Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes.
Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes.
复制标题
客观地测量的短睡眠时间和后来的妊娠睡眠中点与妊娠糖尿病的风险更高有关。
DOI：
10.1016/j.ajog.2017.05.066
复制
发表时间：
2017-10
影响因子：
9.8
通讯作者：
Zee PC
中科院分区：
文献类型：
--
作者：
Facco FL;Grobman WA;Reid KJ;Parker CB;Hunter SM;Silver RM;Basner RC;Saade GR;Pien GW;Manchanda S;Louis JM;Nhan-Chang CL;Chung JH;Wing DA;Simhan HN;Haas DM;Iams J;Parry S;Zee PC
实验和流行病学数据表明，在未怀孕的成年人中，睡眠时间可能是慢性疾病的重要风险因素。虽然孕妇经常抱怨睡眠不好，但很少有研究客观地评估怀孕期间的睡眠质量，或探讨睡眠障碍与孕产妇和围产期结局之间的关系。我们的目的是研究客观评估的睡眠时间，时间和连续性（通过腕关节活动记录仪测量）和孕产妇心血管疾病和代谢疾病之间的关系。这是一项针对未经产女性的前瞻性队列研究。妇女在妊娠16 0/7和21 6/7周之间被招募。他们被要求戴上腕动监测仪，并在七天的召唤期内完成每日睡眠记录。主要睡眠暴露变量是总有效夜晚（最少5个夜晚，最多7个夜晚）的以下各项的平均值：主要睡眠期间的短睡眠持续时间（< 7小时/夜晚）、晚睡眠中点（睡眠开始和睡眠偏移之间的中点> 5 AM）、以及睡眠开始后的觉醒时间分钟数（WASO）和睡眠碎片指数的前四分位数。关注的主要结局是妊娠期高血压疾病（轻度、重度或叠加先兆子痫;子痫;或产前妊娠高血压）和妊娠期糖尿病（GDM）的复合结局。卡方检验用于评估睡眠变量和分类基线特征之间的关联。粗比值比和95%的置信区间估计单变量logistic回归模型，以描述睡眠特征和妊娠期高血压疾病和GDM之间的关系的大小。对于在单变量分析中显著的关联，使用多元逻辑回归来进一步探索睡眠特征与妊娠结局的关联。901名符合条件的妇女同意参加。其中782名女性提交了有效的腕动记录研究。睡眠时间短和睡眠中点晚与GDM风险增加相关（OR 2.24，95%CI 1.11，4.53; OR 2.58，95%CI 1.24，5.36），但与高血压疾病风险无关。一个包含睡眠持续时间和睡眠中点及其相互作用项的模型显示，虽然这些暴露之间没有显著的相互作用，但睡眠持续时间短和睡眠中点晚对GDM的主要影响仍然显著（aOR 2.06，95% CI 1.01，4.19; aOR 2.37，95% CI 1.13，4.97）。此外，在分别调整年龄，BMI和种族/民族后，短睡眠时间和较晚的睡眠中点仍然与GDM相关。睡眠质量指标（WASO，睡眠片段）与高血压疾病或GDM之间没有相关性。我们的研究结果表明，睡眠时间短，晚睡眠中点与GDM之间的关系。我们的数据表明，这两个睡眠特征的独立贡献的风险GDM的未经产妇。客观测量的短睡眠时间和晚睡眠时间都与妊娠糖尿病的发展有关。
Experimental and epidemiologic data suggest that among non-pregnant adults, sleep duration may be an important risk factor for chronic disease. Although pregnant women commonly complain of poor sleep, few studies have objectively evaluated the quality of sleep in pregnancy or have explored the relationship between sleep disturbances and maternal and perinatal outcomes. Our objective was to examine the relationship between objectively assessed sleep duration, timing and continuity (measured via wrist actigraphy) and maternal cardiovascular and metabolic morbidity specific to pregnancy. This was a prospective cohort study of nulliparous women. Women were recruited between 16 0/7 and 21 6/7 weeks’ gestation. They were asked to wear a wrist actigraphy monitor and to complete a daily sleep log for a seven consecutive-day period. The primary sleep exposure variables were the averages of the following over the total valid nights (minimum 5, maximum 7 nights): short sleep duration during the primary sleep period (< 7 hours/night), late sleep midpoint (midpoint between sleep onset and sleep offset > 5 AM), and top quartile of minutes of wake time after sleep onset (WASO) and sleep fragmentation index. The primary outcomes of interest were a composite of hypertensive disorders of pregnancy (mild, severe, or superimposed preeclampsia; eclampsia; or antepartum gestational hypertension) and gestational diabetes (GDM). Chi-square tests were used to assess associations between sleep variables and categorical baseline characteristics. Crude odds ratios and 95% confidence intervals were estimated from univariate logistic regression models to characterize the magnitude of the relationship between sleep characteristics and hypertensive disorders of pregnancy and GDM. For associations that were significant in univariate analysis, multiple logistic regression was used to explore further the association of sleep characteristics with pregnancy outcomes. Nine-hundred and one eligible women consented to participate. Of these women 782 submitted valid actigraphy studies. Short sleep duration and a later sleep midpoint were associated with an increased risk of GDM (OR 2.24, 95% CI 1.11, 4.53; OR 2.58, 95% CI 1.24, 5.36, respectively) but not of hypertensive disorders. A model with both sleep duration and sleep midpoint as well as their interaction term revealed that while there was no significant interaction between these exposures, the main effects of both short sleep duration and later sleep midpoint with GDM remained significant (aOR 2.06, 95% CI 1.01, 4.19; aOR 2.37, 95% CI 1.13, 4.97, respectively). Additionally, after adjusting separately for age, BMI and race/ethnicity, both short sleep duration and later sleep midpoint remained associated with GDM. No associations were demonstrated between the sleep quality measures (WASO, sleep fragmentation) and hypertensive disorders or GDM. Our results demonstrate a relationship between short sleep duration and later sleep midpoint with GDM. Our data suggest independent contributions of these two sleep characteristics to the risk for GDM in nulliparous women. Both objectively measured short sleep duration and later sleep timing are associated with development of gestational diabetes.
登录
查看更多内容
影响因子：
9.1
作者：
Mullington, Janet M.;Haack, Monika;Toth, Maria;Serrador, Jorge A.;Meier-Ewert, Hans K.
通讯作者：
Meier-Ewert, Hans K.
影响因子：
9.8
作者：
Haas, David M.;Parker, Corette B.;Wing, Deborah A.;Parry, Samuel;Grobman, William A.;Mercer, Brian M.;Simhan, Hyagriv N.;Hoffman, Matthew K.;Silver, Robert M.;Wadhwa, Pathik;Iams, Jay D.;Koch, Matthew A.;Caritis, Steve N.;Wapner, Ronald J.;Esplin, Sean;Elovitz, Michal A.;Foroud, Tatiana;Peaceman, Alan M.;Saade, George R.;Willinger, Marian;Reddy, Uma M.
通讯作者：
Reddy, Uma M.
影响因子：
16.2
作者：
Cappuccio FP;D'Elia L;Strazzullo P;Miller MA
通讯作者：
Miller MA
影响因子：
7.2
作者：
Facco, Francesca L.;Kramer, Jamie;Grobman, William A.
通讯作者：
Grobman, William A.
影响因子：
120.7
作者：
King, Christopher Ryan;Knutson, Kristen L.;Rathouz, Paul J.;Sidney, Steve;Liu, Kiang;Lauderdale, Diane S.
通讯作者：
Lauderdale, Diane S.