Systemic inflammation and sympathetic activation in gestational diabetes mellitus with obstructive sleep apnea

Abstract

Background Although some evidence suggests an association between obstructive sleep apnea (OSA) and gestational diabetes mellitus (GDM), its consequences still remain largely unknown. We sought to determine whether OSA is associated with higher inflammation and sympathetic levels in GDM, and to relate them with insulin resistance and perinatal outcomes. Methods OSA was identified by polysomnography and defined as an apnea–hypopnea index of ≥ 5 h−1. Plasma cytokines (TNF-α, IL-1β, IL-6, IL-8, IL-10), metanephrine, and normetanephrine were determined by immunoassays. Results We included 17 patients with GDM and OSA and 34 without OSA. Women with GDM and OSA had higher normetanephrine concentrations [81 IQR (59–134) vs. 68 (51–81) pg/mL]. No differences in the inflammatory profile were found, while IL-1β was higher in patients with mean nocturnal oxyhemoglobin saturation ≤ 94%. We found positive correlations between increased sympathetic activation and IL-1β, with obstructive apneas, while time in REM showed an inverse relationship with IL-1β and metanephrine. Furthermore, IL-10 was inversely related with time in sleep stages 1–2, and with the arousal index, and it was positively related with time in slow-wave sleep. Significant correlations were also found between IL-1β and insulin resistance. There were no significant differences in neonatal characteristics; however, we found inverse relationships between IL-10 and birth weight (BW), and percentile of BW. Conclusions OSA increased sympathetic activity, and IL-1β concentration was higher in patients with GDM with lower nocturnal oxygenation, all of which were related with obstructive events, and time in REM. Moreover, IL-1β was related with insulin resistance, and IL-10 inversely correlated with neonatal BW.

Interleukin-10 is not associated with obstructive sleep apnea hypopnea syndrome: A meta-analysis and meta-regression

“…The remaining 49 articles were screened, and 18 articles were excluded for various reasons, such as lack of a control group, lack of data, studies published in languages other than English or Chinese, unclear measurement units, case reports, and reviews. Finally, 25 papers [11,12,23–45] comprising 31 studies were included in the current meta-analysis, as showed in Figure 1.…”

“…These studies were published from 2002 to 2022. Among these studies, 11 studies [11,[24][25][26]29,30,32,36,[41][42][43][44][45] reported the relationship between plasma IL-10 levels and OSAHS, A study reported differences in IL-10 levels in tonsil tissue between OSAHS patients and non-OSHAS patient, [22] and 19 studies [12,23,27,28,31,[33][34][35][37][38][39][40] reported the relationship between the serum IL-10 levels and OSA. The determination methods of IL-10 varied across the studies; however, most of them use enzyme-linked immunosorbent assay (ELISA).…”

Increased susceptibility to new-onset atrial fibrillation in diabetic women with poor sleep behaviour traits: findings from the prospective cohort study in the UK Biobank

“…Currently, there is still relatively limited studies on the relationship between different OSA phenotypes and cardiovascular complications. A study by Al Oweidat K et al found that rapid eye movement OSA was more common in patients with type 2 diabetes, and was associated with factors related to insulin resistance such as sympathetic nerve activity and increased IL-1b [ 47 , 48 ]. Accurately identifying the different phenotypes of OSA is crucial for clinicians, which helps them to develop more precise and effective treatment plans for their patients, thus reducing the negative impact on cardiac structure and myocardium [ 48 ].…”

The Role of Inflammation, Hypoxia, and Opioid Receptor Expression in Pain Modulation in Patients Suffering from Obstructive Sleep Apnea

“…A decreased baroreflex sensitivity may be provoked by repetitive blood pressure surges during sleep and increased SNS activation [ 74 , 75 ]. Some authors have proven that increased SNS activation leads to elevated interleukin concentrations in OSA patients [ 76 ] ( Figure 2 ).…”