Margaret H Bublitz1,2,3, Joao Filipe Monteiro4, Andrew Caraganis3, Susan Martin3, Jeffrey Parker5, Lucia Larson1,3, Margaret A Miller1,3, Ghada Bourjeily1,3. 1. Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. 2. Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. 3. Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island. 4. Department of Medicine, Rhode Island Hospital, Providence, Rhode Island. 5. Center for Sleep Disorders, Rhode Island Hospital, East Providence, Rhode Island.
Abstract
STUDY OBJECTIVES: Obstructive sleep apnea (OSA) in pregnancy is associated with gestational diabetes mellitus (GDM). This propensity toward heightened insulin resistance in OSA patients has not been well characterized and may be related to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. The aim of this study was to (1) assess the prevalence of OSA in pregnant women with GDM, (2) evaluate whether HPA axis dysregulation relates to OSA, and (3) investigate the relation between insulin resistance and OSA. We hypothesized that OSA is prevalent among pregnant women with GDM and that women with OSA will have higher levels of insulin resistance and dysregulation of the HPA axis. METHODS: Twenty-five pregnant women in whom GDM was diagnosed were enrolled. Subjects answered sleep questionnaires and underwent in-home sleep studies using a level III device. The presence of OSA was defined by apnea-hypopnea index ≥ 5 events/h. Homeostasis Model Assessment of insulin resistance was derived from measurements of fasting glucose and C-peptide levels. Three salivary cortisol levels were obtained across 1 day to assess circadian variation. Multivariable linear regression analyses were used to assess associations between variables. RESULTS: The sample consisted of 54% Caucasian pregnant women with a median body mass index of 36.1 and interquartile ratio of 10.6 kg/m2. OSA was diagnosed in 17% of participants. Circadian variation of cortisol was preserved in women with OSA. Women with OSA displayed blunted cortisol awakening responses. CONCLUSIONS: OSA is prevalent in women with GDM. OSA is associated with preserved circadian variation and blunted cortisol awakening responses.
STUDY OBJECTIVES: Obstructive sleep apnea (OSA) in pregnancy is associated with gestational diabetes mellitus (GDM). This propensity toward heightened insulin resistance in OSA patients has not been well characterized and may be related to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. The aim of this study was to (1) assess the prevalence of OSA in pregnant women with GDM, (2) evaluate whether HPA axis dysregulation relates to OSA, and (3) investigate the relation between insulin resistance and OSA. We hypothesized that OSA is prevalent among pregnant women with GDM and that women with OSA will have higher levels of insulin resistance and dysregulation of the HPA axis. METHODS: Twenty-five pregnant women in whom GDM was diagnosed were enrolled. Subjects answered sleep questionnaires and underwent in-home sleep studies using a level III device. The presence of OSA was defined by apnea-hypopnea index ≥ 5 events/h. Homeostasis Model Assessment of insulin resistance was derived from measurements of fasting glucose and C-peptide levels. Three salivary cortisol levels were obtained across 1 day to assess circadian variation. Multivariable linear regression analyses were used to assess associations between variables. RESULTS: The sample consisted of 54% Caucasian pregnant women with a median body mass index of 36.1 and interquartile ratio of 10.6 kg/m2. OSA was diagnosed in 17% of participants. Circadian variation of cortisol was preserved in women with OSA. Women with OSA displayed blunted cortisol awakening responses. CONCLUSIONS: OSA is prevalent in women with GDM. OSA is associated with preserved circadian variation and blunted cortisol awakening responses.
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