B31-11 Patient-Perceived Barriers and Facilitators to CPAP and Mandibular Advancement Splints for Sleep-Disordered Breathing During Pregnancy: A Mixed Methods Study

Rationale While Continuous Positive Airway Pressure (CPAP) remains the first-line treatment for sleep-disordered breathing (SDB), adherence remains suboptimal in pregnancy. Unique contextual factors related to pregnancy may influence CPAP use, but have not been systematically studied. Poor adherence may leave mothers and offspring vulnerable to potentially preventable complications. We aimed to identify pregnant patient perceptions regarding barriers and facilitators to CPAP. Guided by patient partner input (JB, KT) during the study design phase, all patients were offered mandibular advancement splints (MAS) as an alternative or adjunct to promote overall treatment uptake. Methods We conducted a convergent, mixed-methods study of pregnant women diagnosed with SDB, co-designed with patient partners. Participants received CPAP and/or MAS, based on expressed preference and without charge. We conducted semi-structured interviews on facilitators and barriers one-month after CPAP initiation. Independent coders (NVivo software) are performing deductive-inductive thematic analysis (6 transcripts completed to date). The quantitative data we are collecting includes objective adherence data for CPAP and MAS, baseline sleep parameters, and information on sleep, mood, quality of life, and self-efficacy (validated questionnaires). Results We have completed analysis of 6 transcripts to date and will continue until thematic saturation (estimated sample size of ∼30). Participants were on average 29±4.8 (SD) weeks of gestation and 36± 6y age, with a mean AHI=26±18 and ODI= 17±20. Mean CPAP usage was 4.7±1.5 h/day. Mean MAS usage was 2.7 ± 3.3 h/day. All participants received both CPAP and MAS and used them interchangeably, according to preference. Pregnancy-related barriers included positional restrictions due to the gravid uterus and pregnancy-related sleep disruption. Childcare responsibilities were also a common barrier. General barriers encompassed device-related issues and psychological concerns. Key pregnancy-related facilitators included a novel phenomenon, “compelled compliance,” ie. usage driven by fetal health concerns rather than personal benefit perception. General motivators included symptom improvement, having MAS as an alternative option, strong family (i.e., partner) support and easy access/reliable information from the healthcare team. Conclusions Preliminary results from this mixed-methods study indicate that pregnant patients often use CPAP and MAS interchangeably when given a choice. Pregnancy-specific barriers suggest that adherence strategies designed for the general population may not address the unique psychological and physiological context of pregnancy. These findings support the need for pregnancy-tailored, patient-led interventions that incorporate facilitators such as partner engagement, provider support, and education on maternal and fetal benefits.