Sleep-Related Determinants of Gestational Diabetes

描述（由申请人提供）：睡眠障碍在怀孕期间很常见。超过四分之一的孕妇会出现睡眠呼吸紊乱。许多孕妇的睡眠质量和连续性都很差。越来越多的普通人群研究证据表明，睡眠呼吸障碍、睡眠时间短和睡眠质量差（包括慢波睡眠减少）与代谢综合征、2型糖尿病和胰岛素抵抗风险增加独立相关。对妊娠期的初步研究发现，这些问题（自我报告的睡眠呼吸障碍和睡眠时间短）与妊娠期糖尿病（GDM）之间存在类似的关系。我们还发现，中度/重度睡眠呼吸暂停和白天小睡都与怀孕期间的高血糖症有关。因此，睡眠障碍可能是GDM的一类新的可改变的危险因素。妊娠期糖尿病与不良母胎结局相关，也是母亲和儿童2型糖尿病、心血管疾病和肥胖的预测因子。本研究的目的是（1）评估妊娠期间慢波睡眠的变化以及获得高级训练（K99阶段）和（2）在病例对照研究（R 00阶段）中调查睡眠障碍和特征与妊娠期糖尿病的独立关联。在K99指导阶段，将使用从怀孕妇女的第一个和第三个三个月收集的档案多导睡眠图数据来确定慢波睡眠变化。在此期间，睡眠持续时间的活动记录评估和生物标志物评估的培训将建立在我之前的脑电图（EEG）分析和睡眠行为和主观属性评估的经验基础上。在R 00阶段，将进行病例对照研究，以确定睡眠障碍和睡眠特征与GDM的独立关联，从宾夕法尼亚大学医院（HUP）和宾夕法尼亚医院（PAH）的产科服务中招募140例病例和280例对照（年龄、种族、产次和体重指数（BMI）1：2匹配）。将从家庭多导睡眠图、睡眠日记、腕动记录和问卷调查中收集数据。为了探索性目的，将采集睡眠前后的血清样本。对病例状态和BMI不知情的技术人员将进行所有睡眠评分。

DESCRIPTION (provided by applicant): Sleep disturbances are common during pregnancy. Over a quarter of pregnant women develop sleep- disordered breathing. Many pregnant women experience poor sleep quality and continuity. Growing evidence from studies of the general population shows that sleep-disordered breathing, short sleep duration and poor sleep quality (including reduced slow wave sleep) are independently associated with increased risk of metabolic syndrome, type 2 diabetes and insulin resistance. Preliminary studies in pregnancy have found a similar, analogous relationship between these problems (self-reported sleep-disordered breathing and short sleep duration) and gestational diabetes mellitus (GDM). We have also found that a moderate/severe sleep apnea and daytime napping are both associated with hyperglycemia during pregnancy. Thus, sleep disturbances may constitute a class of novel MODIFIABLE risk factors for GDM. GDM is associated with adverse maternal-fetal outcomes and is also a predictor of type 2 diabetes, cardiovascular disease and obesity in both mother and child. The aims of the proposed study are (1) to evaluate changes in slow wave sleep during pregnancy as well as obtain advanced training (K99 phase) and (2) to investigate the independent association of sleep disturbances and characteristics with gestational diabetes in a case-control study (R00 phase). In the K99 mentored phase, slow wave sleep changes will be determined using archival polysomnography data gathered from pregnant women in their first and third trimesters. During this time, training in actigraphic evaluation of sleep duration and assessment of biomarkers will build upon my prior experience with electroencephalography (EEG) analysis and assessment of behavioral and subjective properties of sleep. In the R00 phase, a case-control study will be conducted to determine the independent association of sleep disturbances and sleep characteristics with GDM, recruiting 140 cases and 280 controls (1:2 match for age, race, parity and body mass index (BMI)) from the obstetrics services at the Hospital of the University of Pennsylvania (HUP) and at the Pennsylvania Hospital (PAH). Data will be collected from home-based polysomnography, sleep diary, wrist actigraphy and questionnaires. For the exploratory aim, serum samples before and after sleep will be collected. A technician blinded to case status and BMI will perform all sleep scoring.