title: Interactions between pregnancy, obstructive sleep apnea, and gestational diabetes mellitus.
abstract: BACKGROUND
  Questionnaire studies linked symptoms of obstructive sleep apnea (OSA) to the risk of gestational diabetes mellitus (GDM). Whether this association is present when OSA is assessed objectively by polysomnography is not known.
  
  
  OBJECTIVE
  The objective of the study was to assess the relationship between pregnancy, OSA, and GDM.
  
  
  METHODS
  We conducted observational case-control studies using polysomnography in 15 nonpregnant, nondiabetic women (NP-NGT), 15 pregnant women with normal glucose tolerance (P-NGT), and 15 pregnant women with GDM (P-GDM). The groups were frequency matched for age and race/ethnicity. Pregnant women were studied during the late second to early third trimester.
  
  
  METHODS
  Comparisons of OSA diagnosis and sleep parameters between NP-NGT and P-NGT to assess the impact of pregnancy and between P-NGT and P-GDM to explore the association between GDM and OSA were measured.
  
  
  RESULTS
  Compared with NP-NGT, P-NGT women had a higher apnea hypopnea index (AHI) (median 2.0 vs 0.5, P = .03) and more disrupted sleep as reflected by a higher wake time after sleep onset (median 66 vs 21 min, P < .01) and a higher microarousal index (median 16.4 vs 10.6, P = .01). Among the pregnant women, P-GDM had markedly lower total sleep time (median 397 vs 464 min, P = .02) and a higher AHI (median 8.2 vs 2.0, P = .05) than P-NGT women. OSA was more prevalent in P-GDM than in P-NGT women (73% vs 27%, P = .01). After adjustment for prepregnancy body mass index, the diagnosis of GDM was associated with a diagnosis of OSA [odds ratio 6.60 (95% confidence interval 1.15-37.96)]. In pregnancy, after adjusting for prepregnancy body mass index, higher microarousal index significantly associated with higher hemoglobin A1c and fasting glucose levels. Higher oxygen desaturation index was associated with higher fasting glucose levels.
  
  
  CONCLUSIONS
  Pregnancy is associated with sleep disturbances. Sleep is more disturbed in GDM than in P-NGT women. There is a strong association between GDM and OSA.
authors: MD, Section of Endocrinology, Department of Medicine, Rush University Medical Center, 1725 West Harrison Street, Suite 250, Chicago, Illinois 60612. sreutrak10800@gmail.com.
authors: Sirimon
authors: S
authors: Reutrakul
authors: Nausheen
authors: N
authors: Zaidi
authors: Kristen
authors: K
authors: Wroblewski
authors: Helen H
authors: HH
authors: Kay
authors: Mahmoud
authors: M
authors: Ismail
authors: David A
authors: DA
authors: Ehrmann
authors: Eve
authors: E
authors: Van Cauter
mesh_terms: D000328:Adult; D001786:Blood Glucose; D015992:Body Mass Index; D016022:Case-Control Studies; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011263:Pregnancy Trimester, Third; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000503:physiopathology*
chemical_list: D001786:Blood Glucose
references: Eur Respir J. 2010 Oct;36(4):849-55
references: 20525714
references: BMC Womens Health. 2010 May 14;10:17
references: 20470416
references: Proc Natl Acad Sci U S A. 2008 Jan 22;105(3):1044-9
references: 18172212
references: J Appl Physiol (1985). 2009 May;106(5):1538-44
references: 19265062
references: Int J Gynaecol Obstet. 2008 Feb;100(2):141-6
references: 17976624
references: Curr Opin Pulm Med. 2010 Nov;16(6):574-82
references: 20859210
references: Am J Obstet Gynecol. 2012 Feb;206(2):136.e1-5
references: 22000892
references: Chest. 2010 Jan;137(1):95-101
references: 19542260
references: Diabetes Care. 2011 Nov;34(11):2454-7
references: 21926292
references: Am J Perinatol. 2012 Apr;29(4):277-82
references: 22105436
references: Eur Respir J. 2006 Feb;27(2):328-33
references: 16452588
references: Ann Intern Med. 2012 Oct 16;157(8):549-57
references: 23070488
references: Chest. 2001 Nov;120(5):1448-54
references: 11713118
references: Thorax. 2007 Nov;62(11):969-74
references: 17557769
references: Sleep. 2005 Oct;28(10):1299-305
references: 16295215
references: N Engl J Med. 1993 Apr 29;328(17):1230-5
references: 8464434
references: Pediatr Res. 2012 Sep;72(3):293-8
references: 22669298
references: J Appl Physiol (1985). 2005 Oct;99(4):1592-9
references: 16160020
references: Lancet. 1999 Oct 23;354(9188):1435-9
references: 10543671
references: Am J Respir Crit Care Med. 2010 Mar 1;181(5):507-13
references: 20019340
references: Sleep. 2005 Jun;28(6):737-41
references: 16477961
references: Obstet Gynecol. 2010 Jan;115(1):77-83
references: 20027038
references: Am J Obstet Gynecol. 2010 Aug;203(2):142.e1-5
references: 20510182
references: Sleep. 2008 Jul;31(7):1018-24
references: 18652097
references: Diabetes Care. 2009 Jun;32(6):1017-9
references: 19279303
references: Sleep. 2004 Nov 1;27(7):1405-17
references: 15586794
references: Diabetes Care. 2010 Jan;33 Suppl 1:S11-61
references: 20042772
references: Am J Obstet Gynecol. 2010 Mar;202(3):261.e1-5
references: 20005507
references: Diabetes Care. 2012 Jan;35 Suppl 1:S11-63
references: 22187469
references: Sleep Med. 2007 Dec;9(1):15-21
references: 17644475
references: Arch Intern Med. 2005 Feb 28;165(4):447-52
references: 15738376