Gestational Diabetes Increases Risk of Sleep Apnea

The risk of obstructive sleep apnea is increased nearly 7-fold in pregnant women with gestational diabetes mellitus (DM), according to the results of the first study to use polysomnography to evaluate sleep quality, including obstructive sleep apnea, in women who have the condition.

“The risk of developing obstructive sleep apnea increases substantially in women who have gestational diabetes likely due to the fact that obstructive sleep apnea is a risk factor for abnormal glucose metabolism. Each component of sleep apnea, fragmented and shortened sleep as well as hypoxemia, has been linked to insulin resistance and abnormal glucose metabolism,” lead author Sirimon Reutrakul, MD, of the Section of Endocrinology, Department of Medicine, at Rush University Medical Center in Chicago, told ConsultantLive.

Dr Reutrakul added that “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. Nearly 75% of the participants in our study who had gestational diabetes also suffered from obstructive sleep apnea.”

In a series of observational case control studies, Reutrakul and colleagues monitored 45 women for sleep apnea and other sleep disruptions. The research examined sleep health in 15 pregnant women who had gestational DM, 15 pregnant women who did not have the condition, and 15 women who were not pregnant and did not have DM. The groups were matched for age and race. Pregnant women were studied during the late second to early third trimester.

The study found a strong association between obstructive sleep apnea and gestational DM in this group of mostly overweight or obese women even after adjusting for pre-pregnancy body mass index. Pregnant women who had gestational DM had markedly lower total sleep time (1 hour less) and a higher apnea hypopnea index, indicating they had more fragmented sleep than women who did not have gestational DM. Past research has shown that lost sleep, fragmented sleep, and shorter periods spent in deep sleep-all symptoms of obstructive sleep apnea-are likely to raise the risk of DM. Among pregnant women, a higher microarousal index was significantly associated with higher HbA1C and fasting glucose levels.

“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 and obesity, and symptoms, such as frequent snoring, are present,” Dr Reutrakul said. “Women already diagnosed with obstructive sleep apnea should be monitored for signs of gestational diabetes during pregnancy.”

Weight control could possibly help both conditions, Dr Reutrakul said. “Our data are preliminary but raise the issue of the strong association between gestational diabetes and obstructive sleep apnea. With the obesity epidemic, many women at the reproductive age may be at risk for both obstructive sleep apnea and gestational diabetes.”

She added, “Primary care physicians should consider testing of both conditions in a high-risk group.”

The results of the study were published online on August 20, 2013, in the Journal of Clinical Endocrinology & Metabolism.