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ACTIGRAPHIC ASSESSMENT OF PATIENTS WITH GESTATIONAL DIABETES SHOWS SEVERE COMPROMISE OF SLEEP MEASURES
Sleep pattern assessed by actigraphy has been seldom reported in gestational diabetes mellitus (GDM). Importantly, studies have shown that short sleep duration and later sleep midpoint have been linked to hypertension and GDM latter in pregnancy. These issues are vital because Hypertension, GDM and Sleep disturbances are frequent during pregnancy and can lead to adverse outcomes.
To evaluate sleep/wake activity, with objective and subjective measures, using daily wrist actigraphy and behavior questionnaires.
A cross-sectional study evaluated 53 GDM patients in the last trimester of pregnancy, attending a public health care unity in Brazil. Valid actigraphy recordings (5 to 7 days) were obtained from 41 patients. GDM was defined according to WHO 2013 criteria. Sleep onset latency, sleep duration, sleep efficiency and wake after onset of sleep (WASO) were analyzed. Patients were interviewed to complete the Pittsburgh Sleep Quality Index (PSQI,) Epworth Sleepiness Scale, Fatigue Severity Scale, Insomnia Severity Index and Edinburgh Postnatal Depression Scale (EPDS). Short sleep duration was defined if sleep duration was < 7 hours; prolonged sleep latency if >30 minutes and reduced sleep efficiency if <85%. Pregestational diabetes patients were excluded. The study was approved by Federal University of Ceára ethic board, approval number 1.801.860.
Forty-one GDM patients aged 27 - 46 y (35.2±4.8), BMI 24.3 to 41.1(31.5±4.4) with a mean gestational age of 27 weeks were studied, showing normal sleep latency (0.50 to 29.3 min; 8.5±8.0), reduced sleep duration (148-455min; 262.9±75.1), reduced sleep efficiency (63.7-98.4%; 84.5±8,5) and increased WASO (3.8-150.4min; 58.3±34.8). Delayed midpoint sleep was detected only in three patients. Sleep efficiency correlated with fatigue (FSS r=-.42 p=.02), depressive symptoms (EDP r=-.51 p=.007), sleep quality (PSQI r=-.39 p=.04) and there was a trend with insomnia (ISI r=-.34 p=.07). WASO was correlated with fatigue (FSS r=.41 p=.03), depressive symptoms (EDP r=.55 p=.003), sleep quality (PSQI r=-.39 p=.04), and insomnia (ISI r=.39 p=.04).
Actigraphic evaluation of GDM patients in the last trimester of pregnancy show severe compromise of sleep efficiency, short sleep duration and increased WASO. Actigraphic measures were associated with depressive symptoms; a less powerful association was found with behavioral questionnaires evaluating fatigue, insomnia and sleep quality.
Actigraphy; Sleep Disturbances; Gestational Diabetes
Centro Integrado de Diabetes e Hipertensão (CIDH- CE) - Ceara - Brasil, Centro Universitário Christus, Faculdade de Medicina - Ceara - Brasil, Universidade Federal Do Ceará- UFC, Faculdade de Medicina - Ceara - Brasil
Mariana Salles Ballalai, Cristina Figueiredo Sampaio Façanha, Victória Sudário Alencar, Vittória Nobre Jacinto, Frederico Luís Braz Furtado, Pedro Felipe Carvalhefo Bruin, Rejane Belchior Lima Macêdo, Veralice Meireles Sales Bruin