title: Can gestational hypertension be modified by treating nocturnal airflow limitation?
abstract: OBJECTIVE
  Recent evidence suggests that women with gestational hypertension (GH) have a high rate of sleep disordered breathing (SDB), and treatment for even marginal SDB may improve blood pressure control in women with GH. We assessed whether the application SDB treatment could improve blood pressure in women with GH.
  
  
  METHODS
  This was a single-center randomized study. Subjects underwent an unattended home-based diagnostic sleep study. The study was then repeated with subjects wearing one of two randomly assigned treatments: auto-titrating continuous positive airway pressure (auto-CPAP) or mandibular advancement device (MAD) + nasal strip. First morning blood pressure and blood for standard GH measures plus inflammatory markers were taken after each study. Subjects completed a series of questionnaires addressing sleep quality and tolerance of assigned therapy.
  
  
  RESULTS
  Twenty-four women completed the protocol-13 in the MAD group and 11 in auto-CPAP. The overall rate of SDB was 38%. Auto-CPAP was more effective at treating SDB than MAD + nasal strip, although the women randomized to MAD + nasal strip reported the greater comfort with therapy. First morning blood pressure was not consistently improved with either therapy. When subjects were stratified according to those whose blood pressure increased or decreased with therapy, an association was suggested between blood pressure improvement and reduced levels of tumour necrosis factor-α.
  
  
  CONCLUSIONS
  We demonstrated that 38% of women with GH had concurrent SDB. We did not find an improvement in blood pressure or inflammatory markers with a single night of either the auto-CPAP or MAD + nasal strip interventions. However important lessons from this study may guide future investigations in this area.
authors.affiliation: University of Saskatchewan, Saskatoon, SK Canada. j.reid@usask.ca
authors.forename: John
authors.initials: J
authors.lastname: Reid
authors.forename: Regina
authors.initials: R
authors.lastname: Taylor-Gjevre
authors.forename: John
authors.initials: J
authors.lastname: Gjevre
authors.forename: Robert
authors.initials: R
authors.lastname: Skomro
authors.forename: Mark
authors.initials: M
authors.lastname: Fenton
authors.forename: Femi
authors.initials: F
authors.lastname: Olatunbosun
authors.forename: John R
authors.initials: JR
authors.lastname: Gordon
authors.forename: David
authors.initials: D
authors.lastname: Cotton
mesh_terms: D000328:Adult; D001794:Blood Pressure; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000503:physiopathology*; D019186:Mandibular Advancement / Q000379:methods*; D010349:Patient Compliance; D017286:Polysomnography / Q000379:methods; D011247:Pregnancy; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Hypertension; preeclampsia; sleep apnea; sleep disordered breathing; treatment