REM-Related OSA Associated With Increased Gestational Diabetes Risk

REM Sleep Traces
Rapid eye movement-related obstructive sleep apnea and other sleep disordered breathing events are associated with an increased risk for gestational diabetes.

Rapid eye movement (REM)-related obstructive sleep apnea (OSA) and other sleep disordered breathing events are associated with an increased risk for gestational diabetes, according to a study recently published in Annals of the American Thoracic Society. 

This case control study included 46 women with newly diagnosed gestational diabetes, as well as 46 control women matched for gestational age within 4 weeks, age within 2 years, body mass index within 3 kg/m², race, and parity. All participants underwent overnight polysomnography sessions and completed sleep questionnaires. The primary outcome of the study was gestational diabetes, for which participants were screened at approximately 28 weeks of gestation. Variables examined included OSA classification, pregnancy body mass index, overall sleep efficiency, participant characteristics, and other variables. 

OSA was significantly more common in patients with gestational diabetes than in control individuals (22% vs 9%, respectively; P <.001). OSA was associated with a greater risk of developing gestational diabetes (odds ratio [OR], 4.71; 95% CI, 1.05-21.04). In adjusted models, the risk for gestational diabetes was also higher in women with greater overall apnea hypopnea index (AHI) events per hour (OR, 1.81; 95% CI, 1.01-3.27), AHI during REM sleep (OR, 2.09; 95% CI, 1.02-4.31), Sleep Apnea Symptom Score (OR, 2.72; 95% CI, 1.11-6.69), and oxygen desaturation index ≥4% (OR, 2.21; 1.03-4.73). In addition, the researchers found that a higher percentage of non-REM sleep was associated with a decreased risk for gestational diabetes (OR 0.88; 95% CI, 0.78-0.99).

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Study limitations included a specific population (ie, more mild OSA), inability to assess causality, and potential underestimation of the effect of acute OSA on risk for gestational diabetes.

The study researchers concluded that these results support the conclusion that “[gestational diabetes] risk is linked to several sleep-related risk factors including REM-related OSA, and is multifactorial.” However, mechanisms related to these factors are not yet fully understood. The researchers suggested concurrent assessment of these risk factors to “facilitate the identification of women at risk for [gestational diabetes] and the initiation of [gestational diabetes] prevention strategies.”


Izci Balserak B, Pien GW, Prasad B, et al. Obstructive sleep apnea is associated with newly-diagnosed gestational diabetes mellitus [published online February 10, 2020]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201906-473OC