Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes

Abstract

Background Experimental and epidemiologic data suggest that among non-pregnant adults, sleep duration may be an important risk factor for chronic disease. Although pregnant women commonly complain of poor sleep, few studies have objectively evaluated the quality of sleep in pregnancy or have explored the relationship between sleep disturbances and maternal and perinatal outcomes. Objectives Our objective was to examine the relationship between objectively assessed sleep duration, timing and continuity (measured via wrist actigraphy) and maternal cardiovascular and metabolic morbidity specific to pregnancy. Study Design This was a prospective cohort study of nulliparous women. Women were recruited between 16 0/7 and 21 6/7 weeks’ gestation. They were asked to wear a wrist actigraphy monitor and to complete a daily sleep log for a seven consecutive-day period. The primary sleep exposure variables were the averages of the following over the total valid nights (minimum 5, maximum 7 nights): short sleep duration during the primary sleep period (< 7 hours/night), late sleep midpoint (midpoint between sleep onset and sleep offset > 5 AM), and top quartile of minutes of wake time after sleep onset (WASO) and sleep fragmentation index. The primary outcomes of interest were a composite of hypertensive disorders of pregnancy (mild, severe, or superimposed preeclampsia; eclampsia; or antepartum gestational hypertension) and gestational diabetes (GDM). Chi-square tests were used to assess associations between sleep variables and categorical baseline characteristics. Crude odds ratios and 95% confidence intervals were estimated from univariate logistic regression models to characterize the magnitude of the relationship between sleep characteristics and hypertensive disorders of pregnancy and GDM. For associations that were significant in univariate analysis, multiple logistic regression was used to explore further the association of sleep characteristics with pregnancy outcomes. Results Nine-hundred and one eligible women consented to participate. Of these women 782 submitted valid actigraphy studies. Short sleep duration and a later sleep midpoint were associated with an increased risk of GDM (OR 2.24, 95% CI 1.11, 4.53; OR 2.58, 95% CI 1.24, 5.36, respectively) but not of hypertensive disorders. A model with both sleep duration and sleep midpoint as well as their interaction term revealed that while there was no significant interaction between these exposures, the main effects of both short sleep duration and later sleep midpoint with GDM remained significant (aOR 2.06, 95% CI 1.01, 4.19; aOR 2.37, 95% CI 1.13, 4.97, respectively). Additionally, after adjusting separately for age, BMI and race/ethnicity, both short sleep duration and later sleep midpoint remained associated with GDM. No associations were demonstrated between the sleep quality measures (WASO, sleep fragmentation) and hypertensive disorders or GDM. Conclusions Our results demonstrate a relationship between short sleep duration and later sleep midpoin...

Simulated shift work disrupts maternal circadian rhythms and metabolism, and increases gestation length in sheep

“…; Facco et al . ). Poor quality sleep and excessive tiredness are characteristic of shift work (McDowall et al .…”

“…Also consistent with the hypothesis that shift work impairs metabolism in pregnancy, the late sleep midpoint in humans (>05.00 h) is associated with increased rates of gestational diabetes, independent of sleep quality or duration, and shift workers have a later sleep midpoint compared to others (Facco et al . ). Clearly, further investigation of the impact of shift work on maternal metabolic health is required.…”

“…Associations between shift work and metabolic dysfunction during pregnancy have not been reported in women, although a sleep duration of <7 hours per night more than doubles the risk of developing gestational diabetes (Facco et al . ) and sleep disruption is a well‐recognized consequence of shift work (McDowall et al . ).…”

“…Shift working populations include many women of reproductive age, with ß65% of all female shift workers aged between 15 and 44 years of age (Australian Bureau of Statistics, 2012;Alterman et al 2013). Associations between shift work and metabolic dysfunction during pregnancy have not been reported in women, although a sleep duration of <7 hours per night more than doubles the risk of developing gestational diabetes (Facco et al 2017) and sleep disruption is a well-recognized consequence of shift work (McDowall et al 2017). Epidemiological studies demonstrate an association between shift work and an increased risk of miscarriage, preterm birth and intrauterine growth restriction (Croteau et al 2006;Lawson et al 2009;Bonzini et al 2011;Fernandez et al 2016).…”

Maternal sleep practices and stillbirth: Findings from an international case‐control study

“…There is a large literature demonstrating that maternal sleep disturbance, such as sleep-disordered breathing, short sleep duration, and poor sleep quality are common during pregnancy and have strong associations with poor outcomes such as gestational hypertension and preeclampsia, 15-18 gestational diabetes, 16,19,20 fetal growth restriction, [21][22][23] and preterm birth. This allowed for exploration of changes in sleep across pregnancy since women were queried about sleep practices before pregnancy, in the last month, and on the last night.…”