Grant: Project Grant

Problems of high blood pressure during pregnancy ("hypertensive disorders of pregnancy", HDP) can lead to devastating medical complications for both mother and baby. New approaches to preventing and treating HDP are needed. Studies have shown that breathing problems during sleep characterized by blockage of the airway leading to disrupted sleep and low blood oxygen ("obstructive sleep-disordered breathing", OSDB) can affect up to one quarter of pregnant women by the end of pregnancy. In the general non-pregnant population, ODSB is associated with high blood pressure and treatment of ODSB can lead to improvement in blood pressure. In pregnancy, many studies have drawn a link between HDP and OSDB. However there have been very few studies evaluating the effects of treating OSDB in pregnant women with HDP. This project will be an initial or "pilot" study evaluating whether we can successfully recruit pregnant women with HDP, perform sleep studies to identify SDB, and then randomize half of the women with ODSB to successful treatment with positive airway pressure (PAP) treatment during sleep throughout the remainder of their pregnancy and the immediate post-delivery period. The other half of the subjects will receive treatment with nasal dilator strips applied to the nose at night, as a control treatment. In addition to evaluating the feasibility/success rates of conducting this protocol, we will obtain important data on blood pressure control and whether complications of HDP for the mothers and babies are improved with PAP treatment. The results of this study will provide important new information on the effects of OSDB treatment on complications of HDP, and will be crucial to guiding future research protocols in this important area. We believe that this work will ultimately have substantial impact on the delivery of health care, leading to improved prevention, treatment and prognosis of pregnant women with hypertensive disorders of pregnancy.