The Relationship and Potential Mechanistic Pathways Between Sleep Disturbances and Maternal Hyperglycemia

Abstract

This paper reviews recent work investigating the influence of sleep disturbances on maternal hyperglycemia, particularly gestational diabetes mellitus (GDM). The incidence and prevalence of hyperglycemia are increasing worldwide, which is cause for concern because GDM and even mild hyperglycemia are associated with adverse pregnancy outcomes. A better understanding of sleep-related risk factors for maternal hyperglycemia is an important health matter. Evidence demonstrates associations between sleep disturbances, especially sleep-disordered breathing, and hyperglycemia, but causal effects and the underlying mechanisms linking these conditions have not been fully elucidated. Subjective sleep assessments show associations between sleep disturbances and maternal hyperglycemia. There are, however, few studies using objective measures to support these findings. Large prospective studies are required to examine causal relationships between sleep disturbances and maternal hyperglycemia. There is also a need for smaller mechanistic studies to understand the pathophysiology. Furthermore, interventional studies are required to address whether improvement of sleep parameters can prevent/decrease the risk of developing maternal hyperglycemia. Taken together, the data suggests that sleep disturbances during pregnancy are important to identify and manage in order to minimize maternal hyperglycemia and GDM, and improve maternal and fetal well-being.

Sleep disturbance in people with diabetes: A concept analysis

“…Based on the current evidence, sleep disturbance in people with diabetes was most commonly described as impaired sleep quality that is characterised by difficulty in initiating or maintaining sleep (Chasens, Sereika, & Burke, ; Happe, Treptau, Ziegler, & Harms, ; Izci‐Balserak & Pien, ; Knutson, Van Cauter, Zee, Liu, & Lauderdale, ; Olsson et al., ; Reddy, Philpot, Ford, & Dunbar, ; Reutrakul & Van Cauter, ; Sridhar & Madhu, ; Sridhar & Putcha, ). For instance, Knutson et al.…”

A longitudinal study of sleep duration in pregnancy and subsequent risk of gestational diabetes: findings from a prospective, multiracial cohort

“…22 Additional proposed mechanisms are disruption of the hypothalamic-pituitary-adrenal axis, elevations in growth hormone and cortisol levels, and diminished glucose uptake in the brain. 3,23 The mechanisms by which prolonged sleep can adversely influence glucose tolerance are not well understood. One possibility is that excessive sleep allows for less time to be physically active.…”

“…24,25 Additionally, both prolonged and reduced sleep could contribute to insulin resistance in pregnancy by dysregulating appetite hormones such as leptin and ghrelin, which may ultimately disrupt energy homeostasis and cause weight gain. 3,23 Our study had several strengths. To our knowledge, this study is the first to longitudinally examine sleep patterns in pregnancy and investigate trimester-specific associations between sleep duration and subsequent GDM risk.…”

Sleep Fragmentation During Late Gestation Induces Metabolic Perturbations and Epigenetic Changes in Adiponectin Gene Expression in Male Adult Offspring Mice

“…During the third trimester of human pregnancy, the prevalence of habitual snoring and attendant sleep fragmentation (SF) has been estimated to affect 10–27% of pregnant women (15) and can impose significant increases in the risk for gestational diabetes and other complications (14,16). However, the long-term impact of sleep perturbations on metabolic function in the offspring has not been investigated.…”