Glucose intolerance and gestational diabetes risk in relation to sleep duration and snoring during pregnancy: a pilot study

Abstract

BackgroundInsufficient sleep and poor sleep quality, considered endemic in modern society, are associated with obesity, impaired glucose tolerance and diabetes. Little, however, is known about the consequences of insufficient sleep and poor sleep quality during pregnancy on glucose tolerance and gestational diabetes.MethodsA cohort of 1,290 women was interviewed during early pregnancy. We collected information about sleep duration and snoring during early pregnancy. Results from screening and diagnostic testing for gestational diabetes mellitus (GDM) were abstracted from medical records. Generalized linear models were fitted to derive relative risk (RR) and 95% confidence intervals (95% CIs) of GDM associated with sleep duration and snoring, respectively.ResultsAfter adjusting for maternal age and race/ethnicity, GDM risk was increased among women sleeping ≤ 4 hours compared with those sleeping 9 hours per night (RR = 5.56; 95% CI 1.31-23.69). The corresponding RR for lean women (<25 kg/m2) was 3.23 (95% CI 0.34-30.41) and 9.83 (95% CI 1.12-86.32) for overweight women (≥ 25 kg/m2). Overall, snoring was associated with a 1.86-fold increased risk of GDM (RR = 1.86; 95% CI 0.88-3.94). The risk of GDM was particularly elevated among overweight women who snored. Compared with lean women who did not snore, those who were overweight and snored had a 6.9-fold increased risk of GDM (95% CI 2.87-16.6).ConclusionsThese preliminary findings suggest associations of short sleep duration and snoring with glucose intolerance and GDM. Though consistent with studies of men and non-pregnant women, larger studies that include objective measures of sleep duration, quality and apnea are needed to obtain more precise estimates of observed associations.

Psychometric Properties of the Pittsburgh Sleep Quality Index (PSQI) in a Cohort of Peruvian Pregnant Women

“…1,2 Sleep complaints and disorders experienced in early pregnancy have been linked to hyperemesis, cesarean delivery, preterm birth, gestational diabetes mellitus, fetal growth restriction, and preeclampsia. [2][3][4][5] Of note, an emerging literature has suggested that sleep disorders and poor sleep quality predict an increased risk of mood disorders including depressive symptomatology in late pregnancy. 6,7 However, despite these observations and their clinical implications, relatively little has been done to design and implement clinical protocols that may be used to reliably and validly assess sleep effi ciency and night and daytime disturbance among pregnant women.…”

Sleep Disruption and Gestational Diabetes

“…Several investigators have now reported a positive association between self-reported short sleep duration and gestational diabetes ( Table 1) [40][41][42]. The data suggests that women with self-reported shortened sleep durations during pregnancy have a 2-10 times greater risk of GDM .…”

“…The data suggests that women with self-reported shortened sleep durations during pregnancy have a 2-10 times greater risk of GDM . Facco et al and Qiu et al found that the risk of GDM remained even after controlling various confounding factors including body mass index (BMI) [40,41]. In addition, Qiu et al described a curvilinear relationship between maternal habitual nightly sleep duration in early pregnancy and maternal mean 1-hr OGTT values.…”

“…Qui et al described a curvilinear relationship between habitual nightly sleep duration in early pregnancy and maternal mean-1hour plasma glucose after a 50 gram oral glucose challenge [41]. Compared to women who reported sleeping 9 hours per night on average, mean glucose concentrations were 16.3 mg/dl (p=.04) higher for women sleep ≤ 4 hours per night and 6.3 mg/dl (p=.07) higher for women sleeping ≥ 10 hours per night.…”

Sleep-disordered Breathing in Pregnancy

“…Sleep fragmentation, intermittent hypoxia and intrathoracic pressure changes linked to SDB also activate the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis, which in turn leads to increased release of the glucocorticoid cortisol [42][43][44][45][46]. Disproportionate sympathetic activation persists into the daytime, leading to increased peripheral vascular reactivity and catecholamine production, blunted baroreflex sensitivity, hindered pancreatic insulin secretion and excited hepatic glucose release [40].…”