Continuous Positive Airway Pressure Treatment in Gestational Diabetes Women with Obstructive Sleep Apnea: Effects on Pregnancy Outcomes

Presentation Number: OR11-4
Date of Presentation: April 1st, 2017

Ekasitt Wanitcharoenkul*1, Boonsong Ongphiphadhanakul2, Naricha Chirakalwasan3, Somvang Amnakkittikul4, Suranut Charoensri5, Sunee Saetung6, Punyu Panburana4, Sommart Bumrungphuet5 and Sirimon Reutrakul4
1Faculty of Medicine Ramathibodi hospital, Bangkok, Thailand, 2Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 3Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 4Faculty of Medicine Ramahibodi Hospital, Bangkok, Thailand, 5Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand, 6Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Abstract

Background: Obstructive sleep apnea (OSA) has been shown to be associated with gestational diabetes (GDM) and adverse pregnancy outcomes including preeclampsia, caesarean section and premature delivery. However, the data on the effect of continuous positive airway pressure treatment (CPAP) on pregnancy outcomes were lacking. We previously reported an improved insulin secretion as a result of a 2-week CPAP treatment in women with diet-controlled GDM and OSA in the third trimester. The aim of this study was to report pregnancy outcomes in these women, and compare them with GDM women without OSA.

Methods: Obese pregnant women (pre-pregnancy BMI >=25 kg/m2) with diet-controlled GDM were asked to participate. OSA was screened using an overnight home monitor. Those diagnosed with OSA were randomized to receive CPAP treatment for 2 weeks or be wait-list controls. After randomization period ended, all women were offered CPAP treatment until delivery. Pregnancy outcomes were collected in all women from medical records.

Results: Of the 82 women screened at a median gestational age (GA) of 29 weeks, 43 had OSA (apnea hypopnea index >=5). Of these, 28 had CPAP treatment and 15 did not. Pregnancy outcomes were available in 78 women (38 in No-OSA group, 28 in OSA/CPAP group and 11 OSA/no-CPAP group).

When comparing women among the three groups; No-OSA vs. OSA/CPAP vs. OSA/No-CPAP, there were no significant differences their age, pre-pregnancy BMI, gravida and para. There were also no significant differences in the pregnancy outcomes including subsequent rates of insulin use, preterm delivery (<37 weeks), preeclampsia, unplanned caesarean section, birth weight (3164±489 gm vs. 3099±509 gm vs. 3196±608, p=0.821), Apgar score at 1 minute and 5 minutes, or the rate of small for gestational age and large for gestational age.

Of the 28 women exposed to CPAP, 23 had used CPAP for >=2 weeks. There was no significant difference in GA at CPAP start between those using CPAP >=2 vs. <2 weeks (30.7±3.0 vs. 30.0 ± 3.7 weeks, p=0.619). Those using CPAP >=2 weeks used the device on average for 37±16 days and for 74±18% of the days.

When comparing women in No-OSA group (n=38) vs. OSA with CPAP use >=2 weeks (n=23) and OSA with CPAP use <2 weeks (n=16), the rate of preterm delivery was significantly less in those who used CPAP >=2 weeks (13.1% vs. 0% vs. 31.2%, p=0.017). In addition, unplanned caesarean section was also significantly less (34.2% vs. 13.0% vs 52.0%, p=0.026). Other pregnancy outcomes were similar among groups.

Conclusion: CPAP use in pregnant women with diet-controlled GDM and OSA was safe. CPAP use for >=2 weeks in the third trimester was associated with a significantly less risk for premature delivery and unplanned caesarean section. This information supported the benefits of CPAP treatment in this patient group and should be confirmed in a larger study.

 

Nothing to Disclose: EW, BO, NC, SA, SC, SS, PP, SB, SR