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Smocot J, Benedetti A, Newbold R, Meltzer S, Kimoff RJ, Garfield N, Rey E, Dasgupta K, Gagnon R, Pamidi S. Impact of Continuous Positive Airway Pressure on Glucose Profiles in Gestational Diabetes: A Pilot Randomized Controlled Trial. Am J Respir Crit Care Med 2024; 210:677-679. [PMID: 38820207 DOI: 10.1164/rccm.202401-0099le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/31/2024] [Indexed: 06/02/2024] Open
Affiliation(s)
- Joshua Smocot
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, Research Institute of the McGill University Health Centre
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health
| | - Raphieal Newbold
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, Research Institute of the McGill University Health Centre
| | - Sara Meltzer
- Division of Endocrinology, Department of Medicine
| | - R John Kimoff
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, Research Institute of the McGill University Health Centre
| | | | - Evelyne Rey
- Department of Medicine and Obstetrics and Gynaecology, Université de Montréal, Montreal, Quebec, Canada; and
- Division of Obstetric Medicine, Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Kaberi Dasgupta
- Division of Internal Medicine, Department of Medicine, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and
| | - Robert Gagnon
- Department of Obstetrics and Gynaecology, McGill University, Montreal, Quebec, Canada
| | - Sushmita Pamidi
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, Research Institute of the McGill University Health Centre
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2
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Alex RM, Mann DL, Azarbarzin A, Vena D, Gell LK, Wellman A, Grobman WA, Facco FL, Silver RM, Pien GW, Louis JM, Zee PC, Rueschman M, Sofer T, Redline S, Sands SA. Adverse pregnancy outcomes and pharyngeal flow limitation during sleep: Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b). Eur Respir J 2024; 64:2301707. [PMID: 38575160 DOI: 10.1183/13993003.01707-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Pharyngeal flow limitation during pregnancy may be a risk factor for adverse pregnancy outcomes but was previously challenging to quantify. Our objective was to determine whether a novel objective measure of flow limitation identifies an increased risk of pre-eclampsia (primary outcome) and other adverse outcomes in a prospective cohort: Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b). METHODS Flow limitation severity scores (0%=fully obstructed, 100%=open airway), quantified from breath-by-breath airflow shape, were obtained from home sleep tests during early (6-15 weeks) and mid (22-31 weeks) pregnancy. Multivariable logistic regression quantified associations between flow limitation (median overnight severity, both time-points averaged) and pre-eclampsia, adjusting for maternal age, body mass index (BMI), race, ethnicity, chronic hypertension and flow limitation during wakefulness. Secondary outcomes were hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM) and infant birthweight. RESULTS Of 1939 participants with flow limitation data at both time-points (mean±sd age 27.0±5.4 years and BMI 27.7±6.1 kg·m-2), 5.8% developed pre-eclampsia, 12.7% developed HDP and 4.5% developed GDM. Greater flow limitation was associated with increased pre-eclampsia risk: adjusted OR 2.49 (95% CI 1.69-3.69) per 2sd increase in severity. Findings persisted in women without sleep apnoea (apnoea-hypopnoea index <5 events·h-1). Flow limitation was associated with HDP (OR 1.77 (95% CI 1.33-2.38)) and reduced infant birthweight (83.7 (95% CI 31.8-135.6) g), but not GDM. CONCLUSIONS Greater flow limitation is associated with increased risk of pre-eclampsia, HDP and lower infant birthweight. Flow limitation may provide an early target for mitigating the consequences of sleep disordered breathing during pregnancy.
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Affiliation(s)
- Raichel M Alex
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Dwayne L Mann
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Laura K Gell
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Francesca L Facco
- Department of Obstetrics and Gynecology, University of Pittsburgh, Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Robert M Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Grace W Pien
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judette M Louis
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Phyllis C Zee
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Rueschman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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3
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Cànaves-Gómez L, Fleischer A, Muncunill-Farreny J, Gimenez MP, Álvarez Ruiz De Larrinaga A, Sánchez Baron A, Codina Marcet M, De-La-Peña M, Morell-Garcia D, Peña Zarza J, Piñas Zebrian C, García Fernández S, Alonso A. Effect of Obstructive Sleep Apnea during Pregnancy on Fetal Development: Gene Expression Profile of Cord Blood. Int J Mol Sci 2024; 25:5537. [PMID: 38791576 PMCID: PMC11121783 DOI: 10.3390/ijms25105537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Obstructive sleep apnea (OSA) is quite prevalent during pregnancy and is associated with adverse perinatal outcomes, but its potential influence on fetal development remains unclear. This study investigated maternal OSA impact on the fetus by analyzing gene expression profiles in whole cord blood (WCB). Ten women in the third trimester of pregnancy were included, five OSA and five non-OSA cases. WCB RNA expression was analyzed by microarray technology to identify differentially expressed genes (DEGs) under OSA conditions. After data normalization, 3238 genes showed significant differential expression under OSA conditions, with 2690 upregulated genes and 548 downregulated genes. Functional enrichment was conducted using gene set enrichment analysis (GSEA) applied to Gene Ontology annotations. Key biological processes involved in OSA were identified, including response to oxidative stress and hypoxia, apoptosis, insulin response and secretion, and placental development. Moreover, DEGs were confirmed through qPCR analyses in additional WCB samples (7 with OSA and 13 without OSA). This highlighted differential expression of several genes in OSA (EGR1, PFN1 and PRKAR1A), with distinct gene expression profiles observed during rapid eye movement (REM)-OSA in pregnancy (PFN1, UBA52, EGR1, STX4, MYC, JUNB, and MAPKAP). These findings suggest that OSA, particularly during REM sleep, may negatively impact various biological processes during fetal development.
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Affiliation(s)
- Laura Cànaves-Gómez
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain; (L.C.-G.); (A.F.); (J.M.-F.); (M.P.G.); (M.D.-L.-P.); (D.M.-G.); (J.P.Z.); (C.P.Z.); (S.G.F.)
| | - Aarne Fleischer
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain; (L.C.-G.); (A.F.); (J.M.-F.); (M.P.G.); (M.D.-L.-P.); (D.M.-G.); (J.P.Z.); (C.P.Z.); (S.G.F.)
- Genomic & Bioinformatics Platform, IdISBa, 07120 Palma de Mallorca, Spain
| | - Josep Muncunill-Farreny
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain; (L.C.-G.); (A.F.); (J.M.-F.); (M.P.G.); (M.D.-L.-P.); (D.M.-G.); (J.P.Z.); (C.P.Z.); (S.G.F.)
- Genomic & Bioinformatics Platform, IdISBa, 07120 Palma de Mallorca, Spain
| | - María Paloma Gimenez
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain; (L.C.-G.); (A.F.); (J.M.-F.); (M.P.G.); (M.D.-L.-P.); (D.M.-G.); (J.P.Z.); (C.P.Z.); (S.G.F.)
| | - Ainhoa Álvarez Ruiz De Larrinaga
- Hospital Universitario de Araba, 01009 Vitoria-Gasteiz, Spain;
- Departamento de Neurociencias, Instituto de Investigación Sanitaria Bioaraba, 01009 Vitoria-Gasteiz, Spain
| | | | - Mercedes Codina Marcet
- Servicio de Endocrinología, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain;
| | - Mónica De-La-Peña
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain; (L.C.-G.); (A.F.); (J.M.-F.); (M.P.G.); (M.D.-L.-P.); (D.M.-G.); (J.P.Z.); (C.P.Z.); (S.G.F.)
- Servicio de Neumología, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain
- Facultad de Medicina, Universidad de las Islas Baleares, 07122 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), 28029 Madrid, Spain
| | - Daniel Morell-Garcia
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain; (L.C.-G.); (A.F.); (J.M.-F.); (M.P.G.); (M.D.-L.-P.); (D.M.-G.); (J.P.Z.); (C.P.Z.); (S.G.F.)
- Servicio de Análisis Clínicos, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain
| | - José Peña Zarza
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain; (L.C.-G.); (A.F.); (J.M.-F.); (M.P.G.); (M.D.-L.-P.); (D.M.-G.); (J.P.Z.); (C.P.Z.); (S.G.F.)
- Servicio de Pediatría, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain
| | - Concepción Piñas Zebrian
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain; (L.C.-G.); (A.F.); (J.M.-F.); (M.P.G.); (M.D.-L.-P.); (D.M.-G.); (J.P.Z.); (C.P.Z.); (S.G.F.)
- Servicio de Neumología, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain
| | - Susana García Fernández
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain; (L.C.-G.); (A.F.); (J.M.-F.); (M.P.G.); (M.D.-L.-P.); (D.M.-G.); (J.P.Z.); (C.P.Z.); (S.G.F.)
- Servicio de Neumología, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain
| | - Alberto Alonso
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain; (L.C.-G.); (A.F.); (J.M.-F.); (M.P.G.); (M.D.-L.-P.); (D.M.-G.); (J.P.Z.); (C.P.Z.); (S.G.F.)
- Servicio de Neumología, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain
- Facultad de Medicina, Universidad de las Islas Baleares, 07122 Palma de Mallorca, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), 28029 Madrid, Spain
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Eleftheriou D, Athanasiadou KI, Sifnaios E, Vagiakis E, Katsaounou P, Psaltopoulou T, Paschou SA, Trakada G. Sleep disorders during pregnancy: an underestimated risk factor for gestational diabetes mellitus. Endocrine 2024; 83:41-50. [PMID: 37740834 PMCID: PMC10805805 DOI: 10.1007/s12020-023-03537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
Sleep disorders are highly prevalent during pregnancy and significantly affect women's health and quality of life. Gestational diabetes mellitus (GDM) is one of the most common metabolic complications during pregnancy and constitutes a significant risk factor for both mother and fetus in the short and the long term. While the association between sleep disorders and type 2 diabetes mellitus (T2DM) is indisputable, it is not clear whether there is a link between sleep disorders and GDM. The aim of this article was to investigate the association between sleep disorders and GDM and whether the treatment of sleep disorders may prevent GDM development. Insomnia, obstructive sleep apnea (OSA), restless legs syndrome (RLS), and narcolepsy were the most common sleep disorders identified during pregnancy and were related to poor sleep quality and short or prolonged sleep duration. They were all associated with an increased risk of GDM. The ideal sleep duration for pregnant women was determined at 8-9 h daily. In conclusion, sleep disorders constitute a risk factor for GDM. It is imperative that prospective studies be conducted to evaluate the effect of the early management of sleep disorders on GDM manifestation and control. Healthcare providers should highlight the importance of sufficient sleep to reinforce pregnancy outcomes.
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Affiliation(s)
- Danai Eleftheriou
- Respiratory Medicine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kleoniki I Athanasiadou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Emmanouil Vagiakis
- Respiratory Department, First ICU Evangelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Katsaounou
- Respiratory Department, First ICU Evangelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Psaltopoulou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Georgia Trakada
- Respiratory Medicine Unit, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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5
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Kember AJ, Elangainesan P, Ferraro ZM, Jones C, Hobson SR. Common sleep disorders in pregnancy: a review. Front Med (Lausanne) 2023; 10:1235252. [PMID: 37671402 PMCID: PMC10475609 DOI: 10.3389/fmed.2023.1235252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023] Open
Abstract
In this review, we provide a comprehensive overview of common sleep disorders during pregnancy, including their characterization, prevalence, risk factors, and possible contribution to maternal and fetal outcomes. We conducted a quasi-systematic literature search of the MEDLINE database and identified 744 studies from 1991 through 2021, inclusive, that met our inclusion criteria. We synthesized the existing literature on sleep disorders during pregnancy and highlighted controversies, research gaps, and needed clinical developments. Our review covers a range of sleep disorders, including insomnia, obstructive sleep apnea, restless legs syndrome, and circadian rhythm disorders. We discuss the prevalence of these disorders in pregnancy and their potential impact on maternal and fetal health outcomes. We also explore the relationship between sleep disorders, pre-pregnancy comorbidities such as obesity, and pregnancy-related conditions such as gestational diabetes mellitus and preeclampsia. In addition to summarizing the existing literature on sleep disorders during pregnancy, we also highlight opportunities for further research in this area. We suggest that future studies should strive to employ validated and objective measurement tools for sleep disorders and prioritize utilization of longitudinal methods with participant follow-up through postpartum, mid-life, menopause, and beyond. We also put forward investigation into the impact of circadian rhythm disruption on reproductive physiology and early pregnancy outcomes as an area of important work. Overall, our review provides valuable insights on sleep and reproduction and into common sleep disorders during pregnancy and their potential impact on maternal and fetal health outcomes.
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Affiliation(s)
- Allan J. Kember
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Shiphrah Biomedical Inc., Toronto, ON, Canada
| | - Praniya Elangainesan
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
| | - Zachary M. Ferraro
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Claire Jones
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Reproductive Endocrinology and Infertility, Mount Sinai Hospital, Toronto, ON, Canada
| | - Sebastian R. Hobson
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada
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6
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Dominguez JE, Cantrell S, Habib AS, Izci-Balserak B, Lockhart E, Louis JM, Miskovic A, Nadler JW, Nagappa M, O'Brien LM, Won C, Bourjeily G. Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy. Obstet Gynecol 2023; 142:403-423. [PMID: 37411038 PMCID: PMC10351908 DOI: 10.1097/aog.0000000000005261] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 07/08/2023]
Abstract
The Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology tasked an expert group to review existing evidence and to generate recommendations on the screening, diagnosis, and treatment of patients with obstructive sleep apnea during pregnancy. These recommendations are based on a systematic review of the available scientific evidence and expert opinion when scientific evidence is lacking. This guideline may not be appropriate for all clinical situations and patients, and physicians must decide whether these recommendations are appropriate for their patients on an individual basis. We recognize that not all pregnant people may identify as women. However, data on non-cisgendered pregnant patients are lacking, and many published studies use gender-binary terms; therefore, depending on the study referenced, we may refer to pregnant individuals as women. This guideline may inform the creation of clinical protocols by individual institutions that consider the unique considerations of their patient populations and the available resources.
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Affiliation(s)
- Jennifer E Dominguez
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
| | - Sarah Cantrell
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Ashraf S Habib
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Bilgay Izci-Balserak
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Ellen Lockhart
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Judette M Louis
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Alice Miskovic
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Jacob W Nadler
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Mahesh Nagappa
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Louise M O'Brien
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Christine Won
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
- From the Department of Anesthesiology, Duke University Medical Center Library & Archives, and the Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina; the Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois; AMN Healthcare, Dallas, Texas; the Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida; Anesthesiology, Great Ormond Street Hospital for Children, London, United Kingdom; the Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York; the Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Toronto, Ontario, Canada; the Departments of Neurology, Obstetrics and Gynecology, and Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan; the Department of Medicine, Yale School of Medicine, New Haven, Connecticut; and the Department of Medicine, Brown University, Providence, Rhode Island
| | - Ghada Bourjeily
- Jennifer E. Dominguez, MD, MHS, and Ghada Bourjeily, MD, are the Guideline Committee Co-Chairs
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7
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Onslow ML, Wolsk J, Wisniewski S, Patel S, Gallaher M, Hubel C, Cashmere DJ, Facco FL. The association between sleep-disordered breathing and maternal endothelial and metabolic markers in pregnancies complicated by obesity. J Clin Sleep Med 2023; 19:97-109. [PMID: 36004747 PMCID: PMC9806794 DOI: 10.5664/jcsm.10254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVES To evaluate the impact of sleep-disordered breathing (SDB) on vascular, angiogenic and metabolic analytes in pregnancy. METHODS Participants with a body mass index ≥30 kg/m2 underwent polysomnography at 14-20 weeks gestation (visit 1). Participants with SDB (defined as an apnea-hypopnea index ≥5 events/h) were then enrolled in a separate trial. SDB-negative participants returned for a polysomnogram at 28-31 weeks (visit 2) and were recategorized as persistent-negative SDB or new-onset SDB. Mean arterial blood pressure, mean uterine artery Doppler pulsatility index, endoglin, soluble Feline McDonough Sarcoma-like tyrosine kinase 1, placental growth factor, and the homeostatic model assessment for insulin resistance were measured after each visit. Our primary outcome was a composite of uterine artery Doppler pulsatility index, soluble FMS-like tyrosine kinase 1/placental growth factor ratio, and homeostatic model assessment for insulin resistance. For secondary analyses, each outcome variable was analyzed independently. RESULTS A total of 242 and 130 participants completed visit 1 and visit 2, respectively. Newly diagnosed SDB was present in 37% of individuals at visit 1 and 31% of individuals at visit 2. No significant differences in our composite outcome vector were observed in individuals with and without SDB at either visit. In our secondary analysis, mean arterial blood pressure (88.7 ± 7.3 mm Hg vs 85.4 ± 7.1 mm Hg, P = .04) and fasting glucose (92.4 ± 15.2 mg/dL vs 86.6 ± 11.5 mg/dL, P = .05) were higher in participants with early pregnancy SDB. These associations were not observed for new-onset SDB. No associations were observed between uterine artery Doppler pulsatility index and angiogenic markers and SDB in pregnancy. CONCLUSIONS SDB in early pregnancy was not associated with our composite primary outcome but was associated with higher mean arterial blood pressure and fasting glucose. The pathophysiologic changes that occur in pregnant individuals with SDB and how they lead to an increased risk of preeclampsia and gestational diabetes remain poorly understood. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Sleep Disordered Breathing, Obesity and Pregnancy Study (SOAP); URL: https://clinicaltrials.gov/ct2/show/NCT02086448; Identifier: NCT02086448. CITATION Onslow ML, Wolsk J, Wisniewski S, et al. The association between sleep-disordered breathing and maternal endothelial and metabolic markers in pregnancies complicated by obesity. J Clin Sleep Med. 2023;19(1):97-109.
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Affiliation(s)
- Mitchell L. Onslow
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Obstetrics and Gynecology, University Hospitals, Cleveland, Ohio
| | - Jennifer Wolsk
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen Wisniewski
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sanjay Patel
- Center for Sleep and Cardiovascular Outcomes Research, Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Carl Hubel
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Magee‐Womens Research Institute, Pittsburgh, Pennsylvania
| | | | - Francesca L. Facco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Effect of Evidence-Based Diet Nursing on Intestinal Flora and Maternal and Infant Prognosis in Patients with Gestational Diabetes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1241530. [PMID: 36091592 PMCID: PMC9458402 DOI: 10.1155/2022/1241530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/18/2022]
Abstract
Background. Gestational diabetes mellitus (GDM) refers to the diabetes first discovered or occurring during pregnancy. The incidence of gestational diabetes in China is about 1%–5%, with an increasing trend in recent years. Objective. To observe the effect of evidence-based diet nursing on intestinal flora and maternal and infant prognosis in patients with gestational diabetes. Methods. One hundred and thirty patients with GDM admitted to our hospital from January 2020 to January 2022 were selected and divided into two groups according to the intervention method, with 65 cases in each group. The control group was given routine nursing plus diet nursing, while the observation group was given evidence-based nursing plus diet nursing. The changes of blood glucose index and intestinal flora before and after intervention in the two groups were detected, and the compliance behavior, pregnancy outcome, and perinatal outcome in the two groups were statistically analyzed. Results. After the intervention, the fasting blood glucose, 2 h postprandial blood glucose, and HbA1c in the two groups gradually decreased (
). Further comparison between the groups showed that the fasting blood glucose, 2 h postprandial blood glucose, and HbA1c in the observation group were lower than those in the control group (
). After intervention, the ratios of Bifidobacterium, Lactobacillus, and Bifidobacterium to E. coli in the two groups gradually increased (
). Furthermore, comparison between the groups showed that the ratios of Bifidobacterium, Lactobacillus, and Bifidobacterium to E. coli in the observation group were higher than those in the control group (
). The blood glucose rate, regular prenatal examination rate, and diet control rate of the observation group were 100.00%, 100.00%, and 95.38%, respectively, which were higher than 89.23%, 92.31%, and 84.62% of the control group, and the difference was significant (
). The pregnancy infection rate and cesarean section rate in the observation group were 0.00% and 33.85%, respectively, which were lower than 6.15% and 60.00% in the control group, and the difference was significant (
).The premature delivery rate and polyhydramnios rate in the observation group were 3.08% and 1.54%, respectively, which were not significantly different from 6.15% to 7.69% in the control group (
). The rates of macrosomia, neonatal hypoglycemia, and neonatal hyperbilirubinemia in the observation group were 1.54%, 3.08%, and 9.23%, respectively, which were lower than those in the control group (10.77%, 13.85%, and 23.08%), and the differences were significant (
). The fetal malformation rate and neonatal asphyxia rate in the observation group were 0.00% and 1.54%, respectively, which were not significantly different from 1.54% to 7.69% in the control group (
). Conclusion. The application of evidence-based care combined with dietary care in GDM patients can improve intestinal flora, control blood glucose, improve patient compliance behavior, and improve maternal and infant outcomes.
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Sanapo L, Bublitz MH, Bai A, Mehta N, Messerlian GM, Catalano P, Bourjeily G. Association between sleep disordered breathing in early pregnancy and glucose metabolism. Sleep 2022; 45:zsab281. [PMID: 34999843 PMCID: PMC8996028 DOI: 10.1093/sleep/zsab281] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/12/2021] [Indexed: 08/26/2023] Open
Abstract
STUDY OBJECTIVES To examine the association between maternal sleep disordered breathing (SDB) and glucose metabolism in early gestation. METHODS Women with body mass index (BMI) ≥27 kg/m2 and singleton pregnancies underwent in-home sleep study (HSAT) and homeostatic model assessment (HOMA) in early pregnancy. Insulin resistance (HOMA-IR) and β-cell function (HOMA %B) were derived. Exclusion criteria included pregestational diabetes, use of continuous positive airway pressure and chronic steroid therapy. We performed linear regression analyses to evaluate the association between continuous measures of SDB (respiratory event index (REI), and oxygen desaturation index (ODI)) and glucose metabolism parameters (HOMA-IR and HOMA %B). Analyses were adjusted for a set of a priori selected variables which included gestational age, maternal age, BMI, ethnicity, race, and parity. RESULTS One hundred and ninety-two pregnant women with median (interquartile range) BMI of 35.14 (8.30) kg/m2 underwent HSAT and HOMA assessment at 11.14 (3) and 15.35 (4.14) gestational weeks, respectively. REI and ODI, as continuous values, were associated with HOMA-IR after adjusting for covariates. OSA (obstructive sleep apnea) diagnosis (REI > 5 events per hour) was not associated with HOMA-IR after adjusting for BMI (p ≥ 0.05). None of the parameters were associated with HOMA %B (p > 0.07). CONCLUSIONS SDB and insulin resistance are associated in early pregnancy, with a dose response association between respiratory event index severity and insulin resistance. Further studies are needed to establish if pregnant women with overweight and obesity may benefit from early SDB screening to improve glucose metabolic outcome. Clinical trials: NCT02412696, Positive Airway Pressure, Sleep Apnea, and the Placenta (PAP-SAP) https://clinicaltrials.gov/ct2/show/NCT02412696?term=Bourjeily&draw=2&rank=2 and NCT02917876, Predictors of De-novo Development of Obstructive Sleep Apnea in Pregnancy (Predictors) https://clinicaltrials.gov/ct2/show/NCT02917876?term=Bourjeily&draw=2&rank=1.
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Affiliation(s)
- Laura Sanapo
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, RI, USA
- Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Margaret H Bublitz
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, RI, USA
- Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Alice Bai
- Brown University, Providence, RI, USA
| | - Niharika Mehta
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, RI, USA
- Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Geralyn M Messerlian
- Departments of Pathology and Laboratory Medicine and Obstetrics and Gynecology, Women and Infants Hospital, Brown University, Providence, RI, USA
| | - Patrick Catalano
- Mother Infant Research Institute, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Ghada Bourjeily
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, RI, USA
- Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA
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10
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Pamidi S, Kalyani RR, Pien GW. Sleep-disordered breathing in pregnancy and glucose metabolism: is earlier detection better? Sleep 2022; 45:6523134. [DOI: 10.1093/sleep/zsac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sushmita Pamidi
- Department of Medicine, Division of Respiratory Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Rita R Kalyani
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Grace W Pien
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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A Review of the Associations Between Obstructive Sleep Apnea and Gestational Diabetes Mellitus and Possible Mechanisms of Disease. Reprod Sci 2022; 30:81-92. [PMID: 35257355 PMCID: PMC9810675 DOI: 10.1007/s43032-022-00904-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/25/2022] [Indexed: 01/07/2023]
Abstract
Obstructive sleep apnea (OSA) usually leads to the occurrence of diabetes. Gestational diabetes mellitus (GDM) is a common gestational complication associated with adverse maternal and fetal outcomes. Increasing studies suggest that women with OSA during pregnancy may be at a significantly greater risk of developing GDM. It is crucial to explore the association between OSA and GDM and the mechanisms underlying this association. In this review, we presented a comprehensive literature review of the following: the association between OSA and GDM, the possible mechanisms of this association, and the effects of continuous positive airway pressure (CPAP) on OSA with GDM. The results showed that most authors suggested that there was an association between OSA and GDM. The intermittent hypoxemia (IH) and reduction of slow-wave sleep (SWS) may be the key to this association. IH induces the products of oxidative stress and inflammation as well as dysregulation of the hypothalamic-pituitary-adrenal, which lead to diabetes. In addition, SWS reduction in OSA enhances the inflammation by increasing the inflammatory cytokines, increases the sympathetic activation, and causes changes in leptin level, which result in the development of GDM. Additionally, whether CPAP is beneficial to GDM remains still unclear.
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12
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Beroukhim G, Esencan E, Seifer DB. Impact of sleep patterns upon female neuroendocrinology and reproductive outcomes: a comprehensive review. Reprod Biol Endocrinol 2022; 20:16. [PMID: 35042515 PMCID: PMC8764829 DOI: 10.1186/s12958-022-00889-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/06/2022] [Indexed: 12/17/2022] Open
Abstract
Sleep is vital to human bodily function. Growing evidence indicates that sleep deprivation, disruption, dysrhythmia, and disorders are associated with impaired reproductive function and poor clinical outcomes in women. These associations are largely mediated by molecular-genetic and hormonal pathways, which are crucial for the complex and time sensitive processes of hormone synthesis/secretion, folliculogenesis, ovulation, fertilization, implantation, and menstruation. Pathologic sleep patterns are closely linked to menstrual irregularity, polycystic ovarian syndrome, premature ovarian insufficiency, sub/infertility, and early pregnancy loss. Measures of success with assisted reproductive technology are also lower among women who engage in shift work, or experience sleep disruption or short sleep duration. Extremes of sleep duration, poor sleep quality, sleep disordered breathing, and shift work are also associated with several harmful conditions in pregnancy, including gestational diabetes and hypertensive disorders. While accumulating evidence implicates pathologic sleep patterns in impaired reproductive function and poor reproductive outcomes, additional research is needed to determine causality and propose therapeutic interventions.
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Affiliation(s)
- Gabriela Beroukhim
- Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
| | - Ecem Esencan
- Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - David B Seifer
- Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
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13
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Sanapo L, Bourjeily G. Maternal Sleep-Disordered Breathing and Gestational Diabetes. Chest 2021; 159:17-18. [PMID: 33422196 DOI: 10.1016/j.chest.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 01/16/2023] Open
Affiliation(s)
- Laura Sanapo
- The Miriam Hospital, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Ghada Bourjeily
- The Miriam Hospital, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI.
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