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Gestational diabetes linked to increased risk for sleep apnea
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Women with gestational diabetes have a seven-fold risk for developing obstructive sleep apnea compared with other pregnant women, according to a team of researchers in Chicago. These new findings also indicate that women with gestational diabetes experience markedly lower total sleep time.
“It is common for pregnant women to experience sleep disruptions, but the risk of developing obstructive sleep apnea increases substantially in women who have gestational diabetes,” Sirimon Reutrakul, MD, of Rush University Medical Center, said in a press release. “Nearly 75% of the participants in our study who had gestational diabetes also suffered from obstructive sleep apnea.”
Sirimon Reutrakul
Researchers used polysomnography to compare sleep parameters and associations between sleep and gestational diabetes in 15 non-pregnant women without diabetes, 15 pregnant women with normal glucose tolerance and 15 pregnant women with gestational diabetes.
According to data, pregnant women with normal glucose tolerance displayed higher apnea hypopnea index (median: 2.0 vs. 0.5, P=.03), more disrupted sleep due to higher wake time after sleep onset (median: 66 minutes vs. 21 minutes, P<.01) and higher microarousal index (median: 16.4 vs. 10.6, P=.01), compared with women who were not pregnant and did not have diabetes.
The researchers also reported a lower total sleep time among the pregnant women with gestational diabetes (median: 397 minutes vs. 464 minutes, P=.02) and a higher apnea hypopnea index (median: 8.2 vs. 2, P=.05), compared with pregnant women with normal glucose tolerance.
Furthermore, obstructive sleep apnea was more prevalent among pregnant women with gestational diabetes compared with pregnant women with normal glucose tolerance (73% vs. 27%, P=.01), researchers wrote.
Additional data indicate the diagnosis of gestational diabetes was linked to a diagnosis of obstructive sleep apnea following adjustments for BMI prior to pregnancy (OR=6.60; 95% CI, 1.15-37.96), researchers wrote.
“Based on these findings, women who have gestational diabetes should be considered for evaluation for obstructive sleep apnea, especially if other risk factors such as hypertension or obesity are present, and women already diagnosed with sleep apnea should be monitored for signs of gestational diabetes during pregnancy,” Reutrakul said.
Disclosure: Cauter reports grant support from Philips/Respironics, the ResMed Foundation, Amylin/Lylly; consultancy for Pfizer and Viropharma. Cauter is associate editor for the journal Sleep, and serves as an expert witness for Lamson, Dugan and Murray, LLP (Omaha, NE). Ehrmann reports research support from the ResMed Foundation and Kovler Family Foundation. All other researchers report no relevant financial disclosures.
Perspective
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Peter Y. Liu, MD, PhD, FRACP
This study provides tantalizing results showing that obstructive sleep apnea is more prevalent in women with gestational diabetes vs. those who do not; at one point in time that was carefully matched between the two groups. We are left wondering about when these individuals had pre-existing obstructive sleep apnea. Did the obstructive sleep apnea resolve after delivery? The authors also show an association between worsening sleep apnea severity and worse glycemic control, but we do not know whether better control of sleep apnea would have improved glycemic control, particularly since most of the individuals identified had mild obstructive sleep apnea. Nevertheless, this study does show that clinicians ought to strongly consider the possibility of coexisting obstructive sleep apnea in women with gestational diabetes.
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