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

NCT ID: NCT03487185

Last Updated: 2025-02-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-08-03

Study Completion Date

2026-12-31

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Obstructive Sleep Apnea of Adult Preeclampsia Obstetrical Complications

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

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 Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
This study is an unmasked randomized controlled multi-center clinical trial.

Study Groups

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Continuous Positive Airway Pressure

Autotitrating CPAP with weekly contact, incentives for compliance and initial sleep advice counseling

Group Type EXPERIMENTAL

Continuous Positive Airway Pressure

Intervention Type DEVICE

Autotitrating CPAP with weekly contact, incentives for compliance and initial sleep advice counseling

Sleep Advice Control

Initial sleep advice counseling alone

Group Type OTHER

Sleep Advice Control

Intervention Type OTHER

Initial sleep advice counseling alone

Interventions

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Continuous Positive Airway Pressure

Autotitrating CPAP with weekly contact, incentives for compliance and initial sleep advice counseling

Intervention Type DEVICE

Sleep Advice Control

Initial sleep advice counseling alone

Intervention Type OTHER

Other Intervention Names

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CPAP

Eligibility Criteria

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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.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

The George Washington University Biostatistics Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Rebecca Clifton, PhD

Role: PRINCIPAL_INVESTIGATOR

The George Washington University Biostatistics Center

Monica Longo, MD

Role: STUDY_DIRECTOR

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Francesca Facco, MD

Role: STUDY_CHAIR

Magee Women's Hospital of UPMC

Locations

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University of Alabama - Birmingham

Birmingham, Alabama, United States

Site Status RECRUITING

Regents of the University of California San Francisco

San Francisco, California, United States

Site Status RECRUITING

Northwestern University

Chicago, Illinois, United States

Site Status RECRUITING

Columbia University

New York, New York, United States

Site Status RECRUITING

University of North Carolina - Chapel Hill

Chapel Hill, North Carolina, United States

Site Status RECRUITING

Case Western Reserve-Metro Health

Cleveland, Ohio, United States

Site Status RECRUITING

Ohio State University Hospital

Columbus, Ohio, United States

Site Status RECRUITING

Hospital of the University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status RECRUITING

Magee Women's Hospital of UPMC

Pittsburgh, Pennsylvania, United States

Site Status RECRUITING

Brown Univeristy

Providence, Rhode Island, United States

Site Status ACTIVE_NOT_RECRUITING

University of Texas Medical Branch

Galveston, Texas, United States

Site Status RECRUITING

Baylor College of Medicine

Houston, Texas, United States

Site Status RECRUITING

University of Texas - Houston

Houston, Texas, United States

Site Status RECRUITING

University of Utah Medical Center

Salt Lake City, Utah, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Rebecca Clifton, PhD

Role: CONTACT

301-881-9260

Facility Contacts

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Donna Dunn, PhD, CNM, FNP-BC

Role: primary

205.996.6268

Natalie Oman, MPH

Role: primary

206-718-4703

Gail Mallett, RN

Role: primary

312-503-3200

Megan Loffredo, MD, CCRC

Role: primary

203-722-1058

Kelly Clark, RN

Role: primary

919-350-6117

Abigail Pierse, BS

Role: primary

216-778-8443

Anna Bartholomew, RN

Role: primary

614-685-3229

Christina Pizzi, BSN, RN, CBC

Role: primary

267-273-8574

Jeanette Boyce, RN

Role: primary

412-527-8118

Amelia Nounes, MSN, RN

Role: primary

409-747-1758

Christina Reed, RN, NP

Role: primary

832-826-7377

Jia Chen, RN, CCRP

Role: backup

713-798-3798

Felecia Ortiz, RN

Role: primary

713-500-6467

Amber Sowles, RN, BSN, CCRP

Role: primary

801-585-5499

References

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Facco F. Sleep Duration, Sleep Timing, and Sleep Disordered Breathing-Associations With Obesity and Gestational Diabetes in Pregnancy. Clin Obstet Gynecol. 2021 Mar 1;64(1):196-203. doi: 10.1097/GRF.0000000000000587.

Reference Type DERIVED
PMID: 33481418 (View on PubMed)

Other Identifiers

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U24HD036801

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD087192

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD087230

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD027869

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD034208

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD053097

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD040500

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD040485

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD040544

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD040545

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD040560

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD040512

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD027915

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD112096

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD112063

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1HD112092

Identifier Type: NIH

Identifier Source: secondary_id

View Link

HD36801-SLEEP

Identifier Type: -

Identifier Source: org_study_id

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