Skip to main content
SpringerLink
Log in

Sleep-disordered breathing and daytime napping are associated with maternal hyperglycemia

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Objectives

Sleep disturbances in pregnancy may impair glucose mechanism. This study aimed to examine associations of sleep-disordered breathing, sleep, and nap duration with 1-h glucose challenge test (GCT) levels in pregnant women after controlling for known risk factors for gestational diabetes.

Methods

This is a case–control study of 104 pregnant women. All women underwent full polysomnography and a GCT and completed the multivariable apnea prediction and Pittsburgh Sleep Quality indexes. The primary outcome was maternal hyperglycemia measured by GCT. Bivariate and multivariable logistic regression analyses were performed.

Results

Over 13 % subjects reported habitual snoring in the first trimester. Only 9.3 % women with normoglycemia (GCT < 135) were habitual snorers, whereas 45.5 % women with hyperglycemia (GCT ≥ 135) had habitual snoring (p < 0.001). Sleep-disordered breathing symptoms (loud snoring, snorting/gasping, and apneas) (odds ratio (OR) 2.85; 95 % confidence interval (CI) 1.50–5.41; p = 0.001) and total nap duration (OR 1.48; 95 % CI 0.96–2.28; p = 0.08) were associated with hyperglycemia. After adjusting for confounders, sleep-disordered breathing symptoms (OR 3.37; 95 % CI 1.44–8.32; p = 0.005) and nap duration (OR 1.64; 95 % CI 1.00–2.681.02; p = 0.05) continued to be associated with hyperglycemia. However, the primary exposure measure, the apnea/hypopnea index in the first trimester was not significantly associated with hyperglycemia (OR 1.03; 95 % CI 0.83–1.28; p = 0.77).

Conclusions

Sleep-disordered breathing symptoms and nap duration are associated with hyperglycemia. Sleep duration was not associated with hyperglycemia. Research is needed concerning whether women with sleep-disordered breathing and/or daytime napping are at risk for gestational diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, Baldwin CM, Nieto FJ (2005) Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med 165(8):863–867

    Article  PubMed  Google Scholar 

  2. Elmasry A, Janson C, Lindberg E, Gislason T, Tageldin MA, Boman G (2000) The role of habitual snoring and obesity in the development of diabetes: a 10-year follow-up study in a male population. J Int Med 248(1):13–20

    Article  CAS  Google Scholar 

  3. Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, Patel S, Hu FB (2003) A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care 26(2):380–384

    Article  PubMed  Google Scholar 

  4. Al-Delaimy WK, Manson JE, Willett WC, Stampfer MJ, Hu FB (2002) Snoring as a risk factor for type II diabetes mellitus: a prospective study. Am J Epidemiol 155(5):387–393

    Article  PubMed  Google Scholar 

  5. Botros N, Concato J, Mohsenin V, Selim B, Doctor K, Yaggi HK (2009) Obstructive sleep apnea as a risk factor for type 2 diabetes. Am J Med 122(12):1122–1127

    Article  PubMed  Google Scholar 

  6. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE, Sleep Heart Health Study I (2004) Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol 160(6):521–530

    Article  PubMed  Google Scholar 

  7. Tasali E, Van Cauter E, Hoffman L, Ehrmann DA (2008) Impact of obstructive sleep apnea on insulin resistance and glucose tolerance in women with polycystic ovary syndrome. J Clin Endocrinol Metab 93(10):3878–3884

    Article  PubMed  CAS  Google Scholar 

  8. Valham F, Stegmayr B, Eriksson M, Hagg E, Lindberg E, Franklin KA (2009) Snoring and witnessed sleep apnea is related to diabetes mellitus in women. Sleep Med 10(1):112–117

    Article  PubMed  Google Scholar 

  9. Tasali E, Mokhlesi B, Van Cauter E (2008) Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest 133(2):496–506

    Article  PubMed  Google Scholar 

  10. Pien GW, Fife D, Pack AI, Nkwuo JE, Schwab RJ (2005) Changes in symptoms of sleep-disordered breathing during pregnancy. Sleep 28(10):1299–1305

    PubMed  Google Scholar 

  11. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, Kales A (2001) Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 163(3 Pt 1):608–613

    Article  PubMed  CAS  Google Scholar 

  12. Okun ML, Hall M, Coussons-Read ME (2007) Sleep disturbances increase interleukin-6 production during pregnancy: implications for pregnancy complications. Reprod Sci 14(6):560–567

    Article  PubMed  CAS  Google Scholar 

  13. Izci-Balserak B (2008) Sleep-disordered breathing in pregnancy. Int J Sleep Wakefulness 1(3):98–108

    Google Scholar 

  14. Lee KA, Zaffke ME, McEnany G (2000) Parity and sleep patterns during and after pregnancy. Obstet Gynecol 95(1):14–18

    Article  PubMed  CAS  Google Scholar 

  15. Izci B, Vennelle M, Liston WA, Dundas KC, Calder AA, Douglas NJ (2006) Sleep-disordered breathing and upper airway size in pregnancy and post-partum. Eur Respir J 27(2):321–327

    Article  PubMed  CAS  Google Scholar 

  16. Izci-Balserak B, Lee KA (2010) Sleep disturbances and sleep-related disorders in pregnancy. In: Kryger M, Roth T, Dement W (eds) Principles and practice of sleep medicine, vol 5th. Saunders, Philadelphia, pp 1572–1586

    Google Scholar 

  17. Facco FL, Grobman WA, Kramer J, Ho KH, Zee PC (2010) Self-reported short sleep duration and frequent snoring in pregnancy: impact on glucose metabolism. Am J Obstet Gynecol 203(2):142, e141-145

    Article  PubMed  Google Scholar 

  18. Bourjeily G, Raker CA, Chalhoub M, Miller MA (2010) Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing. Eur Respir J 36(4):849–855

    Article  PubMed  CAS  Google Scholar 

  19. Cai XH, Xie YP, Li XC, Qu WL, Li T, Wang HX, Lv JQ, Wang LX (2012) The prevalence and associated risk factors of sleep disorder-related symptoms in pregnant women in China. Sleep Breath. doi:10.1007/s11325-012-0783-2

  20. Frederick IO, Qiu C, Sorensen TK, Enquobahrie DA, Williams MA (2013) The prevalence and correlates of habitual snoring during pregnancy. Sleep Breath. doi:10.1007/s11325-012-0717-z

  21. Williams MA, Miller RS, Qiu C, Cripe SM, Gelaye B, Enquobahrie D (2010) Associations of early pregnancy sleep duration with trimester-specific blood pressures and hypertensive disorders in pregnancy. Sleep 33(10):1363–1371

    PubMed  Google Scholar 

  22. Izci B, Riha RL, Martin SE, Vennelle M, Liston WA, Dundas KC, Calder AA, Douglas NJ (2003) The upper airway in pregnancy and pre-eclampsia. Am J Respir Crit Care Med 167(2):137–140

    Article  PubMed  Google Scholar 

  23. Sahin FK, Koken G, Cosar E, Saylan F, Fidan F, Yilmazer M, Unlu M (2008) Obstructive sleep apnea in pregnancy and fetal outcome. Int J Obstet Gynecol 100(2):141–146

    Article  Google Scholar 

  24. Micheli K, Komninos I, Bagkeris E, Roumeliotaki T, Koutis A, Kogevinas M, Chatzi L (2011) Sleep patterns in late pregnancy and risk of preterm birth and fetal growth restriction. Epidemiology 22(5):738–744

    Article  PubMed  Google Scholar 

  25. Qiu C, Enquobahrie D, Frederick IO, Abetew D, Williams MA (2010) Glucose intolerance and gestational diabetes risk in relation to sleep duration and snoring during pregnancy: a pilot study. BMC women's health 10:17

    Article  PubMed  Google Scholar 

  26. Champagne K, Schwartzman K, Opatrny L, Barriga P, Morin L, Mallozzi A, Benjamin A, Kimoff RJ (2009) Obstructive sleep apnoea and its association with gestational hypertension. Eur Respir J 33(3):559–565

    Article  PubMed  CAS  Google Scholar 

  27. Moore RT (2004) Diabetes in pregnancy. In: Creasy RK, Resnik R, Lams JD (eds) Maternal-fetal medicine: principles and practice, 5th edn. W. B. Saunders, Philadelphia, pp 1023–1062

    Google Scholar 

  28. Group HSCR, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358(19):1991–2002

    Article  PubMed  Google Scholar 

  29. Simeoni U, Barker DJ (2009) Offspring of diabetic pregnancy: long-term outcomes. Semin Fetal Neonatal Med 14(2):119–124

    Article  PubMed  Google Scholar 

  30. Herring SJ, Oken E, Rifas-Shiman SL, Rich-Edwards JW, Stuebe AM, Kleinman KP, Gillman MW (2009) Weight gain in pregnancy and risk of maternal hyperglycemia. Am J Obstet Gynecol 201(1):61.e61–61.e67

    Article  Google Scholar 

  31. Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, Hod M, Kitzmiller JL, Kjos SL, Oats JN, Pettitt DJ, Sacks DA, Zoupas C (2007) Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 30(Suppl 2):S251–S260

    Article  PubMed  CAS  Google Scholar 

  32. Tasali E, Leproult R, Spiegel K (2009) Reduced sleep duration or quality: relationships with insulin resistance and type 2 diabetes. Prog Cardiovasc Dis 51(5):381–391

    Article  PubMed  CAS  Google Scholar 

  33. Codario RA (2005) Type 2 diabetes, pre-diabetes, and the metabolic syndrome: the primary care guide to diagnosis and management. Current clinical practice. Humana Press, Totowa

    Book  Google Scholar 

  34. Maislin G, Pack AI, Kribbs NB, Smith PL, Schwartz AR, Kline LR, Schwab RJ, Dinges DF (1995) A survey screen for prediction of apnea. Sleep 18(3):158–166

    PubMed  CAS  Google Scholar 

  35. Jomeen J, Martin CR (2007) Assessment and relationship of sleep quality to depression in early pregnancy. J Psychosom Res 25:87–99

    Google Scholar 

  36. Chen YH, Kang JH, Lin CC, Wang IT, Keller JJ, Lin HC (2012) Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J Obstet Gynecol 206(2):136, e131-135

    Article  PubMed  Google Scholar 

  37. O'Brien LM, Bullough AS, Owusu JT, Tremblay KA, Brincat CA, Chames MC, Kalbfleisch JD, Chervin RD (2012) Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study. Am J Obstet Gynecol 207(6):487, e481-489

    Article  PubMed  Google Scholar 

  38. Aronsohn RS, Whitmore H, Van Cauter E, Tasali E (2010) Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med 181(5):507–513

    Article  PubMed  Google Scholar 

  39. Izci-Balserak B, Pien GW (2010) Sleep-disordered breathing and pregnancy: potential mechanisms and evidence for maternal and fetal morbidity. Curr Opin Pulm Med 16(6):574–582

    Article  PubMed  Google Scholar 

  40. Tasali E, Leproult R, Spiegel K (2009) Reduced sleep duration or quality: relationships with insulin resistance and type 2 diabetes. Prog Cardiovasc Dis 51(5):381–391

    Article  PubMed  CAS  Google Scholar 

  41. Punjabi NM, Beamer BA (2009) Alterations in glucose disposal in sleep-disordered breathing. Am J Respir Crit Care Med 179(3):235–240

    Article  PubMed  CAS  Google Scholar 

  42. Connolly G, Razak AR, Hayanga A, Russell A, McKenna P, McNicholas WT (2001) Inspiratory flow limitation during sleep in pre-eclampsia: comparison with normal pregnant and nonpregnant women. Eur Respir J 18(4):672–676

    Article  PubMed  CAS  Google Scholar 

  43. Edwards N, Blyton DM, Kirjavainen T, Kesby GJ, Sullivan CE (2000) Nasal continuous positive airway pressure reduces sleep-induced blood pressure increments in preeclampsia. Am J Respir Crit Care Med 162(1):252–257

    Article  PubMed  CAS  Google Scholar 

  44. Guilleminault C, Palombini L, Poyares D, Takaoka S, Huynh NTL, El-Sayed Y (2007) Pre-eclampsia and nasal CPAP: part 1. Early intervention with nasal CPAP in pregnant women with risk-factors for pre-eclampsia: preliminary findings. Sleep Med 9(1):9–14

    Article  PubMed  Google Scholar 

  45. Poyares D, Guilleminault C, Hachul H, Fujita L, Takaoka S, Tufik S, Sass N (2007) Pre-eclampsia and nasal CPAP: part 2. Hypertension during pregnancy, chronic snoring, and early nasal CPAP intervention. Sleep Med 9(1):15–21

    Article  PubMed  Google Scholar 

  46. Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, Wadden TA, Kelley D, Wing RR, Sunyer FX, Darcey V, Kuna ST, Sleep ARG (2009) Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 32(6):1017–1019

    Article  PubMed  Google Scholar 

  47. Louis J, Auckley D, Miladinovic B, Shepherd A, Mencin P, Kumar D, Mercer B, Redline S (2012) Perinatal outcomes associated with obstructive sleep apnea in obese pregnant women. Obstet Gynecol 120(5):1085–1092

    PubMed  Google Scholar 

  48. Lam KH, Jiang CQ, Thomas GN, Lao XQ, McGhee SM, Zhang WS, Schooling CM, Adab P, Cheng KK, Arora T, Taheri S, Lam TH (2010) Napping is associated with increased risk of type 2 diabetes: the Guangzhou Biobank Cohort Study. Sleep 33(3):402–407

    PubMed  Google Scholar 

  49. Xu Q, Song Y, Hollenbeck A, Blair A, Schatzkin A, Chen H (2010) Day napping and short night sleeping are associated with higher risk of diabetes in older adults. Diabetes Care 33(1):78–83

    Article  PubMed  Google Scholar 

  50. Mallon L, Broman JE, Hetta J (2005) High incidence of diabetes in men with sleep complaints or short sleep duration: a 12-year follow-up study of a middle-aged population. Diabetes Care 28(11):2762–2767

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by grants from the National Institutes of Health (T32 HL07713 and 5K23HD041465).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Centre for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, 3624 Market Street, Suite 205, Philadelphia, PA, 19104, USA

    Bilgay Izci Balserak, Nicholas Jackson, Allan I. Pack & Grace W. Pien

  2. Sleep Medicine Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Allan I. Pack & Grace W. Pien

  3. Centre for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Sarah A. Ratcliffe

  4. Pulmonary, Allergy and Critical Care Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Grace W. Pien

  5. Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA

    Bilgay Izci Balserak

Authors
  1. Bilgay Izci Balserak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicholas Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah A. Ratcliffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Allan I. Pack
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Grace W. Pien
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bilgay Izci Balserak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Izci Balserak, B., Jackson, N., Ratcliffe, S.A. et al. Sleep-disordered breathing and daytime napping are associated with maternal hyperglycemia. Sleep Breath 17, 1093–1102 (2013). https://doi.org/10.1007/s11325-013-0809-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-013-0809-4

Keywords

Search

Navigation