Abstract
BackgroundObstructive sleep apnea (OSA) is a major health problem for people with type 2 diabetes mellitus (DM2) and is associated with poorer glycemic control. Early detection is critical to proper management. In this study, we planned to assess and compare the diagnostic accuracy of various OSA screening tools in patients with DM2.MethodsIn this cross-sectional study, we consecutively recruited 58 patients with DM2, presenting to the endocrinology department of Services Hospital Lahore between February 2020 to March 2021. Along with demographic and anthropometric measurements, including BMI and neck circumference, participants answered the snoring, tiredness, observed apnea, high blood pressure - BMI, age, neck circumference, and gender (STOP-BANG) questionnaire, Berlin questionnaire, and Epworth sleepiness scale. All participants then underwent an overnight, level 3 polysomnography.ResultsThe overall prevalence of OSA, diagnosed by overnight polysomnography, was 65.5% in type 2 diabeticDM2 patients. The STOP-BANG questionnaire had the highest sensitivity for mild, moderate, and severe OSA i.e., 84.2%, 90.3%, and 100% respectively. Berlin questionnaire also had 100% sensitivity for severe OSA and was most specific for mild and moderate OSA (70% and 63% respectively) whereas the Epworth sleepiness scale had the highest specificity of 53.3% for severe OSA.ConclusionThis study shows that OSA is highly prevalent in DM2 patients in Pakistan. The STOP-BANG and Berlin questionnaire proved to be effective screening tools, especially for severe OSA. Results of our study should encourage the routine use of these questionnaires in clinical practice, to help in the early identification of OSA in diabetics.
Highlights
Obstructive sleep apnea (OSA) is the intermittent, partial or complete, obstruction of the upper airway during sleep, leading to disturbed sleep and a plethora of functional and metabolic derangements, affecting multiple systems of the body, making it a major health problem [1]
Berlin questionnaire had 100% sensitivity for severe OSA and was most specific for mild and moderate OSA (70% and 63% respectively) whereas the Epworth sleepiness scale had the highest specificity of 53.3% for severe OSA
This study shows that OSA is highly prevalent in DM2 patients in Pakistan
Summary
Obstructive sleep apnea (OSA) is the intermittent, partial or complete, obstruction of the upper airway during sleep, leading to disturbed sleep and a plethora of functional and metabolic derangements, affecting multiple systems of the body, making it a major health problem [1]. Patients with type 2 diabetes mellitus (DM2) are at a greater risk to develop OSA as compared to general population. Intermittent hypoxemia and sleep fragmentation, caused by the recurrent upper airway obstruction due to OSA, lead to sympathetic system activation, hypothalamicpituitary-adrenal axis alterations, adipokine disturbances, systemic inflammation, and oxidative stress, How to cite this article Butt A, Syed U, Arshad A (September 16, 2021) Predictive Value of Clinical and Questionnaire Based Screening Tools of Obstructive Sleep Apnea in Patients With Type 2 Diabetes Mellitus. Autonomic neuropathy, insulin resistance, leptin resistance, and overall oxidative stress, which are consequences of diabetes mellitus, may alter the neuronal and mechanical control of the upper airway muscles, leading to easy collapsibility of these muscles during sleep, causing OSA [5]. We planned to assess and compare the diagnostic accuracy of various OSA screening tools in patients with DM2
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