Continuous Positive Airway Pressure Therapy in Gestational Diabetes With Obstructive Sleep Apnea: A Randomized Controlled Trial

Chirakalwasan, Naricha; Amnakkittikul, Somvang; Wanitcharoenkul, Ekasitt; Charoensri, Suranut; Saetung, Sunee; Chanprasertyothin, Suwannee; Chailurkit, La‐or; Panburana, Panyu; Bumrungphuet, Sommart; Thakkinstian, Ammarin; Reutrakul, Sirimon

doi:10.5664/jcsm.6972

Cited by 41 publications

(85 citation statements)

References 51 publications

(56 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The potential for CPAP treatment to benefit glucose metabolism in women with mild OSA and diet‐controlled gestational diabetes was assessed in a small randomized trial . In all, 18 women were randomized to receive CPAP treatment and 18 women (on a CPAP waiting list) were randomized to standard care, at an average gestational age of 30.3 weeks.…”

Section: Sdb With Adverse Pregnancy Outcomes: Potential Mechanismsmentioning

confidence: 99%

Sleep disordered breathing in pregnancy: A review of the pathophysiology of adverse pregnancy outcomes

2020

View full text Add to dashboard Cite

Sleep disordered breathing (SDB) is a common obesity-related co-morbidity with strong associations to cardiometabolic disease. The risk of SDB is increased during pregnancy, particularly among obese pregnant women. Accumulating evidence suggests that an association exists between maternal SDB and the development of adverse pregnancy outcomes, particularly gestational diabetes and hypertensive disorders of pregnancy. Intermittent hypoxia, a central characteristic of SDB, has been shown in animal and clinical studies to dysregulate several biological pathways. This includes the promotion of oxidative stress, increased inflammation, activation of the hypothalamic-pituitary-adrenal axis, increased sympathetic activity and impaired glucose and insulin metabolism. This review considers how, during pregnancy, these pathophysiological processes are plausible mechanisms through which SDB may contribute to an increased risk of adverse outcomes, for the mother and perhaps also the offspring. However, a lack of robust evidence specific to the pregnant population, including limited evaluation of the placental function in affected pregnancies, limits our ability to draw definite conclusions on mechanisms contributing to adverse pregnancy outcomes and, indeed, the strength of association between SDB and certain pregnancy complications. K E Y W O R D Spregnancy, sleep apnoea, sleep disordered breathing 2 of 13 | JOHNS et al.

show abstract

Section: Sdb With Adverse Pregnancy Outcomes: Potential Mechanismsmentioning

confidence: 99%

Sleep disordered breathing in pregnancy: A review of the pathophysiology of adverse pregnancy outcomes

2020

View full text Add to dashboard Cite

show abstract

“…Small studies indicate that CPAP is safe, can be tolerated in pregnancy, and may improve pregnancy-induced hypertension, pre-eclampsia and GDM [50]. However, the evidence for this is not unequivocal [53], and larger scale randomised controlled trials are needed to fully understand the threshold at which intervention might be helpful.…”

Section: Practical Implicationsmentioning

confidence: 99%

Pregnant pause: should we screen for sleep disordered breathing in pregnancy?

Perkins

Einion

2019

Breathe

View full text Add to dashboard Cite

Physiological and hormonal changes in pregnancy can contribute towards sleep disordered breathing in pregnant women (SDBP). When present, SDBP increases the risk of several adverse maternal and fetal outcomes independent of factors such as age, weight and pre-existing maternal comorbidities. SDBP is underdiagnosed and may be hard to recognise because the presentation can be difficult to differentiate from normal pregnancy and the severity may change over the course of gestation. Timely intervention seems likely to help reduce adverse outcomes, but the relative benefits of intervention are still unclear. The definition of what constitutes a sleep-related breathing “disorder” in pregnancy may be different to the general population and so traditional thresholds for intervention may not be relevant in pregnancy. Any modifications to the disease definition in this group, or implementation of more intensive screening, may result in overdiagnosis. Further research is needed to help clinicians evaluate the balance of benefits and harms in this process. Until this is clearer there is a strong imperative for shared decision making in screening and treatment decisions, and screening programmes should be monitored to assess whether improved outcomes can be achieved at the healthcare system level.Key pointsUntreated sleep disordered breathing in pregnancy poses risks to maternal and fetal wellbeing, but it is underdiagnosed.Careful approaches to screening could improve rates of diagnosis, but thresholds for and benefits of intervention are unclear.Clinical guidelines and screening programmes for sleep disordered breathing in pregnancy need to consider the potential harms of overdiagnosis and should involve shared decision making and careful monitoring of outcomes relevant to the individual.Educational aimsExplore current knowledge of the prevalence of sleep disordered breathing in the pregnant population.Explore the relationship between sleep disordered breathing and adverse outcomes.Understand the approaches to diagnosis and management of sleep disordered breathing in pregnancy.Explore issues around screening, underdiagnosis and overdiagnosis in the context of sleep disordered breathing in pregnancy.

show abstract

“…Pregnancy, and particularly late gestation, has been associated with a relatively high prevalence of altered sleep patterns including restricted sleep duration, fragmented sleep, snoring, and especially OSA [55][56][57][58][59][60][61][62][63][64][65][66][67] . Experimental evidence in murine models has conclusively demonstrated that OSA can induce changes in insulin sensitivity and promote obesogenic behaviours as well as hypertension, i.e., correlates of pre-eclampsia [68][69][70][71][72][73][74] .…”

Section: Obstructive Sleep Apnoea During Pregnancy and Consequences Tmentioning

confidence: 99%

Sleep Apnoea and Early Antecedents of Adult Disease

Gozal¹

2018

BRN

View full text Add to dashboard Cite

Obstructive sleep apnoea (OSA) is a highly prevalent disorder across the life spectrum including early childhood and pregnancy. Occurrence of sleep perturbations and intermittent hypoxia that constitute major hallmarks of OSA during these favourable developmental plasticity windows may facilitate emergence of incremental risks for a variety of ageing-related disorders via a multitude of epigenetic mechanisms. In addition, OSA during late adolescence and adulthood is not immune to epigenetic changes, the latter potentially playing a role in the reversibility of OSA-associated morbidities upon implementation of therapy. Furthermore, unique epigenetic signatures may provide powerful biomarkers for precision-based medicine approaches in the framework of OSA. Taken together, the conceptual umbrellas assigning major roles to epigenetics in the context of OSA-associated phenotypic expression and longitudinal disease risk trajectories is not a farfetched idea any longer. Early adoption of these biologically relevant principles and their implementation to the upcoming future clinical trials appears inevitable if progress is to occur. (BRN Rev. 2018;4(3):185-99)

show abstract

Continuous Positive Airway Pressure Therapy in Gestational Diabetes With Obstructive Sleep Apnea: A Randomized Controlled Trial

Abstract: Registry: ClinicalTrials.gov; Title: Obstructive Sleep Apnea and Gestational Diabetes: Incidence and Effects of Continuous Positive Airway Pressure Treatment on Glucose Metabolism; Identifier: NCT02108197; URL: https://clinicaltrials.gov/ct2/show/NCT02108197.

Cited by 41 publications

References 51 publications

Sleep disordered breathing in pregnancy: A review of the pathophysiology of adverse pregnancy outcomes

Sleep disordered breathing in pregnancy: A review of the pathophysiology of adverse pregnancy outcomes

Pregnant pause: should we screen for sleep disordered breathing in pregnancy?

Sleep Apnoea and Early Antecedents of Adult Disease

Contact Info

Product

Resources

About