnancy, early (6-16 weeks) and late (27-33 weeks), with initiation of APAP therapy if their apnea hypopnea index (AHI) indicated ≥ 5 events per hour. Women of both groups had a sleep study 3 months postpartum. The primary outcome was effect on APO, a composite of hypertension, preterm birth, low birthweight, stillbirth and diabetes. Secondary outcomes included OSA severity and hospital costs.
Among 193 women randomized (100 sleep study screened group; 93 control group; 6 lost to follow up), there were no significant differences in composite APO (46.4% screened vs. 43.3% control, p=0.77), hypertension (23.7% screened vs. 32% control, p=0.25), preterm birth (13.4% screened vs. 10% control, p=0.5), low birthweight (5.2% screened vs. 6.7% control, p=0.76), stillbirth (1% screened vs. 0% control, p=1), gestational diabetes (19.6% screened vs. 13.3% control, p=0.33), or mean cost ($12,185 screened vs. $12,607 control). The AHI increased over the course of pregnancy, peaking at 3 months postpartum (p<.001). There were 24 (25.8%) subjects who had a new diagnosis of OSA, with 6 in whom APAP was prescribed. APAP compliance rates were poor with usage rates ranging from 2% (1 of 64 days) to 43% (6 of 14 days).
Targeted APAP therapy for OSA in a sleep study screened high risk pregnancy group did not decrease composite adverse pregnancy outcomes or hospital costs compared to a group that received no OSA screening. However, a small sample size, low APAP prescription rates and poor compliance resulted in difficulty in drawing a definitive conclusion. The prevalence and severity of OSA worsened over the course of pregnancy, with the highest rates detected in the postpartum period. Large, multi-center clinical trials that are adequately powered are needed.

Copyright © 2022. Published by Elsevier Inc.

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