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A position modification device for the prevention of supine sleep during pregnancy: a randomised crossover trial.
  • +2
  • Danielle Wilson,
  • Carley Whenn,
  • Maree Barnes,
  • Susan Walker,
  • Mark Howard
Danielle Wilson
Institute for Breathing and Sleep

Corresponding Author:danielle.wilson@austin.org.au

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Carley Whenn
Institute for Breathing and Sleep
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Maree Barnes
Institute for Breathing and Sleep
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Susan Walker
The University of Melbourne Department of Obstetrics and Gynaecology
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Mark Howard
Institute for Breathing and Sleep
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Abstract

Objective: to assess the effectiveness and acceptability of a pillow-like position modification device to reduce supine sleep during late pregnancy, and to determine the impacts on the severity of sleep-disordered breathing (SDB) and fetal wellbeing. Design: Randomised cross-over study Setting and population: Individuals in the third trimester of pregnancy receiving antenatal care at a tertiary maternity hospital in Australia. Methods: Participants used their own pillow for a control week and an intervention pillow for a week overnight, in randomized order. Sleep position and total sleep time for each night of both weeks was objectively monitored, with a sleep study and fetal heart rate monitoring performed on the last night of each week. Main Outcome Measures: Percentage of sleep time in the supine position, apnoea-hypopnoea index, fetal heart rate decelerations and birthweight. Results: Forty-one individuals were randomized with data collected on 35 participants over 469 nights. There was no difference in percentage of total sleep time in the supine position overnight between the control or intervention pillow week (13.0% [6.1, 25.5] v 16.0% [5.6, 27.2], p = .81), and no difference in the severity of SDB or fetal heart rate decelerations across weeks. However, increased supine sleep was significantly related to a higher apnea-hypopnea index (r s = .37, p = .003), lower birthweight (r s = -.45, p = .007) and lower customised birthweight centile (r s = -.45, p = .006). The proportion of supine sleep each night of the week varied widely both within and across participants, despite awareness of side-sleeping recommendations. Conclusions: The adoption of a pillow designed to discourage supine sleep was not effective in late pregnancy, with women spending an average of one hour per night supine. Supine sleep was associated with SDB and lower birthweight. Alternative devices should be investigated, incorporating lessons learnt from this study to inform trials of supine sleep minimisation in pregnancy. Clinical Trial Registration Number – ACTRN12620000371998 (Australia New Zealand Clinical Trials Registry)
Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
26 Jan 2024Review(s) Completed, Editorial Evaluation Pending
06 Feb 2024Editorial Decision: Revise Major
11 Jun 2024Review(s) Completed, Editorial Evaluation Pending
20 Jul 2024Editorial Decision: Revise Major
06 Aug 20242nd Revision Received
06 Aug 2024Submission Checks Completed
06 Aug 2024Assigned to Editor
06 Aug 2024Review(s) Completed, Editorial Evaluation Pending
26 Aug 2024Editorial Decision: Accept