Impact of Obstructive Sleep Apnea on Gestational Diabetes Mellitus.

INTRODUCTION: Obstructive sleep apnea (OSA) increases the risk of type 2 diabetes, and hyperinsulinemia. Pregnancy increases the risk of OSA; however, the relationship between OSA and gestational diabetes mellitus (GDM) is unclear. We aimed (1) to evaluate OSA prevalence in GDM patients; (2) to assess the association between OSA and GDM; and (3) to determine the relationships between sleep parameters with insulin resistance (IR). METHODS: A total of 177 consecutive women (89 with GDM, 88 controls) in the third trimester of pregnancy underwent a hospital polysomnography. OSA was defined when the apnea-hypopnea index (AHI) was ≥5h-1. RESULTS: Patients with GDM had higher pregestational body mass index (BMI) and neck circumference than controls, but no differences in snoring or OSA-symptoms, or AHI (3.2±6.0 vs. 1.9±2.7h-1, p=.069). OSA prevalence was not significantly different in both groups. We did not identify OSA as a GDM risk factor in the crude analysis 1.65 (95%CI: 0.73-3.77; p=.232). Multiple regression showed that total sleep time (TST), TST spent with oxygen saturation<90% (T90), and maximum duration of respiratory events as independent factors related with homeostasis model assessment of IR, while T90 was the only independent determinant of quantitative insulin sensitivity check index. CONCLUSION: OSA prevalence during the third trimester of pregnancy was not significantly different in patients with GDM than without GDM, and no associations between OSA and GDM determinants were found. We identified T90 and obstructive respiratory events length positive-related to IR, while TST showed an inverse relationship with IR in pregnant women.

Impact of Obstructive Sleep Apnea on Gestational Diabetes Mellitus / Impacto de la apnea obstructiva del sueño en la diabetes mellitus gestacional

Introduction: Obstructive sleep apnea (OSA) increases the risk of type 2 diabetes, and hyperinsulinemia. Pregnancy increases the risk of OSA; however, the relationship between OSA and gestational diabetes mellitus (GDM) is unclear. We aimed (1) to evaluate OSA prevalence in GDM patients; (2) to assess the association between OSA and GDM; and (3) to determine the relationships between sleep parameters with insulin resistance (IR).MethodsA total of 177 consecutive women (89 with GDM, 88 controls) in the third trimester of pregnancy underwent a hospital polysomnography. OSA was defined when the apnea-hypopnea index (AHI) was ≥5h−1.ResultsPatients with GDM had higher pregestational body mass index (BMI) and neck circumference than controls, but no differences in snoring or OSA-symptoms, or AHI (3.2±6.0 vs. 1.9±2.7h−1, p=.069). OSA prevalence was not significantly different in both groups. We did not identify OSA as a GDM risk factor in the crude analysis 1.65 (95%CI: 0.73–3.77; p=.232). Multiple regression showed that total sleep time (TST), TST spent with oxygen saturation<90% (T90), and maximum duration of respiratory events as independent factors related with homeostasis model assessment of IR, while T90 was the only independent determinant of quantitative insulin sensitivity check index.ConclusionOSA prevalence during the third trimester of pregnancy was not significantly different in patients with GDM than without GDM, and no associations between OSA and GDM determinants were found. We identified T90 and obstructive respiratory events length positive-related to IR, while TST showed an inverse relationship with IR in pregnant women. (AU)

Introducción: La apnea obstructiva del sueño (AOS) aumenta el riesgo de diabetes tipo 2 e hiperinsulinemia. El embarazo aumenta el riesgo de AOS; sin embargo, la relación entre la AOS y la diabetes mellitus gestacional (DMG) no está clara. Nuestros objetivos fueron (1) evaluar la prevalencia de AOS en pacientes con DMG; (2) evaluar la asociación entre la AOS y la DMG; y (3) determinar las relaciones entre los parámetros del sueño y la resistencia a la insulina (RI).MétodosUn total de 177 mujeres seleccionadas consecutivamente (89 de ellas con DMG, 88 controles) en el tercer trimestre del embarazo se sometieron a una polisomnografía hospitalaria. Se clasificó como AOS un índice de apnea-hipopnea (IAH) de ≥5h-1.ResultadosLas pacientes con DMG presentaban un índice de masa corporal (IMC) pregestacional y una circunferencia del cuello más altos que los controles, pero no hubo diferencias en los ronquidos, otros síntomas de AOS o el IAH (3,2±6,0 frente a 1,9±2,7h-1, p=0,069). La diferencia en la prevalencia de AOS entre ambos grupos no fue significativa. No identificamos la AOS como un factor de riesgo de DMG en el análisis bruto (1,65; IC del 95%: 0,73-3,77; p=0,232). Mediante regresión múltiple se determinó que el tiempo total de sueño (TST), el TST pasado con una saturación de oxígeno <90% (T90) y la duración máxima de los eventos respiratorios eran factores independientes relacionados con el Homeostasis Model Assessment of IR (HOMA-IR), mientras que el T90 fue el único determinante independiente del Quantitative Insulin Sensitivity Check Index (QUICKI).ConclusiónLa diferencia de prevalencia de AOS durante el tercer trimestre del embarazo no fue significativa entre las pacientes con DMG y aquellas sin DMG, y no se encontraron asociaciones entre los factores asociados a AOS y DMG. (AU)

Influence of Obstructive Sleep Apnea on Systemic Inflammation in Pregnancy.

Background: Obstructive sleep apnea (OSA) is prevalent in pregnancy and it is associated with adverse pregnancy-related outcomes such as gestational diabetes, pre-eclampsia, and low birth weight. Maternal systemic inflammation is proposed to be one of the main intermediate mechanisms. However, the effects of OSA on systemic inflammation are unknown in normal pregnancy. Methods: Women in the 3rd trimester underwent hospital polysomnography to evaluate whether OSA increases systemic inflammation in normal pregnancy and its potential association with adverse fetal outcomes. OSA was defined as an apnea-hypopnea index (AHI) of ≥ 5 h-1. Plasma cytokines levels (TNF-α, IL-1ß, IL-6, IL-8, and IL-10) were determined by multiple immunoassays. Results: We included 11 patients with OSA and 22 women with AHI < 5 h-1, who were homogeneous in age, and body mass index (BMI). Women with OSA had significant higher levels of TNF-α, IL-1ß, IL-8, and IL-10. We found significant correlations between AHI during REM and TNF-α (r = 0.40), IL-1ß (r = 0.36), IL-6 (r = 0.52), IL-8 (r = 0.43), between obstructive apnea index and TNF-α (r = 0.46) and between AHI and IL-1ß (r = 0.43). We also found that CT90% was related to IL-8 (r = 0.37). There were no significant differences in neonatal characteristics; however, we found inverse correlations between TNF-α and IL-8 with birth weight (both r = -0.48), while IL-8 showed a significant inverse relationship with neonatal gestational age (r = -0.48). Conclusions: OSA in our normal pregnancy population was associated with higher systemic inflammation, which was related to obstructive events, especially during REM sleep. Moreover, systemic inflammation was inversely correlated with neonatal birth weight and age.

Impact of Obstructive Sleep Apnea on Gestational Diabetes Mellitus.

INTRODUCTION: Obstructive sleep apnea (OSA) increases the risk of type 2 diabetes, and hyperinsulinemia. Pregnancy increases the risk of OSA; however, the relationship between OSA and gestational diabetes mellitus (GDM) is unclear. We aimed (1) to evaluate OSA prevalence in GDM patients; (2) to assess the association between OSA and GDM; and (3) to determine the relationships between sleep parameters with insulin resistance (IR). METHODS: A total of 177 consecutive women (89 with GDM, 88 controls) in the third trimester of pregnancy underwent a hospital polysomnography. OSA was defined when the apnea-hypopnea index (AHI) was ≥5h-1. RESULTS: Patients with GDM had higher pregestational body mass index (BMI) and neck circumference than controls, but no differences in snoring or OSA-symptoms, or AHI (3.2±6.0 vs. 1.9±2.7h-1, p=.069). OSA prevalence was not significantly different in both groups. We did not identify OSA as a GDM risk factor in the crude analysis 1.65 (95%CI: 0.73-3.77; p=.232). Multiple regression showed that total sleep time (TST), TST spent with oxygen saturation<90% (T90), and maximum duration of respiratory events as independent factors related with homeostasis model assessment of IR, while T90 was the only independent determinant of quantitative insulin sensitivity check index. CONCLUSION: OSA prevalence during the third trimester of pregnancy was not significantly different in patients with GDM than without GDM, and no associations between OSA and GDM determinants were found. We identified T90 and obstructive respiratory events length positive-related to IR, while TST showed an inverse relationship with IR in pregnant women.

[Routine performance of thyroid ultrasound and fine-needle aspiration biopsy in the setting of a high-resolution endocrinology practice]. / Incorporación de la ecografía y la punción de tiroides a la actividad de endocrinología en una consulta de alta resolución.

INTRODUCTION: Fine-needle aspiration biopsy (FNAB) is considered the reference diagnostic procedure for thyroid nodules. MATERIALS AND METHODS: Routine performance of thyroid ultrasound and ultrasound-guided FNAB by endocrinologists allows a more efficient approach in the setting of a high-resolution practice, thus reducing costs and the time elapsed until diagnosis. RESULTS: We present our initial results of this procedure 2 years after its introduction, with a total of 286 biopsies performed. After a progressive learning curve over time and according to the endocrinologists' previous experience, 72.72% samples were considered satisfactory for diagnosis. Greater difficulty was observed in obtaining optimal cytological specimens in smaller nodules. In conclusion, we have successfully incorporated thyroid ultrasound and ultrasound-guided FNAB into routine endocrine practice. CONCLUSION: Routine performance of thyroid ultrasound in endocrine practice will considerably aid the management of nodular thyroid disease.

Incorporación de la ecografía y la punción de tiroides a la actividad de endocrinología en una consulta de alta resolución / Routine performance of thyroid ultrasound and fine-needle aspiration biopsy in the setting of a high-resolution endocrinology practice

Introducción La PAAF es el procedimiento de referencia para el diagnóstico del nódulo tiroideo. Material y métodos La incorporación de la ecografía cervical y la PAAF guiada por ecografía a la actividad del médico endocrinólogo permite abordar esta patología en el ámbito de una consulta de alta resolución, con la consiguiente reducción en el coste del proceso y en la demora del diagnóstico. Resultados Presentamos los resultados iniciales de esta consulta; tras los dos primeros años y con un total de 286 punciones, nos situamos en un 72,72% de citologías aptas para diagnóstico, siguiendo una curva de aprendizaje acorde con el tiempo transcurrido y con la experiencia previa. Observamos una mayor dificultad en la obtención de citologías óptimas para diagnóstico en los nódulos de menor tamaño. En resumen, hemos incorporado la ecografía y la PAAF guiada por ecografía de manera satisfactoria a la consulta endocrinológica. Conclusión El uso de manera rutinaria de la ecografía en la consulta de endocrinología permite agilizar el manejo de la patología nodular tiroidea (AU)

Introduction Fine-needle aspiration biopsy (FNAB) is considered the reference diagnostic procedure for thyroid nodules. Materials and methods Routine performance of thyroid ultrasound and ultrasound-guided FNAB by endocrinologists allows a more efficient approach in the setting of a high-resolution practice, thus reducing costs and the time elapsed until diagnosis. Results We present our initial results of this procedure 2 years after its introduction, with a total of 286 biopsies performed. After a progressive learning curve over time and according to the endocrinologists’ previous experience, 72.72% samples were considered satisfactory for diagnosis. Greater difficulty was observed in obtaining optimal cytological specimens in smaller nodules. In conclusion, we have successfully incorporated thyroid ultrasound and ultrasound-guided FNAB into routine endocrine practice. Conclusion Routine performance of thyroid ultrasound in endocrine practice will considerably aid the management of nodular thyroid disease (AU)