Influence of Obstructive Sleep Apnea on Maternal and Perinatal Outcomes in Patients With Gestational Diabetes Mellitus

The prevalence of obstructive sleep apnea (OSA) increases during pregnancy and is associated with gestational diabetes mellitus (GDM), although its clinical impact on birth outcomes remains unclear. We aimed to assess the effect of several OSA criteria and intermittent hypoxia in the third trimester on perinatal outcomes in women with GDM. In this prospective study, polysomnography was performed on 89 women with GDM. Insulin resistance indices (HOMA-IR/QUICKI) were calculated, and biomarkers (insulin-like growth factor-1 (IGF-1), resistin, soluble endoglobulin, galectin-3, and free fatty acids) were analysed from women and some cord blood samples using enzyme-linked immunosorbent assay. Whereas OSA did not significantly affect overall perinatal outcomes, specific OSA features-including REM-OSA, supine-position OSA, and an oxygen desaturation index (ODI) ≥ 1 h^-1-were linked to adverse effects on neonatal birthweight and length. Moreover, apnea duration was an independent predictor of birthweight, while insulin resistance was more impaired in women with OSA and showed an inverse relationship with sleep and REM time, respectively. IGF-1 was elevated and demonstrated a significant predictive value for OSA, as indicated by the AUC-ROC curve. In summary, although OSA did not adversely affect overall perinatal outcomes in women with GDM, specific OSA characteristics were associated with adverse neonatal growth metrics. Insulin resistance was higher in women with OSA, and IGF-1 may serve as a potential biomarker for OSA in this population. Further prospective studies with attention to REM-stage, supine-position OSA, apnea duration, and hypoxic burden are needed to elucidate the complex interactions between OSA, GDM, and fetal outcomes.