COBRE-DIABETES

项目总结/摘要 心血管疾病（CVD）是美国女性死亡的主要原因， 妊娠，包括妊娠期糖尿病（GDM），与心血管疾病和2型糖尿病的风险相关 (DM)在以后的生活中糖尿病女性患心血管疾病的风险增加，有GDM病史的女性患心血管疾病的风险增加7倍。 与血糖正常的妊娠妇女相比，产后糖尿病风险更高。一个日益 GDM和DM的重要危险因素是睡眠不足，女性似乎更容易受到影响。 睡眠不足对心脏代谢风险和死亡率的影响。怀孕和产后提供了一个窗口， 有机会减轻不同种族/民族背景的高风险女性的DM 1风险。睡眠不足是 通常在怀孕期间报告，约50%有GDM病史的妇女发展为DM， 对产后睡眠不足和血糖水平知之甚少。此外，睡眠不足和 糖尿病和心血管疾病的相关风险对少数种族/民族的影响不平等。 我们的长期目标是确定和传播以证据为基础的、对文化敏感的干预措施， 减少妇女在怀孕期间和产后的睡眠不足，从而降低2型糖尿病的风险。 本研究的目的是了解睡眠不足和血糖水平之间的关系 有GDM病史的女性我们提出了一项研究，200名妇女与GDM的历史，在A甜 选择（ASC）计划，一个在檀香山Kapi`olani医疗中心建立的门诊糖尿病计划， Hawai`i于1995年启动，招募了10 000多名患有GDM和/或先前存在DM的多种族妇女。 我们将评估睡眠不足-睡眠持续时间，睡眠质量，失眠严重程度和早晚睡眠 choronotype使用验证的评估工具。 我们的第一个目标是描述导致人群中睡眠不足风险的潜在因素 来自不同种族/民族背景的产后妇女，既往有GDM病史。我们将进行 通过从ASC方案中招募妇女，共设立4-8个重点小组，每个重点小组有5-10名参与者 在产后6 - 12个月。我们的目标是更深入地了解妇女的观点， 既往妊娠合并GDM对妊娠期及产后睡眠不足的影响。我们的第二个目标 是研究睡眠不足和血糖状态之间的关系， 有GDM病史的种族/民族背景。将在150名女性中评估睡眠不足和HbA 1c 在产后6 - 12个月从ASC项目中恢复。睡眠不足将使用匹兹堡 睡眠质量指数（PSQI）、失眠严重程度指数和早晚时钟类型评估，以及 使用HbA 1c家庭检测试剂盒检测血糖状态。睡眠不足与血糖水平之间的关系 将使用血糖状态的线性回归对睡眠不足的每种测量进行估计，并作为 复合睡眠不足评分，调整混杂因素。

PROJECT SUMMARY/ABSTRACT Cardiovascular disease (CVD) is the leading cause of death in women in the U.S, and complications during pregnancy, including gestational diabetes (GDM), are associated with risk of CVD and type 2 diabetes mellitus (DM) later in life. Women with DM have increased risk of CVD, and women with a history of GDM have 7 times higher risk for DM post-delivery compared with women who had a normoglycemic pregnancy. An increasingly important risk factor for GDM and DM is sleep deficiency, and women appear to be more vulnerable to the effects of sleep deficiency on cardiometabolic risk and mortality. Pregnancy and postpartum offer a window of opportunity to mitigate DM1 risk in high risk women of diverse racial/ethnic background. Sleep deficiencies are commonly reported during pregnancy and about 50% of women with history of GDM develop DM, however little is known about sleep deficiency and glycemic status at postpartum. Furthermore, sleep deficiencies and associated risk of diabetes and CVD unequally affect racial/ethnic minorities. Our long-term goal is to identify and disseminate evidence-based, culturally sensitive interventions to reduce sleep deficiencies in women during pregnancy and postpartum, and thus reduce the risk of type 2 DM. The objectives of this study are to understand the association between sleep deficiencies and glycemic status in women with a history of GDM. We propose a study with 200 women with history of GDM in the A Sweeter Choice (ASC) program, an established outpatient diabetes program at Kapi`olani Medical Center, Honolulu, Hawai`i, started in 1995 that has recruited over 10,000 multi-ethnic women with GDM and/or preexisting DM. We will assess sleep deficiency - sleep duration, sleep quality, insomnia severity, and morning-evening sleep choronotype using validated assessment tools. Our first aim is to describe the underlying factors contributing to risk for sleep deficiency in a population of postpartum women from diverse race/ethnic backgrounds with a prior history of GDM. We will conduct a total of 4-8 focus groups with 5-10 participants in each focus group by recruiting women from the ASC program at 6 – 12 months postpartum. Our goal is to gain a deeper understanding of the perspectives of women with a prior pregnancy complicated by GDM on sleep deficiency during pregnancy and postpartum. Our second aim is to examine the association of sleep deficiencies and glycemic status in a population of women from diverse race/ethnic backgrounds with a history of GDM. Sleep deficiencies and HbA1c will be evaluated in 150 women from the ASC program at 6 – 12 months postpartum. Sleep deficiencies will be assessed using the Pittsburgh Sleep Quality Index (PSQI), insomnia severity index, and the morning-evening chronotype assessment, and glycemic status using an HbA1c home test kit. The association between sleep deficiencies and glycemic status will be estimated using linear regression of glycemic status on each measure of sleep deficiency and as a composite sleep deficiency score, adjusted for confounders.