Sleep-disordered breathing early in pregnancy linked to insulin resistance

January 12, 2022

3 minutes read

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According to a study published in sleep.

“We decided to conduct this study to better understand the relationship between maternal sleep-related breathing disorder (SDS) and glucose metabolism in early pregnancy,” the author Laura Sanapo, MD, MSHS, RDMS, a researcher from Miriam Hospital, Women’s Medicine Collaborative in Providence, Rhode Island, said Healio.

According to Sanapo, women often experience snoring and obstructive sleep apnea (OSA) during pregnancy. SDB is also underdiagnosed, although it affects up to 70% of high-risk pregnancies, she continued, especially those complicated by maternal obesity, and it is more common than other obstetric complications like diabetes and high blood pressure.

Previous research has shown that women with SDSs during pregnancy are at greater risk of developing diabetes late in pregnancy than women without SDSs after controlling obesity and other confounders, Sanapo said.

However, whether women with SDS begin pregnancy early with glucose abnormalities that precede the onset of diabetes, such as decreased insulin sensitivity, is unknown, Sanapo added.

What the study showed

The cross-sectional study was based on the baseline characteristics of 192 women with singleton pregnancies and risk factors for OSA such as a BMI of 27 kg / m² or more2 and snoring three or more days a week.

The researchers performed sleep apnea tests (HSAT) at home at 11 weeks gestation and homeostatic model assessments (HOMA) at 15 weeks gestation.

HSAT found 61 participants (32%) with OSA based on Respiratory Event Index (REI) scores of five or more events per hour. These participants were older, had a higher BMI, and were more likely to be multipath than those who were not diagnosed with OSA.

Virtually all respiratory events were obstructive and both groups showed minimal sleep hypoxia. The median REI was categorized as mild (less than 15 events per hour), even though 10 women had REI values ​​greater than 15 events per hour.

HOMA, designed to provide an estimate of insulin resistance, sensitivity and B-cell function (HOMA% B), measured fasting glucose and C-peptide. Venipuncture after 8 hours of fasting yielded blood in the morning.

Participants diagnosed with OSA had higher levels of glucose and C-peptide and had higher levels of insulin resistance (HOMA-IR) than participants who were not diagnosed with OSA, the researchers said.

For every 10 unit increase in REI, there was a 0.3 unit increase in HOMA-IR and a 4 unit increase in fasting glucose. However, there was no significant association between REI and HOMA% B.

The researchers also found an association between HOMA-IR and Oxygen Desaturation Index (ODI), but no association between ODI and HOMA% B.

In addition, 20 participants (32.8%) in the OSA group and 22 (16.8%) in the non-OSA group had fasting glucose levels of 95 mg / dL or higher. REI and ODI were both associated with fasting glucose levels after fitting for the same covariates (B = 0.22; P. = 0.012 and B = 0.27; P. = 0.003 or).

Laura Sanapo

“Of a group of women without preginal diabetes, those diagnosed with SDS early in pregnancy have lower insulin sensitivity and higher fasting glucose levels compared to pregnant women without SDS,” said Sanapo.

The researchers controlled several factors that may contribute to abnormal glucose markers in pregnancy, such as the mother’s BMI, age, race, ethnicity, and the number of previous pregnancies.

Why the insights are important

Sanapo said these results are important for four reasons.

First, the development of diabetes is usually preceded by decreased insulin sensitivity. Second, the study demonstrated this association between SDS and reduced insulin sensitivity very early in pregnancy, about 10 weeks before typical screenings for gestational diabetes in the general pregnant population.

Third, Sanapo found that the normal range of insulin resistance during pregnancy is very narrow, so even slight changes related to the maternal SDS can result in abnormal values. Finally, SDS is a modifiable risk factor that can be managed by non-pharmacological interventions that are safe during pregnancy.

“Therefore, women who are overweight and obese can benefit from pre-conception or early pregnancy SDS screening to improve glucose metabolism and reduce the risk of developing diabetes during pregnancy,” said Sanapo.

These women can then benefit from tailored interventions to improve pregnancy outcomes, such as:

“Therefore, the ideal time to actually screen and intervene would be with women of childbearing potential who are considering pregnancy,” she said.

The researchers now want to better understand the mechanistic processes that link these disorders in order to identify therapeutic targets. They are also trying to determine whether screening should be universal or for select groups of high-risk pregnancies, or whether screening should be done before conception.

In addition, the researchers want to investigate whether SDS treatment can prevent the development of gestational diabetes or other adverse perinatal consequences.

“SDS is a common morbidity in high-risk pregnancies and has been linked to many conditions that are directly related or viewed as a major cause of maternal mortality,” said Sanapo. “Research in this area is needed and can have a profound impact on maternal health.”


For more informations:

Laura Sanapo, MD, MSHS, RDMS, reachable at

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