Patterns of adherence to continuous positive airway pressure and mandibular advancement splints in pregnant individuals with sleep-disordered breathing.

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Sleep and Breathing Pub Date : 2025-04-04 DOI:10.1007/s11325-025-03284-5

Joshua Smocot, Nelly Huynh, Pattaraporn Panyarath, R John Kimoff, Sara Meltzer, Léa Drouin-Gagné, Raphieal Newbold, Courtney Hebert, Andrea Benedetti, Jean-Patrick Arcache, Anne-Maude Morency, Natasha Garfield, Evelyne Rey, Sushmita Pamidi

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引用次数: 0

Abstract

Purpose: Night-to-night adherence to sleep-disordered breathing (SDB) treatment with either continuous positive airway pressure (CPAP) or mandibular advancement splints (MAS) in pregnancy has not been well characterized. The objective of this study was to assess night-to-night adherence patterns from existing CPAP and MAS data in pregnancy.

Methods: Three separate pregnancy cohorts evaluating treatment for SDB in the second and third trimester were used: 1) CPAP in gestational diabetes mellitus (GDM), 2) CPAP in hypertensive disorders of pregnancy (HDP), and 3) mandibular advancement splints (MAS). The first 30 days of objective adherence data obtained from CPAP and MAS devices were used in this descriptive analysis.

Results: Data from 37 CPAP users and 15 MAS users was analyzed. For the GDM and HDP cohorts, three patterns of adherence were observed: 1) consistent CPAP users (38%), 2) improved CPAP usage after initial adaptation (16%), and 3) inconsistent CPAP users (46%). For the MAS cohort, the three observed patterns of adherence were: 1) consistent MAS users (47%), 2) initial usage with subsequent decrease in adherence (20%), and 3) inconsistent MAS users (33%). Participant characteristics (demographics, disease severity) were similar between adherence groups, with the exception of longer total sleep time in consistent CPAP users of the GDM cohort and greater gestational age in consistent CPAP users of the HDP cohort.

Conclusion: Overall, objective night-to-night adherence patterns revealed that almost half of CPAP and MAS users had difficulty adapting to treatment in the first 30 days of treatment. Early usage patterns in pregnancy may provide insight into identifying patients who are at risk for poor adherence and for developing tailored and timely interventions to enhance adherence to therapy.

Trial registration: ClinicalTrials.gov Identifiers: NCT02245659, NCT03309826, NCT03138291.

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妊娠期睡眠呼吸障碍患者持续气道正压和下颌前移夹板的依从模式。

目的：妊娠期持续气道正压通气（CPAP）或下颌前移夹板（MAS）治疗睡眠呼吸障碍（SDB）的夜间依从性尚未得到很好的表征。本研究的目的是评估妊娠期CPAP和MAS数据的夜间依从性模式。方法：采用三个独立的妊娠队列评估妊娠中期和晚期SDB的治疗：1)CPAP治疗妊娠糖尿病（GDM）， 2) CPAP治疗妊娠高血压疾病（HDP）， 3)下颌前移夹板（MAS）。从CPAP和MAS设备获得的前30天的客观依从性数据用于描述性分析。结果：分析了37名CPAP使用者和15名MAS使用者的数据。对于GDM和HDP队列，观察到三种依从性模式：1)一致的CPAP使用者（38%），2)初始适应后CPAP使用改善（16%），3)不一致的CPAP使用者（46%）。对于MAS队列，观察到的三种依从性模式是：1)一致的MAS使用者（47%），2)初始使用后依从性下降（20%），3)不一致的MAS使用者（33%）。参与者特征（人口统计学，疾病严重程度）在依从组之间相似，除了GDM队列中持续使用CPAP的患者总睡眠时间较长，HDP队列中持续使用CPAP的患者胎龄较大。结论：总体而言，客观的夜对夜依从模式显示，几乎一半的CPAP和MAS使用者在治疗的前30天难以适应治疗。妊娠期的早期使用模式可能有助于识别有依从性差风险的患者，并有助于制定量身定制的及时干预措施，以加强对治疗的依从性。试验注册：ClinicalTrials.gov标识符：NCT02245659， NCT03309826, NCT03138291。

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来源期刊

Sleep and Breathing 医学-呼吸系统

CiteScore

5.20

自引率

4.00%

发文量

222

审稿时长

3-8 weeks

期刊介绍： The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep. Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.