We hypothesized that poor sleep quality exacerbates glucose intolerance manifested as elevated glycosylated hemoglobin (HbA1c), which increases the risk for gestational diabetes. To test this, 38 pregnant and 22 non-pregnant (age, 18–35 years; body-mass index, 20–35 kg/m2) otherwise healthy women were enrolled in the study. Sleep quality was assessed during gestational week 24 (pregnant), or outside of the menstrual period (non-pregnant), using qualitative (Pittsburgh Sleep Quality Index) and objective (actigraphic wrist-watch) measures. Blood glucose, total cortisol, and depression status were evaluated. Eight pregnant and one non-pregnant women were lost to follow-up, or withdrew from the study. There was a higher incidence of poor sleep quality in pregnant (73%) relative to non-pregnant women (43%). Although actigraphic data revealed no differences in actual sleep hours between pregnant and non-pregnant women, the number of wake episodes and sleep fragmentation were higher in pregnant women. Poor sleep quality was positively correlated with higher HbA1c in both pregnant (r = 0.46, n = 26, p = 0.0151) and non-pregnant women (r = 0.50, n = 19, p = 0.0217), reflecting higher average blood glucose concentrations. In contrast, poor sleep was negatively correlated with cortisol responses in pregnant women (r = −0.46, n = 25, p = 0.0167). Three pregnant women had elevated one-hour oral glucose tolerance test results (>153 mg/dL glucose). These same pregnant women exhibited poor sleep quality. These results support the suggestion that poor sleep quality is an important risk factor that is associated with glucose intolerance and attendant health complications in pregnancy.

Alongside the known direct, short-term effects of anesthesia in general, there is emerging evidence of an immunomodulatory effect with specific anesthetics that may decrease patient's defences against malignant neoplastic growths. This effect is especially important in the setting of surgical management of neoplasms, which is often the best option for long-term survival in patients with solid neoplasm. Many studies have speculated on the best anesthetic technique to reduce the neoplasm recurrence and promote patient survival, however, we often neglect the sympathetic stress response to neoplasia and how anesthetics modulate this effect. In this review, we study the evidence as it pertains to anesthetic techniques and pain control, particularly general vs. regional anesthesia, and opioid analgesia. At this time there is not enough evidence to support that regional anesthesia has a more favorable outcome than general anesthesia, or that opioids should not be used in neoplasm-related pain management because of their potential pro-metastatic properties secondary to opioid-induced immunosuppression. Instead, the debate over anesthetic use should be centered on adequate pain control since overwhelming evidence have shown that pain-related stress reaction mediated via β-adrenergic activation, promotes neoplastic propagation and metastasis, hence decreasing survival rates.