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Halifax PrenaBelt Trial

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ClinicalTrials.gov Identifier: NCT02377817
Recruitment Status : Completed
First Posted : March 4, 2015
Results First Posted : April 2, 2020
Last Update Posted : April 2, 2020
Sponsor:
Collaborators:
Grand Challenges Canada
Innovative Canadians for Change
Global Innovations for Reproductive Health and Life
Kaishin Chu Design
Nova Scotia Health Authority
University of Michigan
Harvard University
Information provided by (Responsible Party):
Allan Kember, IWK Health Centre

Brief Summary:

Back and right-sided sleeping position in pregnant women has recently emerged as a potential risk factor for low birthweight (LBW) and stillbirth (SB) in the medical literature. Assuming that sleep position in pregnant women is modifiable, the same literature has indicated that this risk factor is modifiable; however, there is no evidence that this risk factor is truly modifiable.

The proposed link between back and right-sided sleeping position in a pregnant woman and LBW and SB of her baby is multifactorial; however, it ultimately implicates the woman's body position in causing compression of one of the large veins that brings blood back to her heart. This compression, along with other factors relating to the woman, her placenta, and her developing fetus, may result in decreased blood flow (nutrition and oxygen) to her developing baby, which, depending on the extent and duration, could result in LBW or SB of her baby. If the back sleeping position during pregnancy has a causative role in LBW and subsequently SB, the literature indicates that up to 17% of LBW and consequently 26% of SB could potentially be prevented by changing position to avoid back sleep. Note that 20 million LBW and 2.6 million SB occur each year worldwide.

Positional therapy (PT) is a safe and effective intervention for preventing people who snore or people who's breathing pauses during sleep from sleeping on their back - a position that makes their condition worse. The most basic form of PT modifies a person's sleeping position by either:

  • Preventing them from sleeping on their back through restricting their movement, or
  • Rather than restricting movement, significantly reducing the amount of time they spend sleeping on their back by applying pressure points to their body while they are on their back, which eventually causes them to shift into a different position and avoid lying on their back.

The purpose of this study is to evaluate the ability of a PT intervention to modify the position of pregnant women from their back and right side to their left side while they sleep in late pregnancy.

This study will help determine whether this potential risk factor is modifiable by way of a PT intervention, and whether it is feasible to intervene to reduce or prevent back and right-sided position sleep in late pregnancy. Demonstrating that the sleeping position of pregnant women can be modified through use of a simple, inexpensive PT intervention may be one of the keys to achieving significant reductions in LBW and late SB rates in Canada and worldwide.


Condition or disease Intervention/treatment Phase
Sleep Pregnancy Stillbirth Infant, Low Birth Weight Infant, Small for Gestational Age Infant, Very Low Birth Weight Fetal Growth Retardation Fetal Hypoxia Device: PrenaBelt Device: Sham PrenaBelt Not Applicable

Detailed Description:

The utility of the PrenaBelt in modifying maternal sleeping position and the effect of the PrenaBelt on maternal respiratory and cardiovascular parameters during sleep and sleep staging in the third trimester of pregnancy will be evaluated via a two-night, randomized, cross-over, sham-controlled, triple-blind, sleep study in third trimester pregnant women.

Two nights: one night with a positional therapy (PT) device and one night with sham-PT device to determine treatment effect on outcomes.

Randomized: participants will be randomized to treatment order: sham-PT on first night, then PT on second night, or vice versa. This will avoid the potential impact of changes to sleep across the two nights resulting from familiarization with the equipment, which could bias the results.

Cross-over: on the second night, each participant will be crossed over from PT to sham-PT (or vice versa, depending on randomization order) to allow each participant to act as her own control for comparison of treatment effect on outcomes.

Sham-controlled: a sham-PT device that has the same fit and form of the PT device but without the ability of function (pressure points) will be used as a control. The purpose of a sham-PT device is to identify any specific benefit of one element of a PT device (e.g., fit or form) above and beyond all benefits that might be attributed to everything else about that device (e.g., function). Note that there is no established effective therapy for the population for the indication under study.

Triple blind: participants, sleep technologists monitoring and scoring the sleep tests, and the specialized sleep physician reviewing and reporting the sleep test results will be blinded to the intervention received each night.

Laboratory: conducting this study in a controlled lab setting will allow for continual, real time monitoring of various cardiovascular, respiratory, and sleep parameters of each participant by the sleep technologist. This contributes to a more controlled and safer study overall.

Sleep test: body position, various cardiovascular and respiratory parameters, and sleep parameters will be continuously recorded while the participants are sleeping. Sleep lab procedures will be followed by the personnel conducting, scoring, reviewing, and reporting the sleep tests from participant preparation through discharge

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 23 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Modifying Maternal Sleep Position in the Third Trimester of Pregnancy With Positional Therapy: A Randomized Pilot Trial
Actual Study Start Date : March 15, 2016
Actual Primary Completion Date : January 28, 2017
Actual Study Completion Date : January 28, 2017

Arm Intervention/treatment
Experimental: PrenaBelt on First Sleep Test Night
Participants will be randomized to treatment order: sham PrenaBelt on first night, then PrenaBelt on second night, or vice versa. This will avoid the potential impact of changes to sleep across the two nights resulting from familiarization with the polysomnography equipment, which could bias the results.
Device: PrenaBelt

The PrenaBelt is a belt-like, positional therapy (PT) device designed specifically for pregnant women. While the PrenaBelt does not prevent the user from lying on her back or right side during sleep, it is expected to significantly decrease the amount of time she spends in these two positions via the mechanism of PT. PT is a simple, non-invasive, inexpensive, long-established, safe, and effective intervention for preventing people with positional-dependent snoring or obstructive sleep apnea from sleeping on their back - a position that exacerbates their condition.

The PrenaBelt is worn at the level of the waist. By virtue of its design and position on the user's body, the PrenaBelt affects subtle pressure points on the back and right side of the user when she lies on her back or right side, respectively, activating her body's natural mechanism to spontaneously reposition itself to relieve discomfort, thereby reducing the amount of time she remains on her back or right side.


Device: Sham PrenaBelt
The Sham PrenaBelt and PrenaBelt are the same device except the plastic balls are removed from the Sham PrenaBelt so it cannot provide pressure points.

Sham Comparator: Sham PrenaBelt on First Sleep Test Night
Participants will be randomized to treatment order: sham PrenaBelt on first night, then PrenaBelt on second night, or vice versa. This will avoid the potential impact of changes to sleep across the two nights resulting from familiarization with the polysomnography equipment, which could bias the results.
Device: PrenaBelt

The PrenaBelt is a belt-like, positional therapy (PT) device designed specifically for pregnant women. While the PrenaBelt does not prevent the user from lying on her back or right side during sleep, it is expected to significantly decrease the amount of time she spends in these two positions via the mechanism of PT. PT is a simple, non-invasive, inexpensive, long-established, safe, and effective intervention for preventing people with positional-dependent snoring or obstructive sleep apnea from sleeping on their back - a position that exacerbates their condition.

The PrenaBelt is worn at the level of the waist. By virtue of its design and position on the user's body, the PrenaBelt affects subtle pressure points on the back and right side of the user when she lies on her back or right side, respectively, activating her body's natural mechanism to spontaneously reposition itself to relieve discomfort, thereby reducing the amount of time she remains on her back or right side.


Device: Sham PrenaBelt
The Sham PrenaBelt and PrenaBelt are the same device except the plastic balls are removed from the Sham PrenaBelt so it cannot provide pressure points.




Primary Outcome Measures :
  1. Percentage (%) of Sleep Time Supine [ Time Frame: 1 night (approximately 8 hours) ]
    Proportion of sleeping time spent in the supine position


Secondary Outcome Measures :
  1. Total Sleep Time [ Time Frame: 1 night (approximately 8 hours) ]
    This is a standard polysomnography measure of the amount of time the participant spent sleeping during the sleep test.

  2. Supine Sleep Time [ Time Frame: 1 night (approximately 8 hours) ]
    The time (in minutes) spent sleeping in the supine position.

  3. Left-lateral Sleep Time [ Time Frame: 1 night (approximately 8 hours) ]
    Time (in minutes) spent sleeping in the left-lateral position.

  4. Right-lateral Sleep Time [ Time Frame: 1 night (approximately 8 hours) ]
    Time (in minutes) spent sleeping in the right-lateral position.

  5. Percentage Sleep Left [ Time Frame: 1 night (approximately 8 hours) ]
    Percentage (%) of sleeping time in the left-lateral position.

  6. Percentage Sleep Right [ Time Frame: 1 night (approximately 8 hours) ]
    Percentage (%) of sleeping time in the right-lateral position.

  7. Sleep Latency [ Time Frame: 1 night (approximately 8 hours) ]
    This is a standard polysomnography measure of the amount of time (in minutes) that it takes a participant to transition from full wakefulness to sleep.

  8. Sleep Efficiency [ Time Frame: 1 night (approximately 8 hours) ]
    This is a standard polysomnography measure of the percentage (%) of time the participant was asleep during the sleep test.

  9. Total Arousal Index [ Time Frame: 1 night (approximately 8 hours) ]
    This is a standard polysomnography measure of the number of times the participant was aroused from a deeper stage of NREM sleep to a lighter stage, or from REM sleep toward wakefulness. This is reported as a 'total arousal index', which is an average of the number of arousals per hour, and is further classified as a spontaneous, periodic leg movement, or respiratory arousal index.

  10. Spontaneous Arousal Index [ Time Frame: 1 night (approximately 8 hours) ]
    This is a standard polysomnography measure of the number of times the participant was spontaneously aroused from a deeper stage of NREM sleep to a lighter stage, or from REM sleep toward wakefulness. This is reported as an 'arousal index', which is an average of the number of arousals per hour.

  11. Periodic Limb Movement Arousal Index [ Time Frame: 1 night (approximately 8 hours) ]
    This is a standard polysomnography measure of the number of times the participant was aroused from a deeper stage of NREM sleep to a lighter stage, or from REM sleep toward wakefulness due to periodic limb movements (PLMs). This is reported as an 'arousal index', which is an average of the number of arousals per hour.

  12. Respiratory Arousal Index [ Time Frame: 1 night (approximately 8 hours) ]
    This is a standard polysomnography measure of the number of times the participant was aroused from a deeper stage of NREM sleep to a lighter stage, or from REM sleep toward wakefulness due to respiratory events. This is reported as an 'arousal index', which is an average of the number of arousals per hour.

  13. Percent Stage 1 Sleep [ Time Frame: 1 night (approximately 8 hours) ]
    Percent (%) of total sleep time in sleep stage 1.

  14. Percent Stage 2 Sleep [ Time Frame: 1 night (approximately 8 hours) ]
    Percent (%) of total sleep time in sleep stage 2.

  15. Percent Stage 3 Sleep [ Time Frame: 1 night (approximately 8 hours) ]
    Percent (%) of total sleep time in sleep stage 3.

  16. Percent REM Sleep [ Time Frame: 1 night (approximately 8 hours) ]
    Percent (%) of total sleep time in rapid eye movement (REM) sleep

  17. Apnea Hypopnea Index [ Time Frame: 1 night (approximately 8 hours) ]
    Apnea hypopnea index (AHI) is a standard polysomnography measure to indicate the severity of sleep apnea. AHI is the average number of apnea and hypopnea events per hour. Will be reported as a total AHI in units of 'events per hour'.

  18. Respiratory Effort-Related Arousal Index [ Time Frame: 1 night (approximately 8 hours) ]
    Respiratory Effort-Related Arousal (RERA) index is a standard polysomnography measure to indicate arousals from respiratory effort. Will be reported in units of 'arousals per hour'.

  19. Respiratory Disturbance Index (RDI) [ Time Frame: 1 night (approximately 8 hours) ]
    This is a standard polysomnography measure. Like the AHI, RDI reports on respiratory events during sleep, but unlike the AHI, it also includes respiratory-effort related arousals (RERAs). RERAs are arousals from sleep that do not technically meet the definitions of apneas or hypopneas, but do disrupt sleep. Will be reported as a total RDI as well as RDI while supine and RDI while non-supine.

  20. Peripheral Blood Oxygen Saturation (SpO2) [ Time Frame: 1 night (approximately 8 hours) ]
    SpO2 measured by fingertip pulse oximetry is a standard measure to indicate the oxygen saturation. Mean SpO2, Min SpO2, and Max SpO2 during Rapid Eye Movement (REM), and Non-REM (NREM) states.

  21. Number of Participants With Snoring [ Time Frame: 1 night (approximately 8 hours) ]
    This is a standard polysomnography measure of the presence of snoring via nasal cannula (pressure transducer) and by objective report of the research assistant (real-time audio feed).

  22. PrenaBelt User Feedback Questionnaire - Satisfaction [ Time Frame: 1 night (approximately 8 hours) ]

    Each participant will complete the PrenaBelt User Feedback Questionnaire.

    On a scale of 1 to 10, participant's level of satisfaction with the PrenaBelt. Note:

    1 = extremely dissatisfied 5-6 = acceptable 10 = extremely satisfied


  23. PrenaBelt User Feedback Questionnaire - Comfort [ Time Frame: 1 night (approximately 8 hours) ]

    Each participant will complete the PrenaBelt User Feedback Questionnaire. On a scale of 1 to 10, participant's level of comfort while wearing and sleeping with the PrenaBelt. Note:

    1 = extremely uncomfortable 5-6 = acceptable 10 = extremely comfortable


  24. PrenaBelt User Feedback Questionnaire - Intention to Use [ Time Frame: 1 night (approximately 8 hours) ]

    Each participant will complete the PrenaBelt User Feedback Questionnaire. On a scale of 1 to 10, participant's intention to use the PrenaBelt during a subsequent pregnancy if it was available to her.

    Note:

    1 = participant would never use it again 5-6 = participant would consider using it again 10 = participant would certainly use it again


  25. Sleep Onset Position [ Time Frame: 1 night (approximately 8 hours) ]
    To determine the accuracy of self-reported sleep behaviours against the gold-standard, polysomnography. This is the sleep onset position (left, supine, right) per the participant's self report and is compared with the sleep onset position (left, supine, right) per the polysomnography data.

  26. Waking Position [ Time Frame: 1 night (approximately 8 hours) ]
    To determine the accuracy of self-reported sleep behaviours against the gold-standard, polysomnography. This is the participant's waking position (left, supine, right, prone) per the participant's self report and is compared with the waking position (left, supine, right, prone) per the polysomnography data.

  27. Number of Position Changes [ Time Frame: 1 night (approximately 8 hours) ]
    To determine the accuracy of self-reported sleep behaviours against the gold-standard, polysomnography. This is the number of times the participant changed body position (e.g., supine to left side) per the participant's self report and is compared with the number of times the participant changed body position per the polysomnography data.

  28. Percentage of Total Sleep Time in Each Position [ Time Frame: 1 night (approximately 8 hours) ]
    To determine the accuracy of self-reported sleep behaviours against the gold-standard, polysomnography. This is the percentage (%) of total sleep time in each position (left, supine, right, prone) per the participant's self report and is compared with the percentage (%) of total sleep time in each position (left, supine, right, prone) per the polysomnography data.



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • ≥18 years old
  • low-risk singleton pregnancy
  • in the last trimester of pregnancy (≥28 weeks of gestation)
  • residing in the Halifax Regional Municipality

Exclusion Criteria:

  • BMI ≥ 35 at booking (first antenatal appointment for current pregnancy)
  • pregnancy complicated by obstetric complications (hypertension [pre-eclampsia, gestational hypertension, chronic hypertension], diabetes [gestational or not], or intra-uterine growth restriction [<10th %ile for growth])
  • sleep complicated by medical conditions (known obstructive sleep apnea, known to get <4 hours of sleep per night due to insomnia, or musculoskeletal disorder that prevents sleeping on a certain side [e.g., arthritic shoulder])
  • multiple pregnancy
  • known fetal abnormality
  • non-English speaking and reading

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02377817


Locations
Layout table for location information
Canada, Nova Scotia
IWK Women's Health Centre
Halifax, Nova Scotia, Canada, B3K 6R8
Sponsors and Collaborators
Allan Kember
Grand Challenges Canada
Innovative Canadians for Change
Global Innovations for Reproductive Health and Life
Kaishin Chu Design
Nova Scotia Health Authority
University of Michigan
Harvard University
Investigators
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Principal Investigator: Heather Scott, MD FRCSC The IWK Health Centre
  Study Documents (Full-Text)

Documents provided by Allan Kember, IWK Health Centre:
Statistical Analysis Plan  [PDF] January 26, 2015
Study Protocol  [PDF] March 15, 2016

Additional Information:
Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Allan Kember, Medical Student, IWK Health Centre
ClinicalTrials.gov Identifier: NCT02377817    
Other Study ID Numbers: GCC-S7-0629-01-10-HAL
First Posted: March 4, 2015    Key Record Dates
Results First Posted: April 2, 2020
Last Update Posted: April 2, 2020
Last Verified: March 2020
Keywords provided by Allan Kember, IWK Health Centre:
positional therapy
tennis ball technique
sleep in pregnancy
supine
polysomnography
sleep position
supine position
Additional relevant MeSH terms:
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Stillbirth
Fetal Growth Retardation
Fetal Hypoxia
Body Weight
Hypoxia
Birth Weight
Signs and Symptoms, Respiratory
Fetal Death
Pregnancy Complications
Death
Pathologic Processes
Fetal Diseases
Growth Disorders