The Effect of Continuous Positive Airway Pressure (CPAP) on Physical Activity Levels in Pregnant Women With Gestational Diabetes and Sleep-Disordered Breathing: A Secondary Analysis of a Randomized-Controlled Trial
Notice bibliographique
Résumé
Abstract Rationale: Gestational diabetes (GDM), a common pregnancy complication, is defined by glucose intolerance that is first recognized during pregnancy. Physical activity plays a role in preventing GDM and is essential in its management. Sleep-disordered breathing (SDB) affects up to ∼50% of GDM pregnancies by the third trimester. In our recent pilot RCT, continuous positive airway pressure (CPAP) improved nocturnal glucose levels in those with GDM and SDB. Improvement in SDB symptoms (sleepiness, fatigue), by addressing interrupted sleep, could be associated with increased physical activity, which in turn could contribute to improved glucose control. The objective of this analysis was to assess whether CPAP impacts on objectively measured physical activity levels in patients with GDM and SDB. Methods:In a secondary analysis of a multicenter, pilot RCT that compared CPAP treatment with nasal dilator strips (control) in patients with GDM and SDB, physical activity levels were evaluated before and after the intervention. Participants wore a Sensewear® Armband (BodyMedia Inc., Pittsburgh, PA) for 7 days continuously at baseline and again, 4 weeks after treatment initiation. The armband is a multi-sensor device that uses triaxial accelerometry to measure step counts and various other physical activity metrics. For this preliminary analysis, estimates of the post- and pre-treatment difference in mean daily step counts were obtained for both the CPAP and control groups, and the difference of differences between groups was compared using a T-test. A mixed-effects model was also performed using all available step count data. Results:Of the 45 participants that were randomized (mean ± SD age of 36±4, and pre-pregnancy BMI 30±8 kg/m2), key baseline characteristics were balanced between groups, including SDB severity measures and gestational age. To date, we have analyzed data from 26 individuals with armband data available at both baseline and on-treatment who were therefore included in the complete case analysis. The change in average daily step counts in the control group was 659.36 (-602.81, 1921.53, 95% CI), and in the CPAP group was 506.97 (-3.0,1016.95, 95% CI). The difference of differences (CPAP-NDS; post-pre) of the average step count was 152.39; (-1478.14, 1173.36, 95% CI), which was not statistically significant. Similar results were obtained using the mixed-effects model. Further analysis on the remaining physical activity variables is ongoing. Conclusion:In this preliminary analysis, among patients with SDB and GDM, the difference in step count over 7-days before and after CPAP treatment was not different from that observed in controls.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,013 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,007 | 0,009 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».