Obstructive Sleep Apnea Is Associated with Newly Diagnosed Gestational Diabetes Mellitus

Balserak, Bilgay Izci; Pien, Grace W.; Prasad, Bharati; Mastrogiannis, Dimitrios; Park, Chang; Quinn, Laurie; Herdegen, James J.; Carley, David W.

doi:10.1513/annalsats.201906-473oc

Cited by 19 publications

(29 citation statements)

References 36 publications

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“…Thus, our results demonstrate that SDB in REM sleep may also be quite relevant with respect to glucose dysregulation in pregnant women with GDM. Our results are consistent with the results of a recent case-control study that showed SDB is associated with newly diagnosed GDM 251 . The investigators found that women with SDB had a higher risk of GDM (OR: 4.71 95% CI 1.05, 21.04).…”

Section: Objective 1: Estimating the Association Between Ahi And Glucsupporting

confidence: 93%

Maternal Sleep-Disordered Breathing in Pregnancy Increases Nocturnal Glucose Levels in Women with Gestational Diabetes

Newbold

Meltzer

Benedetti

et al. 2019

C99. Srn: Cardiometabolic Consequences of Sleep Disordered Breathing and the Role of Cpap Therapy

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Rationale: Maternal sleep-disordered breathing (SDB) in pregnancy is associated with an increased risk of gestational diabetes (GDM). However, it is unknown whether SDB severity is associated with poor glycemic control in GDM. Secondly, it is not clear whether continuous positive airway pressure (CPAP), the mainstay of treatment in the general population, is feasible in pregnant women with GDM. Objectives: The first two objectives of this thesis were to determine the association between SDB severity and glucose control using continuous glucose monitoring (CGM) over a 72-hour period among women with GDM. Specifically, the relationships between SDB severity and: 1) daytime, nighttime and mean 24-hour glucose levels (Objective 1) and 2) glucose variability (Objective 2) were assessed. Objective 3 determined the objective adherence to CPAP treatment in pregnant women with GDM. Methods: To achieve objectives 1 and 2, we used a cross-sectional study design including pregnant women with GDM. Participants underwent a one-night, level two home sleep recording and 72-hour CGM. For Objective 1, linear mixed models were used to estimate the association of the apnea-hypopnea index (AHI) with 1) daytime (8am to 9pm), 2) nighttime (11pm-3am; 3am-6am) and 3) mean 24-hour glucose levels. For Objective 2, glucose variability was assessed by the mean amplitude of glucose excursion (MAGE) and the standard deviation of glucose using 24hour glucose data. For Objective 3, a randomized-controlled study was performed in which pregnant women with GDM were randomized to auto-CPAP (experimental group) or nasal dilator strips (control group) for the remainder of pregnancy. Nightly mean CPAP adherence was objectively measured over the entire treatment period. Measurements and Main Results: Among 65 participants that were included in the crosssectional analysis (Objectives and 2), the women were 35±5 (mean±SD) years of age with body mass index (BMI) at enrolment of 33±7 kg/m 2 and 31% were taking insulin and/or metformin for management of their GDM. The mean AHI was 16±11 events/hour. While there were no associations between AHI and daytime or mean 24-hour glucose levels (8am-9pm b: 0.08 mmol/L 95% CI:-0.06, 0.23; 24 hour b: 0.05 mmol/L 95% CI:-0.1, 0.21), increasing AHI (by an increase of 10 events/hour) was associated with elevated nighttime glucose levels, even when adjusted for BMI and medications (11pm-3am b: 0.20 mmol/L (95% CI: 0.04, 0.40)) which, persisted into the morning (8am b:0.26 mmol/L 95% CI: 0.08, 0.4)). For Objective 2, there were no significant associations between SDB and glucose variability. In Objective 3, forty-six participants were diagnosed with SDB. Of those, 22 participants (48%) were randomized to CPAP treatment with the following demographics (mean±SD): 36 ± 5 years of age, BMI of 35 ± 7 kg/m², AHI of 19 ± 9 events/hour and 30 ± 3 weeks gestation at enrolment. Seven participants assigned to CPAP (32%) demonstrated objective adherence of ≥4 hours per night for at least 70% of nights. The average usage for all days du...

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Section: Objective 1: Estimating the Association Between Ahi And Glucsupporting

confidence: 93%

Maternal Sleep-Disordered Breathing in Pregnancy Increases Nocturnal Glucose Levels in Women with Gestational Diabetes

Newbold

Meltzer

Benedetti

et al. 2019

C99. Srn: Cardiometabolic Consequences of Sleep Disordered Breathing and the Role of Cpap Therapy

View full text Add to dashboard Cite

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“…8 Several studies show that gestational diabetes, which occurs in *7% of pregnancies, is two to three times more likely in women who snore than in nonsnorers, after controlling for several factors, including age, BMI, race/ ethnicity, and other sleep disturbances. 8,16,25,26 National databases of pregnancy outcomes and clinical studies using objective measures of clinically defined SDB (e.g., polysomnography and ambulatory devices) also provide evidence of SDB-associated risks to maternal cardiovascular health. Analysis of the National Perinatal Information Center database (2010-2014, >1.5 million records) showed that a diagnosis of SDB was associated with increased cardiometabolic disease risk, including pre-eclampsia (OR 2.22, 95% CI 1.94-2.54), eclampsia (OR 2.95, 95% CI 1.08-8.02), cardiomyopathy (OR 3.59, 95% CI 2.31-5.58) heart failure (OR 3.63, 95% CI 2.33-5.66), and gestational diabetes (OR 1.51, 95% CI 1.34-1.7) in fully adjusted models.…”

Section: Sdb As a Risk Factor For Gestational Cardiovascular Diseasementioning

confidence: 99%

“… 12 , 11 Cross-sectional analysis identified SDB in 22% of women with gestational diabetes, compared with 9% in nondiabetic women, matched for age, BMI, race, and parity. 16 The high prevalence of SDB in pregnancy and comorbidity with pregnancy conditions implicates SDB as a risk factor for maternal cardiometabolic disease.…”

Section: Prevalence Of Sdb In Pregnancymentioning

confidence: 99%

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Sleep-Disordered Breathing and Pregnancy-Related Cardiovascular Disease

Laposky

Pemberton

2021

Journal of Women's Health

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Sleep-disordered breathing (SDB) is a serious medical condition characterized by intermittent episodes of airflow limitation, intermittent hypoxia, and sleep disturbance triggering a pattern of autonomic dysfunction associated with hypertension, diabetes, and other adverse health conditions. SDB incidence is two to three times higher during pregnancy and is associated with an increased risk of cardiometabolic complications, including pre-eclampsia and gestational diabetes. Treatments to protect breathing during sleep are available, pointing to SDB as a potential therapeutic target to reduce maternal cardiometabolic morbidity. However, in clinical practice, the majority of SDB cases in pregnancy are undiagnosed, indicating a need to improve screening for SDB risk factors and referral for diagnostic testing. Furthermore, definitive clinical trials are needed to determine the extent to which SDB intervention reduces the risk of adverse cardiovascular and neonatal outcomes in pregnancy. This review article discusses an accumulation of research pointing to SDB as a prevalent risk factor for gestational cardiometabolic disease, as well as a potential therapeutic target to reduce cardiometabolic morbidity.

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“…However, neither TST nor arousal index were significantly associated with cytokine values. Other studies found that women with GDM or gestational hypertension had markedly lower TST, and a higher AHI (with higher proportion of OSA) than women with uncomplicated pregnancies ( 50 , 51 ). Similarly, a study of 234 pregnant women showed a trend toward decreased TST as the severity of AHI categories increased ( 52 ).…”

Section: Discussionmentioning

confidence: 94%

Influence of Obstructive Sleep Apnea on Systemic Inflammation in Pregnancy

et al. 2021

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Background: Obstructive sleep apnea (OSA) is prevalent in pregnancy and it is associated with adverse pregnancy-related outcomes such as gestational diabetes, pre-eclampsia, and low birth weight. Maternal systemic inflammation is proposed to be one of the main intermediate mechanisms. However, the effects of OSA on systemic inflammation are unknown in normal pregnancy.Methods: Women in the 3rd trimester underwent hospital polysomnography to evaluate whether OSA increases systemic inflammation in normal pregnancy and its potential association with adverse fetal outcomes. OSA was defined as an apnea–hypopnea index (AHI) of ≥ 5 h−1. Plasma cytokines levels (TNF-α, IL-1β, IL-6, IL-8, and IL-10) were determined by multiple immunoassays.Results: We included 11 patients with OSA and 22 women with AHI < 5 h−1, who were homogeneous in age, and body mass index (BMI). Women with OSA had significant higher levels of TNF-α, IL-1β, IL-8, and IL-10. We found significant correlations between AHI during REM and TNF-α (r = 0.40), IL-1β (r = 0.36), IL-6 (r = 0.52), IL-8 (r = 0.43), between obstructive apnea index and TNF-α (r = 0.46) and between AHI and IL-1β (r = 0.43). We also found that CT90% was related to IL-8 (r = 0.37). There were no significant differences in neonatal characteristics; however, we found inverse correlations between TNF-α and IL-8 with birth weight (both r = −0.48), while IL-8 showed a significant inverse relationship with neonatal gestational age (r = −0.48).Conclusions: OSA in our normal pregnancy population was associated with higher systemic inflammation, which was related to obstructive events, especially during REM sleep. Moreover, systemic inflammation was inversely correlated with neonatal birth weight and age.

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Obstructive Sleep Apnea Is Associated with Newly Diagnosed Gestational Diabetes Mellitus

Cited by 19 publications

References 36 publications

Maternal Sleep-Disordered Breathing in Pregnancy Increases Nocturnal Glucose Levels in Women with Gestational Diabetes

Maternal Sleep-Disordered Breathing in Pregnancy Increases Nocturnal Glucose Levels in Women with Gestational Diabetes

Sleep-Disordered Breathing and Pregnancy-Related Cardiovascular Disease

Influence of Obstructive Sleep Apnea on Systemic Inflammation in Pregnancy

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