Grant: Project Grant

Sleep disordered breathing (SDB), a condition where breathing repeatedly stops or becomes shallow during sleep, affects up to half of pregnant individuals, especially later in pregnancy and among those with medical complications. The standard treatment is continuous positive airway pressure (CPAP), which is medically effective, yet many pregnant patients struggle to use it consistently. In our prior study, nearly half had low adherence-even though those who used CPAP showed meaningful metabolic benefits. This highlights the need for treatment options that fit patient comfort and preferences. Mandibular advancement splints (MAS), a mouthguard like device that holds the jaw forward, are an established alternative for SDB and are often easier to tolerate. However, in pregnancy MAS is rarely used, largely due to limited awareness of its value as an adjunct to CPAP and challenges obtaining MAS quickly within the short pregnancy timeline. Our qualitative work showed that pregnant individuals strongly preferred having access to both CPAP and MAS, allowing them to switch between therapies based on nightly comfort, symptoms, and changes across pregnancy. This study will test whether offering both CPAP and MAS-letting patients choose their nightly treatment-improves overall treatment success compared with CPAP alone. We will enroll 350 participants across three Canadian centres. We will examine treatment effectiveness, usage patterns, patient satisfaction, feasibility of offering dual therapy in real world clinics, and potential associations with maternal and fetal health. This research aims to provide an evidence based, scalable, patient centred model of care that improves comfort, adherence, and ultimately pregnancy health outcomes.