Poor sleep quality is associated with impaired glucose tolerance in women after gestational diabetes

https://doi.org/10.1016/j.jpsychires.2015.02.012Get rights and content

Highlights

  • A sleep deficit in new mothers is a universal problem in women after GDM who are already predisposed to diabetes.

  • We found that reduced sleep quality had detrimental effects on glucose metabolism in women after GDM.

  • Impaired sleep was also associated with a higher level of perceived stress in women during the first year after birth.

  • These findings suggest sleep quality and stress management as additional targets for diabetes prevention in women after GDM.

Abstract

We analyzed the association of sleep quality and glucose metabolism in women after gestational diabetes (pGDM) and in women after normoglycemic pregnancy (controls). Data during pregnancy and a visit within the first 15 months after delivery were collected from 61 pGDM and 30 controls in a prospective cohort study. This included a medical history, physical examination, questionnaires (Pittsburgh Sleep Quality Index (PSQI), and Perceived Stress Scale (PSS)), and 5-point oral glucose tolerance test with insulin measurements to determine indices of insulin sensitivity and insulin secretion. We used Spearman correlation coefficients and multivariate regression models for analysis.9.3 ± 3.2 months after delivery, pGDM had significantly higher fasting and 2 h glucose levels and lower insulin sensitivity than controls. There was no significant difference in age, BMI and sleep quality as assessed with the PSQI between the two groups. The PSQI score correlated with the ogtt-2 h plasma glucose in pGDM (δ = 0.41; p = 0.0012), but not in controls. This association was confirmed with a multivariate linear regression model with adjustment for age, BMI and months post-delivery. Perceived stress was an independent risk factor (OR 1.12; 95% CI 1.02–1.23) for impaired sleep. Our findings suggest that post-delivery sleep quality significantly influences glucose tolerance in women after GDM and that impaired sleep is associated with increased stress perception. Measures to improve of sleep quality and reduce perceived stress should therefore be tested as additional strategies to prevent progression to type 2 diabetes after GDM.

Introduction

In epidemiologic studies, sleep disturbances are associated with several metabolic and vascular diseases, e.g. a modestly increased risk of coronary heart disease in women Ayas et al. (2003) and a higher prevalence of obesity and type 2 diabetes mellitus (Type 2 DM) in the general population (Knutson and Van Cauter, 2008). Experimental disruption of sleep in humans rapidly leads to an impairment of glucose tolerance via increased insulin resistance (Meisinger et al., 2005, Knutson and Van Cauter, 2008, Spiegel, 2008, Tasali et al., 2008, Buxton et al., 2010, Knutson, 2012, Morselli et al., 2012).

Pregnancy and the postpartum period are times during which most women experience an impaired sleep quality, both with respect to sleep duration and sleep interruptions (Mindell and Jacobson, 2000).

Women with GDM represent a high-risk group for the development of Type 2 DM. The overall risk of Type 2 DM after a pregnancy complicated by GDM is increased 7.4-fold compared to women after a normoglycemic pregnancy (Reutrakul et al., 2011). A BMI of 30 kg/m2 or more, gestational age at diagnosis of GDM of less than 24 weeks, an antenatal 1 h plasma glucose level of over 200 mg/dl and a requirement for insulin therapy have been identified as risk factors for early progression to after GDM (Kim et al., 2002).

Given the association of sleep and glucose metabolism and the very common state of ‘sleep deprivation’ in new mothers, we wanted to test whether impaired sleep is associated with poor post-partum glucose metabolism in women after GDM. Findings in this high-risk group were compared to a control group of women after a normoglycemic pregnancy. In addition, we tried to identify risk factors for a poor sleep quality in the post-GDM cohort.

Section snippets

Study population

Data were derived from the PPS-Diab (“Prediction, Prevention and Sub-classification of Type 2 Diabetes”) study. This is a prospective, mono-center observational study, which started recruitment in November 2011. The study population consisted of women who had gestational diabetes (pGDM) during their last pregnancy and women after normoglycemic pregnancy as controls in a 2:1 ratio. The cohorts were recruited consecutively from the Diabetes Center and the obstetrics department of the Klinikum der

Baseline characteristics

109 women were included in the study between November 1, 2011 and May 31, 2013. No information from the PSQI questionnaire was documented for 18 participants; hence, those were excluded from further analysis. The final sample consisted of 91 women, thereof 61 after GDM and 30 after normoglycemic pregnancy.

Significant differences between post-GDM patients and controls were found for fasting plasma glucose, 2 h plasma glucose in the OGTT, the Matsuda insulin sensitivity index and the systolic

Conclusion

The main findings of this study are patients with a history of GDM still show significantly impaired glucose sensitivity compared to controls, which significantly correlates with sleep quality respectively sleep duration. Within the GDM group sleep duration was significantly decreased in patients with impaired insulin sensitivity. Sleep quality measured by PSQI is again strongly associated to subjective stress perception and not to factors like time since delivery and the older siblings in the

Funding sources

This work was funded by the Helmholtz Zentrum München, Deutsches Zentrum für Diabetesforschung and Klinikum der Universität München [German Center for Diabetes Research and the University Clinic, Munich].

Author contributions

AL, JS, KGP, UF, SK, MI and HK contributed to the study conception and design. KT, MF, FB, MW, UF, UH and SH recruited study participants and collected data. Data extraction and statistical analyses were carried out by MR and DK. HK and UF wrote the first draft of the manuscript and all authors contributed with critical comments to the final version. All authors have seen and approved the final version. AL is the guarantor of this work and, as such, had full access to all the data in the study

Conflicts of interests

None.

Acknowledgments

We are grateful to all study participants without whom our work would not be possible. We also thank Sarah Michel for language editing of this manuscript. This work was funded by the Helmholtz Zentrum München, Deutsches Zentrum für Diabetesforschung and Klinikum der Universität München [German Center for Diabetes Research and the University Clinic, Munich].

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    These authors contributed equally to this work.

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