Sleep Quality is an Independent Predictor of Blood Glucose and Gestational Diabetes Mellitus: A Longitudinal Study of 4550 Chinese Women

Association between sleep quality and duration during pregnancy and risk of gestational diabetes: A systematic review and meta-analysis

OBJECTIVE

Gestational diabetes mellitus (GDM) is associated with several adverse maternal and neonatal outcomes. Previous studies reported a link between altered sleep and risk of GDM. This systematic review aims to collate evidence on the association between impaired sleep quality and duration, and the risk of GDM.

METHODS

PubMed, Embase, Web of Science, and Scopus databases were searched up to January 20, 2024. Studies reporting the association between impaired sleep quality and duration and risk of GDM were included. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Random-effects meta-analysis was performed, and the results were reported as hazard ratio (HR) with 95% confidence interval (CI).

RESULTS

19 studies were included. Meta-analysis revealed a significant increase in the risk of GDM in pregnant women with poor sleep quality (i.e. <5 PSQI) (HR: 1.50, 95% CI: 1.26 - 1.78, p < .001). Sleep duration of <7 h (HR: 1.56, 95% CI.: 1.20 - 2.01, p < .001), and >8 h (HR: 2.32, 95% CI.: 1.19 - 4.50, p = .01) were also associated with a significantly higher incidence of GDM.

CONCLUSION

Sleep quality and duration emerge as critical risk factors of GDM. Healthcare practitioners should consider targeted interventions to improve sleep hygiene as a potential measure for GDM prevention.

Sleep conditions and sleep hygiene behaviors in early pregnancy are associated with gestational diabetes mellitus: A propensity-score matched study

PURPOSE

To explore the influence of sleep conditions and sleep hygiene behaviors in early pregnancy on gestational diabetes mellitus (GDM) development.

METHODS

This 1:1 propensity-score matched study included 1,216 pregnant women divided into GDM and control groups based on diagnosis via the oral glucose tolerance test at 24-28 gestational weeks. Sleep conditions and hygiene behaviors were evaluated using structural questionnaires, including the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Sleep Hygiene Practice Scale. Univariate and multivariate logistic regression analyses and Spearman's correlation were conducted to identify the associations.

RESULTS

After adjusting for baseline clinical characteristics, women with GDM were more likely to have poor sleep quality (adjusted odds ratio [AOR] = 1.585, 95% confidence interval [CI]: 1.261-1.992) and higher scores for subjective sleep quality, latency, duration, efficiency, and sleep disturbances (all P < 0.01). Mild sleepiness (AOR = 1.311, 95% CI: 1.012-1.699) and worrying about not being able to fall asleep (AOR = 1.123, 95% CI: 1.005-1.255) were more likely to occur in the GDM group. Sleep quality and hygiene behaviors such as sleep-irrelevant activities, staying in bed after waking up, weekend catch-up sleep, and overeating before bedtime were significantly correlated with gestational diabetes variables.

CONCLUSION

Poor sleep conditions and specific sleep hygiene behaviors in early pregnancy may be independent risk factors for GDM. This suggests that sleep assessment and behavior education can be used as new approaches for the early implementation of surveillance and prevention of GDM.

Sleep disorders during pregnancy: an underestimated risk factor for gestational diabetes mellitus

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.

Association of sleep characteristics with renal function in menopausal women without recognized chronic kidney disease

OBJECTIVE

To delineate the association between sleep characteristics and renal function in peri-post menopause free of Chronic kidney disease (CKD) as well as cardiometabolic and hormone indicators.

METHODS

Cross-sectional data from a total of 823 Han-Chinese women aged 40-67 years who visited the Menopause Clinic in the Shanghai Sixth People's Hospital from November 2011 to November 2020 were analyzed through the Pittsburgh Sleep Quality Index (PSQI) and serum cystatin C (Cys-C). Logistic regression models were used to assess the association between cumulative/each sleep parameter and renal function after adjusting for cardiometabolic variables.

RESULTS

After confounding factors, we identified that poor perceived sleep quality, shorter sleep duration (<6 h), low sleep efficiency (<75%), delayed sleep latency and worse sleep disturbance elevated more than doubled the odds ratio for declining renal function (≥0.91 mg/dL, the highest Cys-C) in postmenopause in a graded fashion. Meanwhile, multiple logistic regression analysis revealed that sleep disorder (PSQI ≥ 8), late postmenopause, highest quartile independently increased the odds ratio for declining renal function (OR 2.007, 95% CI: 1.408-2.861, OR = 3.287, 95%CI: 3.425-8.889, OR = 2.345, 95% CI: 1.310-4.199, respectively), while participants with menopausal hormone replacement (MHT) lower the odds of declining renal function (OR = 0.486, 95% CI: 0.324-0.728).

CONCLUSION

The findings proposed that maintaining good sleep quality should be attached great importance to postmenopausal women, which provides clinical evidence for the feasible early detection and effective prevention such as MHT of renal disease progression in postmenopausal women.