What Factors Impact Sleep Apnea Risk in Patients with Gestational Diabetes?

Sleep apnea during pregnancy can lead to significant adverse events for both the mother and the fetus, making screening important. The results of a recent study presented at the 99^th annual meeting of the Endocrine Society suggest numerous factors that can be used to screen patients with gestational diabetes (GDM) for obstructive sleep apnea (OSA).

“Obstructive sleep apnea is highly prevalent in diet-controlled obese women with GDM,” said senior author Sirimon Reutrakul, MD. “An algorithm using the Berlin Questionnaire and neck circumference could help screen for OSA in these women.”

The study authors explored the prevalence of OSA among pregnant women in their second or third trimesters living in Thailand. The participants were obese and used dietary intervention to control their diabetes.

Patients’ characteristics, glycemic parameters, and neck circumference were recorded at baseline. The women also completed the Berlin Questionnaire for OSA, which asks questions regarding snoring, daytime sleepiness, hypertension, and body mass index. The authors noted that if a participant scored positive in at least 2 categories, they were at high risk of developing OSA, according to the study.

Patients also wore a device overnight to determine sleep-related breathing. If their hypopnea index was 5 or higher, the patient was diagnosed with OSA.

The authors indicated there were no differences in age, body mass index pre- and during pregnancy, fasting glucose, of HbA1C levels during the sleep assessment between patients with and without OSA. However, the authors discovered that neck circumference was significantly larger among those with OSA, according to the study.

Approximately 52.4% of women included were diagnosed with OSA, which is higher than the general population. Risk factors included snoring, daytime sleepiness, or high BMI. However, even if those factors were not applicable, a neck circumference of more than 35.5 cm was linked to a high risk of OSA.

A significant portion of those diagnosed with OSA scored positive for 1 or more questionnaire, compared with those without the condition, according to the study.

The authors suggest that healthcare providers should screen patients using the Berlin Questionnaire but also take neck circumference into account.

"Sleep apnea has previously been shown to be associated with adverse fetal and maternal outcomes. Health professionals should be aware of this possible comorbidity in women with gestational diabetes, especially in women who are obese," Dr Reutrakul concluded. "Please note that the women in our cohort were all Asian, and because our cohort was relatively small, this high prevalence should be confirmed in a larger study.”