Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain.
Servicio de Neumología, Hospital Universitari Son Espases, Carretera de Valldemosa 79, 07010, Palma de Mallorca, Balearic Islands, Spain.
BMC Pulm Med. 2022 Mar 18;22(1):94. doi: 10.1186/s12890-022-01888-1.
Although some evidence suggests an association between obstructive sleep apnea (OSA) and gestational diabetes mellitus (GDM), its consequences still remain largely unknown. We sought to determine whether OSA is associated with higher inflammation and sympathetic levels in GDM, and to relate them with insulin resistance and perinatal outcomes.
OSA was identified by polysomnography and defined as an apnea-hypopnea index of ≥ 5 h. Plasma cytokines (TNF-α, IL-1β, IL-6, IL-8, IL-10), metanephrine, and normetanephrine were determined by immunoassays.
We included 17 patients with GDM and OSA and 34 without OSA. Women with GDM and OSA had higher normetanephrine concentrations [81 IQR (59-134) vs. 68 (51-81) pg/mL]. No differences in the inflammatory profile were found, while IL-1β was higher in patients with mean nocturnal oxyhemoglobin saturation ≤ 94%. We found positive correlations between increased sympathetic activation and IL-1β, with obstructive apneas, while time in REM showed an inverse relationship with IL-1β and metanephrine. Furthermore, IL-10 was inversely related with time in sleep stages 1-2, and with the arousal index, and it was positively related with time in slow-wave sleep. Significant correlations were also found between IL-1β and insulin resistance. There were no significant differences in neonatal characteristics; however, we found inverse relationships between IL-10 and birth weight (BW), and percentile of BW.
OSA increased sympathetic activity, and IL-1β concentration was higher in patients with GDM with lower nocturnal oxygenation, all of which were related with obstructive events, and time in REM. Moreover, IL-1β was related with insulin resistance, and IL-10 inversely correlated with neonatal BW.
虽然有一些证据表明阻塞性睡眠呼吸暂停（OSA）与妊娠期糖尿病（GDM）之间存在关联，但其后果仍在很大程度上不为人知。我们试图确定 OSA 是否与 GDM 中更高的炎症和交感神经水平相关，并将其与胰岛素抵抗和围产期结局相关联。
通过多导睡眠图确定 OSA，并将其定义为呼吸暂停-低通气指数≥5 小时。通过免疫测定法测定血浆细胞因子（TNF-α、IL-1β、IL-6、IL-8、IL-10）、间甲肾上腺素和去甲肾上腺素。
我们纳入了 17 名患有 GDM 和 OSA 的患者和 34 名没有 OSA 的患者。患有 GDM 和 OSA 的女性间甲肾上腺素浓度较高[81 IQR（59-134）比 68（51-81）pg/mL]。炎症谱无差异，但平均夜间氧饱和度≤94%的患者中 IL-1β 更高。我们发现，随着阻塞性呼吸暂停的增加，交感神经激活与 IL-1β呈正相关，而 REM 时间呈负相关与 IL-1β和间甲肾上腺素呈负相关。此外，IL-10 与睡眠 1-2 期时间呈负相关，与觉醒指数呈正相关，与慢波睡眠时间呈正相关。IL-1β 与胰岛素抵抗也存在显著相关性。新生儿特征无显著差异；然而，我们发现 IL-10 与出生体重（BW）和 BW 百分位呈负相关。
OSA 增加了交感神经活性，GDM 患者夜间氧合作用较低时，IL-1β 浓度较高，所有这些都与阻塞性事件和 REM 时间有关。此外，IL-1β 与胰岛素抵抗有关，而 IL-10 与新生儿 BW 呈负相关。
