Impact of Obstructive Sleep Apnea on Gestational Diabetes Mellitus

Alonso-Fernández, Alberto; Moncadas, María Cerdá; Larrínaga, Ainhoa Álvarez Ruiz De; Barón, Andrés Sánchez; Marcet, Mercedes Codina; Rodríguez, Paula; Gómez, Ana Victoria Gil; Carrero, María Paloma Giménez; Martínez, Carla Pía; Marin, J.P. Cubero; Peña, Mónica de la; Barceló, Antònia; Morell-García, Daniel; Piérola, Javier; Zarza, José; Cantolla, Joaquín Durán; Trigo, José María Marín; Soriano, Joan B.; García‐Río, Francisco

doi:10.1016/j.arbres.2021.05.005

Cited by 14 publications

(10 citation statements)

References 43 publications

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“…Our study aim was to compare inflammatory/sympathetic biomarkers in women with GDM with and without OSA, and the sample size of the present study may be not sufficiently powered to find differences in the sleep symptoms. As other studies, we did not find differences in subjective self-reported OSA symptoms among OSA and control subjects (Table 2 ) [ 15 , 19 ].…”

Section: Discussionsupporting

confidence: 70%

“…Previous studies did not find differences in subjective sleep time or daytime sleepiness when comparing OSA and non-OSA pregnant women with GDM [ 15 , 19 ]. Also, ESS shows low predictive value of OSA during pregnancy [ 20 ].…”

Section: Discussionmentioning

confidence: 97%

“…Inclusion criteria were: singleton pregnant women in the third trimester of pregnancy and GDM diagnosis, according to the fasting 3-h 100-g glucose tolerance testing [ 14 ]. Patients were excluded if they fulfilled at least one of the following exclusion criteria: (1) previous OSA diagnosis; (2) preeclampsia; (3) previous diagnosis of diabetes mellitus, lung, heart, or kidney diseases; (4) treatment with steroids; (5) unwillingness or inability to participate in the study; (6) imminent delivery due to maternal–fetal disease; or (7) any other concurrent severe medical condition that would contraindicate the patient´s participation in the study according to the investigators’ judgment [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

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Systemic inflammation and sympathetic activation in gestational diabetes mellitus with obstructive sleep apnea

et al. 2022

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Background Although some evidence suggests an association between obstructive sleep apnea (OSA) and gestational diabetes mellitus (GDM), its consequences still remain largely unknown. We sought to determine whether OSA is associated with higher inflammation and sympathetic levels in GDM, and to relate them with insulin resistance and perinatal outcomes. Methods OSA was identified by polysomnography and defined as an apnea–hypopnea index of ≥ 5 h−1. Plasma cytokines (TNF-α, IL-1β, IL-6, IL-8, IL-10), metanephrine, and normetanephrine were determined by immunoassays. Results We included 17 patients with GDM and OSA and 34 without OSA. Women with GDM and OSA had higher normetanephrine concentrations [81 IQR (59–134) vs. 68 (51–81) pg/mL]. No differences in the inflammatory profile were found, while IL-1β was higher in patients with mean nocturnal oxyhemoglobin saturation ≤ 94%. We found positive correlations between increased sympathetic activation and IL-1β, with obstructive apneas, while time in REM showed an inverse relationship with IL-1β and metanephrine. Furthermore, IL-10 was inversely related with time in sleep stages 1–2, and with the arousal index, and it was positively related with time in slow-wave sleep. Significant correlations were also found between IL-1β and insulin resistance. There were no significant differences in neonatal characteristics; however, we found inverse relationships between IL-10 and birth weight (BW), and percentile of BW. Conclusions OSA increased sympathetic activity, and IL-1β concentration was higher in patients with GDM with lower nocturnal oxygenation, all of which were related with obstructive events, and time in REM. Moreover, IL-1β was related with insulin resistance, and IL-10 inversely correlated with neonatal BW.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

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Systemic inflammation and sympathetic activation in gestational diabetes mellitus with obstructive sleep apnea

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“…repeated exposure to stressful situations caused by poor sleep quality increases the amount of cortisol secretion, leading to decreased pancreatic function and increased risk of diabetes. [10][11][12] Also, repeated stoppage of the respiratory system reduces air circulation, which can increase the incidence of respiratory diseases such as pneumonia. 13,14 It is necessary to be fully aware of the risks of OSA, which can cause these chronic diseases, and to actively treat them.…”

Section: Resultsmentioning

confidence: 99%

The Efficacy of 3D Virtual Surgery, CAD/CAM, and 3D Printing Technology for Maxillomandibular Advancement in Obstructive Sleep Apnea Patients

Jeong

et al. 2023

Journal of Craniofacial Surgery

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cellular subtype. Another classification involves cellular morphology. The 2 patterns of cell morphology are Antoni A and Antoni B. In Antoni A, spindle cells are arranged in "interlacing cords, whorls, or palisades," whereas Antoni B is characterized by "stellate cells, with a mucoid stroma." 1 Treatment of orbital schwannomas is mainly surgical. The surgical approach differs depending on the localization of the tumor 1,4 and may occasionally require an interdisciplinary approach between ophthalmology, otorhinolaryngology, and neurosurgery. Surgical excision is considered a definitive treatment, with recurrence rates being very low. 4,7 In our case, we opted for a superior orbitotomy through a lid-split incision. This approach provided us adequate visualization of the schwannoma, which was in the central, anterior orbit. It also allowed an excellent view of the bony defect of orbital roof in the event a reconstruction was needed. Though rare, potential risks unique to this approach are those involving the eyelid margin, including notching, trichiasis, and irregular contour.We believe the patient's acute presentation of symptomatic diplopia is explained by the intralesional hemorrhage seen on MRI, which may have increased the lesion's size abruptly. It is interesting to note the absence of lid retraction in the patient's postoperative period despite having underwent 2 levator palpebrae resections; we hypothesize that the muscle was mechanically stretched by the tumor throughout the years.We believe our case is unique, given the patient's clinical course as well as the surgical approach through vertical lid-split incision technique. The intraoperative view of the defect in the orbital roof was equally special. We hope this report serves as a reminder to retain diagnostic skepticism in the face of recurrent ptosis and to consider vertical lid-split approach for anterior lesions of the orbit.

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“…The main consequence of OSA is nocturnal intermittent hypoxaemia, which, in turn, sets in motion a series of mechanisms capable of intensifying cardiovascular risk factors such as arteriosclerosis and arterial hypertension, as well as cardiovascular events, metabolic dysfunction and neuropsychiatric diseases, and making them more difficult to control [6]. Among the pathophysiological mechanisms mediated by intermittent hypoxemia to produce these phenomena are: sympathetic hyperactivity, increased plasma volume, RAS hyperactivity, increased peripheral insulin resistance, hypercoagulability, endothelial dysfunction, nocturnal fluid redistribution, sleep inefficiency, oxidative stress and inflammation [7][8][9][10][11][12][13]. Therefore, even in an initial approximation, it is already clear that some of the mechanisms capable of generating the aforementioned phenotypes of nocturnal arterial hypertension are similar to those that produce the respiratory events during sleep that define OSA.…”

Section: T He Latest European Society Of Hypertension (Esh)mentioning

confidence: 99%

Nocturnal hypertension phenotypes and obstructive sleep apnoea

Oscullo,

Gomez-Olivas,

Martínez-García

2023

Journal of Hypertension

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Impact of Obstructive Sleep Apnea on Gestational Diabetes Mellitus

Cited by 14 publications

References 43 publications

Systemic inflammation and sympathetic activation in gestational diabetes mellitus with obstructive sleep apnea

Systemic inflammation and sympathetic activation in gestational diabetes mellitus with obstructive sleep apnea

The Efficacy of 3D Virtual Surgery, CAD/CAM, and 3D Printing Technology for Maxillomandibular Advancement in Obstructive Sleep Apnea Patients

Nocturnal hypertension phenotypes and obstructive sleep apnoea

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