Sleep-Related Determinants of Gestational Diabetes

摘要 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。越来越多的证据 对一般人群的研究表明，睡眠呼吸障碍，睡眠时间短， 睡眠质量（包括慢波睡眠减少）与以下风险增加独立相关： 代谢综合征、2型糖尿病和胰岛素抵抗。对怀孕的初步研究发现， 这些问题之间类似的关系（自我报告的睡眠呼吸障碍和短 睡眠持续时间）和妊娠期糖尿病（GDM）。我们还发现，中度/重度睡眠 呼吸暂停和白天打盹都与怀孕期间的高血糖症有关。因此，睡眠 干扰可能构成GDM的一类新的可修改的危险因素。GDM与 不良母胎结局，也是2型糖尿病、心血管疾病和肥胖的预测因子 在母亲和孩子身上。 这项研究的目的是：（1）评估怀孕期间慢波睡眠的变化， 获得高级培训（K99阶段）和（2）调查睡眠障碍的独立关联 病例对照研究（R00期）。 在K99指导阶段，将使用档案多导睡眠图数据确定慢波睡眠变化 从怀孕初期和晚期的孕妇身上收集的数据。在这段时间里， 睡眠持续时间的评估和生物标志物的评估将建立在我以前的经验， 脑电图（EEG）分析和评估睡眠的行为和主观特性。 在R00阶段，将进行一项病例对照研究，以确定睡眠的独立关联 GDM患者140例，对照组280例（年龄1：2匹配， 种族、产次和体重指数（BMI））的数据。 宾夕法尼亚州（HUP）和宾夕法尼亚医院（PAH）。数据将从家庭收集 多导睡眠描记、睡眠日记、腕动描记和问卷调查。为了探索性目的，血清样本 在睡眠前和睡眠后将被收集。对病例状态和BMI不知情的技术人员将执行所有睡眠 得分。

ABSTRACT 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.