Sleep-Disordered Breathing and PAP in Perinatal Depression
Sleep-Disordered Breathing and PAP in Perinatal Depression
The goal of this study is to understand the contribution of sleep-disordered breathing (SDB)
 to one of the most common and debilitating adverse pregnancy outcomes, perinatal depression.
 The study is a randomized trial to test the efficacy of positive airway pressure (PAP) on
 sleep and depression symptoms in perinatal women. Participants will be pregnant women with
 depression and sleep-disordered breathing. Participants will be randomly assigned to receive
 either PAP therapy (PAP group) or treatment as usual within obstetrics (TAU group). Mood and
 sleep assessments will be completed at baseline, after 1 week of enrollment, and monthly
 thereafter through 12 weeks postpartum. Cortisol will be measured using saliva collection at
 baseline and again 8 weeks later.
Inclusion Criteria:

 -  20-32 weeks gestation with a single, live fetus

 -  meet criteria for major depressive disorder per the Structured Clinical Interview for
 DSM-V (SCID)

 -  respiratory distress index (RDI; includes apneas, hypopneas, and respiratory
 effort-related arousals)≥5 per ambulatory assessment plus apnea symptoms (snoring,
 witnessed apnea, daytime sleepiness, sleep disturbance, snort arousals)

 -  stable dose (for ≥8 weeks) of a selective serotonin reuptake inhibitor (SSRI) OR free
 of all antidepressant medications past 4 weeks

 -  obstetrics care is at the University of Michigan, and the woman plans on delivering
 her baby at the University of Michigan

 Exclusion Criteria:

 -  Diagnosis of bipolar disorder, posttraumatic stress disorder, schizophrenia or
 psychosis, dissociative disorders, eating disorder, obsessive-compulsive disorder,
 somatic symptom and related disorders, substance use disorder, panic disorder,
 agoraphobia per DSM-V

 -  diagnosis of, or suspicion for, narcolepsy or REM behavior disorder

 -  current SDB treatment; medical conditions for which PAP is contraindicated (e.g.,
 pneumothorax, pneumocephalus, recent trauma, recent surgery)

 -  evidence of risk for drowsy driving (excessive daytime sleepiness plus history of
 motor vehicle accident or near miss due to sleepiness, fatigue, or inattention in past
 12 months).