Sleep Quality, but Not Quantity, during pregnancy is Associated with Insulin Resistance

Kareem Pierre1 & Sarah Anderson1 Janeen S. Amason, PH.D., RN2, Katherine H. Ingram, Ph.D. 1 (faculty mentor)

INTRODUCTION Department of Exercise Science and Sport Management1 and WellStar School of Nursing2, Kennesaw State University

OBJECTIVE

RESULTSIn recent years, the prevalence of gestational diabetes mellitus (GDM) has been as high as 9.2% of pregnancies in the United States.3 Women with GDM are at high risk of developing type 2 diabetes within 5 years of giving birth and their offspring are at increased risk for obesity and diabetes in their lifetimes.4,1

Risk of gestational diabetes has been associated with insufficient amounts of sleep in pregnancy.2 It is unknown whether poor sleep quality is also associated with risk for gestational diabetes.

CONCLUSIONS

METHODS

FUNDING: This project is funded by internal research grants by the KSU Office of the Vice President for Research and Center for Excellence in Teaching and Learning (CETL).

The purpose of this study was to determine if sleep disturbance, sleep quality, and sleep quantity was associated with insulin resistance, a hallmark characteristic of diabetes, during pregnancy.

• A validated general sleep disturbance questionnaire was given to 25 women recruited from an OB/GYN clinic in the metro area during the second trimester of their first pregnancy.

• A validity check was integrated within the questionnaire to exclude those who did not meet validity standards.

• The General Sleep Questionnaire (Kathy Lee, 1992) was used to assess overall sleep disturbance, sleep quantity and sleep quality.

• Fasting blood glucose and insulin were collected between 24-27 weeks gestation.

• Insulin resistance was calculated from the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR= fasting insulin (mU/L) x fasting glucose (mg/dL)/405).

• Statistics were analyzed using SPSS.• The total scores for each category were

calculated and compared to HOMA-IR and fasting insulin levels using Spearman correlation coefficients.

• Weight was collected during clinical visits to assess overall gestational weight gain

• Body fat percentage was examined at the Kennesaw State University Human Performance Lab using the 4- compartment model (4CM), which analyzes total body water, body density, bone mineral mass, and body weight.

RESULTS

Poor sleep quality, but not quantity, in pregnancy is associated with higher levels of insulin resistance, and therefore a higher risk for gestational diabetes.

Table 1- Participant Characteristics

Figure 1- Relationship Between HOMA-IRand Sleep Scores

• Six of the 25 subjects were excluded for violating the questionnaire validity check.

• There was a non-linear correlation between HOMA-IR and poor sleep quality (ρ= .499, p=.049).

• No correlation was observed between sleep quantity and HOMA-IR (ρ= -.215, p= .423).

• No correlation was observed between sleep disturbance and HOMA-IR (ρ= .370, p= 158).

  N Mean ± Std Min- MaxAge 19 27.84 ± 3.68 20-36

Pre-preg BMI (kg/m2) 19 29.32 ± 7.73 18.42-50.02Body Fat % (4CM) 16 41.94 ± 8.18 27.12-53.57Gest. Wt. Gain (kg) 19 3.25 ± 3.52 -3.1-8.9

Glucose (mg/dl) 16 80.19 ± 10.89 69.0-115.0Insulin(mU/mL) 16 13.36 ± 19.84 3.40-87.00

HOMA-IR 16 1.7 ± 0.71 0.63-3.26

Table 2- Spearman’s Correlations between Sleep and HOMA-IR

(5)

(6)

  Insulin (uI/mL) HOMA-IR

Sleep Disturbance

ρ .433 .370Sig .094 .158

N 16 16Sleep quality

ρ .526 .499Sig .036 .049

N 16 16Sleep

quantityρ -.108 -.215

Sig .691 .423N 16 16

10 15 20 25 30 35 40 45 500

0.51

1.52

2.53

3.5Chart Title

Sleep QualityH

OM

A-IR

0 2 4 6 8 10 12 1401234

Chart Title

Sleep Quantity

HO

MA

-IR

20 30 40 50 60 70 800

0.51

1.52

2.53

Sleep Disturbance

HO

MA

-IR

0 2 4 6 8 10 12 140

20406080

100Chart Title

Sleep Quantity

Insu

lin (u

l/mL)

10 15 20 25 30 35 40 45 500

20

40

60

80

100Chart Title

Sleep Quality

Insu

lin (u

l/mL)

20 30 40 50 60 70 800

20406080

100 Chart Title

Sleep DisturbanceIn

sulin

(ul/m

L)

1. Dabelea, D. (2007). The predisposition to obesity and diabetes in offspring of diabetic mothers. Diabetes Care 30 (2), 169 –174. doi: 10.2337/dc07-s211

2. O'Keeffe, M., St-Onge, M.P., (2013). Sleep duration and disorders in pregnancy: implications for glucose metabolism and pregnancy outcomes. International Journal of Obesity 37(6), 765–770. doi: 10.1038/ijo.2012.142

3. DeSisto, C.L., Kim, S.Y., Sharma, A.J., (2014). Prevalence Estimates of Gestational Diabetes Mellitus in the United States., Pregnancy Risk Assessment Monitoring System (Prams), 2007-2010. Preventing Chronic Disease, 11. doi: 10.5888/pcd11.130415

4. Kim, C., Newton, K., Knopp, R., (2002). Gestational Diabetes and the Incidence of Type 2 Diabetes: A systematic review. Diabetes Care, 25(10), 1862-1868.

5. Grill, Jamie/JGI. Getty. (2013, February 26). [Online Image]. Retrieved:19 April 2016. from http://www.netdoctor.co.uk/conditions/pregnancy-and-family/a9136/sleep-problems-during-pregnancy/.

6. Durnan, J.. (2013). [Online Image]. Date Retrieved: 19 April 2016. from http://drjuliedurnan.com/how-to-beat-insomnia-naturally/.

Figure 2- Relationship Between Fasting Insulin and Sleep Scores