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"Rationale: Maternal sleep-disordered breathing (SDB) in pregnancy is associated with an increased risk of gestational diabetes (GDM). However, it is unknown whether SDB severity is associated with poor glycemic control in GDM. Secondly, it is not clear whether continuous positive airway pressure (CPAP), the mainstay of treatment in the general population, is feasible in pregnant women with GDM.Objectives: The first two objectives of this thesis were to determine the association between SDB severity and glucose control using continuous glucose monitoring (CGM) over a 72-hour period among women with GDM. Specifically, the relationships between SDB severity and: 1) daytime, nighttime and mean 24-hour glucose levels (Objective 1) and 2) glucose variability (Objective 2) were assessed. Objective 3 determined the objective adherence to CPAP treatment in pregnant women with GDM. Methods: To achieve objectives 1 and 2, we used a cross-sectional study design including pregnant women with GDM. Participants underwent a one-night, level two home sleep recording and 72-hour CGM. For Objective 1, linear mixed models were used to estimate the association of the apnea-hypopnea index (AHI) with 1) daytime (8am to 9pm), 2) nighttime (11pm-3am; 3am-6am) and 3) mean 24-hour glucose levels. For Objective 2, glucose variability was assessed by the mean amplitude of glucose excursion (MAGE) and the standard deviation of glucose using 24-hour glucose data. For Objective 3, a randomized-controlled study was performed in which pregnant women with GDM were randomized to auto-CPAP (experimental group) or nasal dilator strips (control group) for the remainder of pregnancy. Nightly mean CPAP adherence was objectively measured over the entire treatment period.Measurements and Main Results: Among 65 participants that were included in the cross-sectional analysis (Objectives 1 and 2), the women were 35±5 (mean±SD) years of age with body mass index (BMI) at enrolment of 33±7 kg/m2 and 31% were taking insulin and/or metformin for management of their GDM. The mean AHI was 16±11 events/hour. While there were no associations between AHI and daytime or mean 24-hour glucose levels (8am-9pm Beta: 0.08 mmol/L 95% CI: -0.06, 0.23; 24 hour Beta: 0.05 mmol/L 95% CI: -0.1, 0.21), increasing AHI (by an increase of 10 events/hour) was associated with elevated nighttime glucose levels, even when adjusted for BMI and medications (11pm-3am Beta: 0.20 mmol/L (95% CI: 0.04, 0.40)) which, persisted into the morning (8am Beta:0.26 mmol/L 95% CI: 0.08, 0.4)). For Objective 2, there were no significant associations between SDB and glucose variability. In Objective 3, forty-six participants were diagnosed with SDB. Of those, 22 participants (48%) were randomized to CPAP treatment with the following demographics (mean±SD): 36 ± 5 years of age, BMI of 35 ± 7 kg/m2, AHI of 19 ± 9 events/hour and 30 ± 3 weeks gestation at enrolment. Seven participants assigned to CPAP (32%) demonstrated objective adherence of ≥4 hours per night for at least 70% of nights. The average usage for all days during the treatment period was 3 hours and 48 minutes. The average treatment duration period was 37 ± 17 days. Conclusions: SDB is associated with higher nocturnal and early morning glucose levels in women with GDM, even after adjusting for BMI and medications. While some pregnant participants were adherent to CPAP, more than half of participants with GDM had difficulty tolerating CPAP treatment. Further studies are needed to better understand factors impacting CPAP adherence in the pregnant population"--
Maternal Sleep-disordered Breathing in Pregnancy Increases Nocturnal Glucose Levels in Women with Gestational Diabetes
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