Maternal Sleep-Disordered Breathing in Pregnancy and Increased Nocturnal Glucose Levels in Women with Gestational Diabetes.

Abstract Background Women with hyperglycemia during pregnancy are at high risk for adverse perinatal outcomes. Maternal sleep-disordered breathing (SDB) during pregnancy is common and is a risk factor for gestational diabetes (GDM). However, the relationship between SDB severity and glucose control is unknown. Research Question Is there an association between SDB severity and glucose levels as assessed by continuous glucose monitoring in GDM? Study Design and Methods: Women with GDM underwent sleep recordings and 72-hour continuous glucose monitoring (CGM). Linear mixed models were used to estimate the association of the apnea-hypopnea index (AHI), REM-AHI, and non-REM-AHI with mean glucose levels during nighttime (two periods: 11pm-3am and 3am-6am), daytime (8am to 9pm) and 24-hours. Models were adjusted for body mass index (BMI) and antihyperglycemic medications. Results In 65 participants who were 35±5 (mean±SD) years of age with BMI=33±7 kg/m2, 31% were taking insulin and/or metformin. A 10-unit increase in AHI was associated with elevated nocturnal glucose levels [11pm-3am: 0.20 mmol/L (95% CI 0.04, 0.40)] with persistent elevations into the morning [8am: 0.26 mmol/L (95% CI 0.08, 0.4)] when adjusted for BMI and medications. REM-AHI was also associated with higher nocturnal and morning glucose levels, whereas non-REM was not. AHI was not associated with either mean daytime or 24-hour glucose levels. Interpretation Greater severity of SDB was associated with higher nocturnal and morning glucose levels in women with GDM.