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
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.013 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.009 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".