Sleep Disordered Breathing, Obesity and Pregnancy Study (SOAP)
Sleep Disordered Breathing, Obesity and Pregnancy Study (SOAP)
The purpose of this study is to better understand how sleep apnea, a common sleep disorder in
 which a person has one or more pauses in breathing or shallow breaths while sleeping, may
 affect pregnancy and to determine the effect of Continuous Positive Airway Pressure (CPAP), a
 treatment that uses mild air pressure to keep the airways open during sleep, for pregnant
 women with sleep apnea.
Emerging data support a link between sleep disordered breathing (SDB) and adverse pregnancy
 outcomes, particularly preeclampsia. Furthermore, SDB, which is characterized by intermittent
 nocturnal hypoxia-reoxygenation as well as sleep disruption, results in endothelial
 dysfunction and metabolic dysregulation, the same biological pathways that have been
 associated with adverse pregnancy outcomes. Obesity is a well-known risk factor for both
 adverse pregnancy outcomes and SDB, and has been associated with the same aforementioned
 biological aberrations. Therefore, obesity complicates the definition of a causal
 relationship between SDB and pregnancy outcomes. While some classic cardiovascular risk
 factors (prehypertension) are certainly relevant in pregnancy, there are also
 well-established risk factors that are unique to pregnancy (uterine vascular stiffness,
 placental angiogenic factors). The interplay between SDB, obesity and these unique
 cardiovascular risk factors remains undefined, and this proposal aims to address this
 knowledge gap. Without this data, our ability to understand how we can mitigate these risks
 through the use of therapeutic interventions for SDB, such as CPAP (continuous positive
 airway pressure), is compromised. To further address this knowledge gap, we will make use of
 the placenta's ability to accumulate evidence of damage over time and provide a record of
 maternal vascular health throughout gestation. Numerous placental lesions deriving from
 maternal vascular disease have been identified and can be readily detected on placental
 pathology. These lesions can provide a measure of the severity of hypoxic stress experienced
 by the fetus during gestation.

 The investigators' central hypothesis is that SDB is an effect modifier that increases
 maternal cardiovascular risk and placental hypoxic injury in obese pregnant women, and that
 CPAP treatment during pregnancy will result in an improved cardiovascular risk and placental
 profile. To test this hypothesis the investigaotrs will identify a cohort of obese women both
 with and without SDB. The investigators will examine SDB's impact on maternal vascular
 stiffness (uterine artery Doppler), angiogenesis (pregnancy specific angiogenic factors e.g.,
 sFLT-1) and metabolism (insulin resistance) across pregnancy (Aim 1). The investigators will
 perform a randomized controlled trial of autotitrating- CPAP verses sham-CPAP in pregnancy to
 examine the impact of CPAP treatment during pregnancy on cardiovascular risk (Aim 2) and will
 explore the interplay between SDB, CPAP and evidence of maternal vascular disease and chronic
 fetal hypoxia by evaluating the placental profile of obese women with and without SDB (Aim
 3).
Inclusion Criteria:

 -  women between 14 0/7 and 20 6/7 weeks gestation at the time of their initial PSG
 assessment.

 -  Pregnancy and current BMI >=30

 -  Self-reported frequent snoring (>=3x/week over past month) or self-reported
 non-snorer.

 Exclusion Criteria:

 -  diagnosis of pregestational diabetes.

 -  self-report a history of sleep apena and who are using or were receommended by a
 physican to use a PAP device already

 -  twins