Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes

Francesca L. Facco, William A. Grobman, Kathryn J. Reid, Corette B. Parker, Shannon M. Hunter, Robert M. Silver, Robert C. Basner, George Saade, Grace W. Pien, Shalini Manchanda, Judette M. Louis, Chia Ling Nhan-Chang, Judith H. Chung, Deborah A. Wing, Hyagriv N. Simhan, David M. Haas, Jay Iams, Samuel Parry, Phyllis C. Zee

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background Experimental and epidemiologic data suggest that among nonpregnant adults, sleep duration may be an important risk factor for chronic disease. Although pregnant women commonly report poor sleep, few studies objectively evaluated the quality of sleep in pregnancy or explored the relationship between sleep disturbances and maternal and perinatal outcomes. Objective Our objective was to examine the relationship between objectively assessed sleep duration, timing, and continuity (measured via wrist actigraphy) and maternal cardiovascular and metabolic morbidity specific to pregnancy. Study Design This was a prospective cohort study of nulliparous women. Women were recruited between 16 0/7 and 21 6/7 weeks’ gestation. They were asked to wear a wrist actigraphy monitor and complete a daily sleep log for a period of 7 consecutive days. The primary sleep exposure variables were the averages of the following over the total valid nights (minimum 5, maximum 7 nights): short sleep duration during the primary sleep period (<7 h/night), late sleep midpoint (midpoint between sleep onset and sleep offset >5 AM), and top quartile of minutes of wake time after sleep onset and sleep fragmentation index. The primary outcomes of interest were a composite of hypertensive disorders of pregnancy (mild, severe, or superimposed preeclampsia; eclampsia; or antepartum gestational hypertension) and gestational diabetes mellitus. We used χ2 tests to assess associations between sleep variables and categorical baseline characteristics. Crude odds ratios and 95% confidence intervals were estimated from univariate logistic regression models to characterize the magnitude of the relationship between sleep characteristics and hypertensive disorders of pregnancy and gestational diabetes. For associations significant in univariate analysis, multiple logistic regression was used to explore further the association of sleep characteristics with pregnancy outcomes. Results In all, 901 eligible women consented to participate; 782 submitted valid actigraphy studies. Short sleep duration and a later sleep midpoint were associated with an increased risk of gestational diabetes (odds ratio, 2.24; 95% confidence interval, 1.11–4.53; and odds ratio, 2.58; 95% confidence interval, 1.24–5.36, respectively) but not of hypertensive disorders. A model with both sleep duration and sleep midpoint as well as their interaction term revealed that while there was no significant interaction between these exposures, the main effects of both short sleep duration and later sleep midpoint with gestational diabetes remained significant (adjusted odds ratio, 2.06; 95% confidence interval, 1.01–4.19; and adjusted odds ratio, 2.37; 95% confidence interval, 1.13–4.97, respectively). Additionally, after adjusting separately for age, body mass index, and race/ethnicity, both short sleep duration and later sleep midpoint remained associated with gestational diabetes. No associations were demonstrated between the sleep quality measures (wake after sleep onset, sleep fragmentation) and hypertensive disorders or gestational diabetes. Conclusion Our results demonstrate a relationship between short sleep duration and later sleep midpoint with gestational diabetes. Our data suggest independent contributions of these 2 sleep characteristics to the risk for gestational diabetes in nulliparous women.

Original languageEnglish (US)
Pages (from-to)447.e1-447.e13
JournalAmerican Journal of Obstetrics and Gynecology
Volume217
Issue number4
DOIs
StatePublished - Oct 1 2017

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Gestational Diabetes
Sleep
Pregnancy
Actigraphy
Odds Ratio
Confidence Intervals
Sleep Deprivation
Logistic Models
Wrist

Keywords

  • actigraphy
  • gestational diabetes
  • hypertension
  • pregnancy outcomes
  • sleep duration
  • sleep midpoint
  • sleep quality

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes. / Facco, Francesca L.; Grobman, William A.; Reid, Kathryn J.; Parker, Corette B.; Hunter, Shannon M.; Silver, Robert M.; Basner, Robert C.; Saade, George; Pien, Grace W.; Manchanda, Shalini; Louis, Judette M.; Nhan-Chang, Chia Ling; Chung, Judith H.; Wing, Deborah A.; Simhan, Hyagriv N.; Haas, David M.; Iams, Jay; Parry, Samuel; Zee, Phyllis C.

In: American Journal of Obstetrics and Gynecology, Vol. 217, No. 4, 01.10.2017, p. 447.e1-447.e13.

Research output: Contribution to journalArticle

Facco, FL, Grobman, WA, Reid, KJ, Parker, CB, Hunter, SM, Silver, RM, Basner, RC, Saade, G, Pien, GW, Manchanda, S, Louis, JM, Nhan-Chang, CL, Chung, JH, Wing, DA, Simhan, HN, Haas, DM, Iams, J, Parry, S & Zee, PC 2017, 'Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes', American Journal of Obstetrics and Gynecology, vol. 217, no. 4, pp. 447.e1-447.e13. https://doi.org/10.1016/j.ajog.2017.05.066
Facco, Francesca L. ; Grobman, William A. ; Reid, Kathryn J. ; Parker, Corette B. ; Hunter, Shannon M. ; Silver, Robert M. ; Basner, Robert C. ; Saade, George ; Pien, Grace W. ; Manchanda, Shalini ; Louis, Judette M. ; Nhan-Chang, Chia Ling ; Chung, Judith H. ; Wing, Deborah A. ; Simhan, Hyagriv N. ; Haas, David M. ; Iams, Jay ; Parry, Samuel ; Zee, Phyllis C. / Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes. In: American Journal of Obstetrics and Gynecology. 2017 ; Vol. 217, No. 4. pp. 447.e1-447.e13.
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abstract = "Background Experimental and epidemiologic data suggest that among nonpregnant adults, sleep duration may be an important risk factor for chronic disease. Although pregnant women commonly report poor sleep, few studies objectively evaluated the quality of sleep in pregnancy or explored the relationship between sleep disturbances and maternal and perinatal outcomes. Objective Our objective was to examine the relationship between objectively assessed sleep duration, timing, and continuity (measured via wrist actigraphy) and maternal cardiovascular and metabolic morbidity specific to pregnancy. Study Design This was a prospective cohort study of nulliparous women. Women were recruited between 16 0/7 and 21 6/7 weeks’ gestation. They were asked to wear a wrist actigraphy monitor and complete a daily sleep log for a period of 7 consecutive days. The primary sleep exposure variables were the averages of the following over the total valid nights (minimum 5, maximum 7 nights): short sleep duration during the primary sleep period (<7 h/night), late sleep midpoint (midpoint between sleep onset and sleep offset >5 AM), and top quartile of minutes of wake time after sleep onset and sleep fragmentation index. The primary outcomes of interest were a composite of hypertensive disorders of pregnancy (mild, severe, or superimposed preeclampsia; eclampsia; or antepartum gestational hypertension) and gestational diabetes mellitus. We used χ2 tests to assess associations between sleep variables and categorical baseline characteristics. Crude odds ratios and 95{\%} confidence intervals were estimated from univariate logistic regression models to characterize the magnitude of the relationship between sleep characteristics and hypertensive disorders of pregnancy and gestational diabetes. For associations significant in univariate analysis, multiple logistic regression was used to explore further the association of sleep characteristics with pregnancy outcomes. Results In all, 901 eligible women consented to participate; 782 submitted valid actigraphy studies. Short sleep duration and a later sleep midpoint were associated with an increased risk of gestational diabetes (odds ratio, 2.24; 95{\%} confidence interval, 1.11–4.53; and odds ratio, 2.58; 95{\%} confidence interval, 1.24–5.36, respectively) but not of hypertensive disorders. A model with both sleep duration and sleep midpoint as well as their interaction term revealed that while there was no significant interaction between these exposures, the main effects of both short sleep duration and later sleep midpoint with gestational diabetes remained significant (adjusted odds ratio, 2.06; 95{\%} confidence interval, 1.01–4.19; and adjusted odds ratio, 2.37; 95{\%} confidence interval, 1.13–4.97, respectively). Additionally, after adjusting separately for age, body mass index, and race/ethnicity, both short sleep duration and later sleep midpoint remained associated with gestational diabetes. No associations were demonstrated between the sleep quality measures (wake after sleep onset, sleep fragmentation) and hypertensive disorders or gestational diabetes. Conclusion Our results demonstrate a relationship between short sleep duration and later sleep midpoint with gestational diabetes. Our data suggest independent contributions of these 2 sleep characteristics to the risk for gestational diabetes in nulliparous women.",
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T1 - Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes

AU - Facco, Francesca L.

AU - Grobman, William A.

AU - Reid, Kathryn J.

AU - Parker, Corette B.

AU - Hunter, Shannon M.

AU - Silver, Robert M.

AU - Basner, Robert C.

AU - Saade, George

AU - Pien, Grace W.

AU - Manchanda, Shalini

AU - Louis, Judette M.

AU - Nhan-Chang, Chia Ling

AU - Chung, Judith H.

AU - Wing, Deborah A.

AU - Simhan, Hyagriv N.

AU - Haas, David M.

AU - Iams, Jay

AU - Parry, Samuel

AU - Zee, Phyllis C.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background Experimental and epidemiologic data suggest that among nonpregnant adults, sleep duration may be an important risk factor for chronic disease. Although pregnant women commonly report poor sleep, few studies objectively evaluated the quality of sleep in pregnancy or explored the relationship between sleep disturbances and maternal and perinatal outcomes. Objective Our objective was to examine the relationship between objectively assessed sleep duration, timing, and continuity (measured via wrist actigraphy) and maternal cardiovascular and metabolic morbidity specific to pregnancy. Study Design This was a prospective cohort study of nulliparous women. Women were recruited between 16 0/7 and 21 6/7 weeks’ gestation. They were asked to wear a wrist actigraphy monitor and complete a daily sleep log for a period of 7 consecutive days. The primary sleep exposure variables were the averages of the following over the total valid nights (minimum 5, maximum 7 nights): short sleep duration during the primary sleep period (<7 h/night), late sleep midpoint (midpoint between sleep onset and sleep offset >5 AM), and top quartile of minutes of wake time after sleep onset and sleep fragmentation index. The primary outcomes of interest were a composite of hypertensive disorders of pregnancy (mild, severe, or superimposed preeclampsia; eclampsia; or antepartum gestational hypertension) and gestational diabetes mellitus. We used χ2 tests to assess associations between sleep variables and categorical baseline characteristics. Crude odds ratios and 95% confidence intervals were estimated from univariate logistic regression models to characterize the magnitude of the relationship between sleep characteristics and hypertensive disorders of pregnancy and gestational diabetes. For associations significant in univariate analysis, multiple logistic regression was used to explore further the association of sleep characteristics with pregnancy outcomes. Results In all, 901 eligible women consented to participate; 782 submitted valid actigraphy studies. Short sleep duration and a later sleep midpoint were associated with an increased risk of gestational diabetes (odds ratio, 2.24; 95% confidence interval, 1.11–4.53; and odds ratio, 2.58; 95% confidence interval, 1.24–5.36, respectively) but not of hypertensive disorders. A model with both sleep duration and sleep midpoint as well as their interaction term revealed that while there was no significant interaction between these exposures, the main effects of both short sleep duration and later sleep midpoint with gestational diabetes remained significant (adjusted odds ratio, 2.06; 95% confidence interval, 1.01–4.19; and adjusted odds ratio, 2.37; 95% confidence interval, 1.13–4.97, respectively). Additionally, after adjusting separately for age, body mass index, and race/ethnicity, both short sleep duration and later sleep midpoint remained associated with gestational diabetes. No associations were demonstrated between the sleep quality measures (wake after sleep onset, sleep fragmentation) and hypertensive disorders or gestational diabetes. Conclusion Our results demonstrate a relationship between short sleep duration and later sleep midpoint with gestational diabetes. Our data suggest independent contributions of these 2 sleep characteristics to the risk for gestational diabetes in nulliparous women.

AB - Background Experimental and epidemiologic data suggest that among nonpregnant adults, sleep duration may be an important risk factor for chronic disease. Although pregnant women commonly report poor sleep, few studies objectively evaluated the quality of sleep in pregnancy or explored the relationship between sleep disturbances and maternal and perinatal outcomes. Objective Our objective was to examine the relationship between objectively assessed sleep duration, timing, and continuity (measured via wrist actigraphy) and maternal cardiovascular and metabolic morbidity specific to pregnancy. Study Design This was a prospective cohort study of nulliparous women. Women were recruited between 16 0/7 and 21 6/7 weeks’ gestation. They were asked to wear a wrist actigraphy monitor and complete a daily sleep log for a period of 7 consecutive days. The primary sleep exposure variables were the averages of the following over the total valid nights (minimum 5, maximum 7 nights): short sleep duration during the primary sleep period (<7 h/night), late sleep midpoint (midpoint between sleep onset and sleep offset >5 AM), and top quartile of minutes of wake time after sleep onset and sleep fragmentation index. The primary outcomes of interest were a composite of hypertensive disorders of pregnancy (mild, severe, or superimposed preeclampsia; eclampsia; or antepartum gestational hypertension) and gestational diabetes mellitus. We used χ2 tests to assess associations between sleep variables and categorical baseline characteristics. Crude odds ratios and 95% confidence intervals were estimated from univariate logistic regression models to characterize the magnitude of the relationship between sleep characteristics and hypertensive disorders of pregnancy and gestational diabetes. For associations significant in univariate analysis, multiple logistic regression was used to explore further the association of sleep characteristics with pregnancy outcomes. Results In all, 901 eligible women consented to participate; 782 submitted valid actigraphy studies. Short sleep duration and a later sleep midpoint were associated with an increased risk of gestational diabetes (odds ratio, 2.24; 95% confidence interval, 1.11–4.53; and odds ratio, 2.58; 95% confidence interval, 1.24–5.36, respectively) but not of hypertensive disorders. A model with both sleep duration and sleep midpoint as well as their interaction term revealed that while there was no significant interaction between these exposures, the main effects of both short sleep duration and later sleep midpoint with gestational diabetes remained significant (adjusted odds ratio, 2.06; 95% confidence interval, 1.01–4.19; and adjusted odds ratio, 2.37; 95% confidence interval, 1.13–4.97, respectively). Additionally, after adjusting separately for age, body mass index, and race/ethnicity, both short sleep duration and later sleep midpoint remained associated with gestational diabetes. No associations were demonstrated between the sleep quality measures (wake after sleep onset, sleep fragmentation) and hypertensive disorders or gestational diabetes. Conclusion Our results demonstrate a relationship between short sleep duration and later sleep midpoint with gestational diabetes. Our data suggest independent contributions of these 2 sleep characteristics to the risk for gestational diabetes in nulliparous women.

KW - actigraphy

KW - gestational diabetes

KW - hypertension

KW - pregnancy outcomes

KW - sleep duration

KW - sleep midpoint

KW - sleep quality

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