OSA in Pregnant Women With Chronic HTN

Study Overview
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Brief Summary
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The purpose of this study is to identify whether pregnant women with chronic hypertension are at significantly higher risk of having undiagnosed OSA and should be routinely screened with home sleep tests. The investigators will recruit 120 pregnant subjects between 10-20 weeks gestation from the Duke High Risk Obstetrics Clinic over a 20-month period. They will be enrolled into one of two groups: 1) chronic hypertension (on medication or hypertensive blood pressures documented at 3 clinic visits); 2) normal blood pressure, and not on any treatment for chronic HTN and no history of chronic HTN, and matched for BMI (+/- 3 kg/m2) with the chronic HTN group. The two groups will be matched for BMI to control for the effect of obesity on OSA diagnosis and cHTN. The primary hypothesis, that OSA prevalence differs between patients with chronic HTN and normotensive controls, will be assessed with a two-group two-sided Fisher's exact test. A Fisher's exact test with a 0.05 two-sided significance level will have 92% power to detect the difference between a normotensive OSA rate of 0.10 and a chronic hypertensive OSA rate of 0.40 when the sample size in each group is 50. There are no risks associated with the use of the home sleep test device, but subjects that have a severe latex allergy should not participate, as the device

Official Title
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Obstructive Sleep Apnea Among Pregnant Women With Chronic Hypertension

Conditions
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Sleep Apnea, Obstructive, Pregnancy, Hypertension

Intervention / Treatment
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* Diagnostic Test: WP200U home sleep study device


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pregnant woman who are patients of:Duke Hospital, Duke Birthing Center (DBC), Duke Perinatal Durham clinic, Inpatients will be recruited from the obstetric antepartum service. Gestational age 10 weeks, 0 days to 20 weeks, 6 days 18 years or older English speaking They will be enrolled into one of two groups:-Chronic hypertension (on medication or hypertensive blood pressures documented on two clinic visits (including prior to pregnancy), -Normal blood pressure, and not on any treatment for chronic HTN and no history of chronic HTN, and matched for BMI (+/- 3 kg/m2) with the chronic HTN group The two groups will be matched for body mass index to control for the effect of obesity on OSA diagnosis and HTN. Subjects will be not be excluded if they have an established diagnosis of OSA that is not currently being treated. Exclusion Criteria: Being treated for OSA On chronic opioids On alpha-blockers (which can interfere with the PAT signal) Have secondary HTN Unwilling to remove nail polish and/or shorten one nail (which can also interfere with the PAT signal) Have a severe allergy to latex Do not speak English.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Chronic Hypretension in Pregnancy<br>Pregnant subjects between 10-20 weeks gestation with chronic hypertension (on medication or hypertensive blood pressures documented at 2 clinic visits) | Diagnostic Test: WP200U home sleep study device<br>* WP200U, is a Type III, wrist-worn, FDA-approved home sleep testing device that utilizes finger plethysmography (peripheral arterial tone, oxyhemoglobin saturation and heart rate), actigraphy (movement), acoustic decibel detection (snoring volume), and accelerometry (body position) to help diagnose sleep-related breathing disorders (including snoring), and to give information about sleep stages and position during actual sleep time.<br>* Other names: WatchPAT;|
| Normotensive in Pregnancy<br>Pregnant subjects between 10-20 weeks gestation with normal blood pressure, and not on any treatment for chronic hypertension and no history of chronic hypertension, and matched for body mass index (+/- 3 kg/m2) with the chronic hypertension group. | Diagnostic Test: WP200U home sleep study device<br>* WP200U, is a Type III, wrist-worn, FDA-approved home sleep testing device that utilizes finger plethysmography (peripheral arterial tone, oxyhemoglobin saturation and heart rate), actigraphy (movement), acoustic decibel detection (snoring volume), and accelerometry (body position) to help diagnose sleep-related breathing disorders (including snoring), and to give information about sleep stages and position during actual sleep time.<br>* Other names: WatchPAT;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of OSA in pregnant women with chronic HTN |  | 20 months | 
| Prevalence of OSA in pregnant women who are normotensive and BMI-matched to women with chronic HTN |  | 20 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Apnea-hypopnea indices in pregnant women with untreated OSA and cHTN |  | 20 months | 
| Apnea-hypopnea indices in pregnant women with untreated OSA and normotensive. |  | 20 months | 
| Oxygen-desaturation indices in pregnant women with untreated OSA and cHTN |  | 20 months | 
| Oxygen-desaturation indices in pregnant women with untreated OSA and normotensive. |  | 20 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sleep disordered breathing, Obstructive sleep apnea, Hypertension, Pregnancy