The Sleep in Pregnancy Study
The Sleep in Pregnancy Study
Sleep disordered breathing (SDB) insidiously worsens metabolic function, heightens insulin
 resistance (IR), and in pregnancy is thought to precipitate gestational diabetes, preterm
 birth, growth restriction, gestational hypertension, and preeclampsia. Despite the fact that
 sleep disturbances are common during pregnancy, SDB remains under-recognized,
 under-diagnosed, and poorly understood, particularly in pregnancies affected by obesity.
 Sixty percent of pregnancies are now affected by obesity, yet the relationship between SDB,
 patterns of glycemia, and insulin resistance (IR) in obese pregnant women is a neglected area
 with major therapeutic implications to improve maternal and infant health. Using a
 prospective design in which diet and gestational age are highly controlled, the investigators
 propose to measure SDB (apneas/hypopneas) in obese pregnant women using an ambulatory sleep
 monitoring system. In parallel, robust patterns of glycemia will be measured with a
 continuous glucose monitoring system (CGMS), followed by a 75g oral glucose tolerance test to
 measure insulin action. The investigators global hypothesis is that worse SDB in part
 accounts for higher 24-hour patterns of glycemia in obese normal glucose tolerant (NGT)
 pregnant women in their 3rd trimester. The Investigators will test the hypothesis that: 1) In
 obese NGT pregnant women at 32-34 weeks gestation on a controlled eucaloric diet, higher
 apnea hypopnea index (AHI) will be positively associated with 24-hour glycemia measured by a
 CGMS and that, 2) Higher AHI in obese NGT pregnant women at 32-34 weeks gestation on a
 eucaloric controlled diet will be associated with higher insulin resistance measured by a 75g
 oral glucose tolerance test (Matsuda Model). Early identification and treatment has the
 potential to decrease long-term maternal cardiovascular morbidity and mortality.
Inclusion Criteria:

 -  Pregnant women:

 1. Between the ages of 20-39 yrs,

 2. At 32-34 weeks gestation,

 3. Who have a BMI of ≥30 to ≤40 kg/m2,

 4. Who have a singleton pregnancy, and

 5. Who have a normal glucose tolerance test on entrance to the study.

 Exclusion Criteria:

 -  Pregnant Women:

 1. Who have a diagnosis of diabetes (GDM, type 1 or type 2),

 2. Who are using beta blockers/glucocorticoids.

 3. Who have other children who are ≤2 yrs old (due to risk of disrupted sleep),

 4. With diagnosed sleep disorders (e.g. OSA, insomnia, restless leg syndrome),

 5. Who work night or rotating shifts,

 6. Who report use of sleep medications will be excluded,

 7. With diagnosed pulmonary or cardiovascular disease

 8. Who do not speak English.