To study the prevalence of obstructive sleep apnoea in type 2 diabetes patients in Western Rajasthan, India

Abstract

Background: Obstructive Sleep Apnoea (OSA) has been too common yet under diagnosed clinical entity. It is associated with the metabolic syndrome, a cluster of cardio-metabolic parameters including central obesity, insulin resistance, hypertension and dyslipidemia. Obesity predisposes to both OSA and disorders in glucose metabolism. There is growing evidence that OSA confers an independent risk of adverse glucose metabolism.Methods: The present study conducted in the Department of Medicine at MDM Hospital attached to Dr. S.N. Medical College, Jodhpur, Rajasthan, India. Participants after understanding the study protocol and procedure, asked to give their written consent for the study. It was a cross sectional hospital based study in patients, screened at Diabetic clinic and those referred from the periphery. Berlin questionnaires and Epworth score are tools to screen for OSA attending the Medicine OPD and IPD, Dr. S. N. Medical College, Jodhpur. 50 patients with type 2 DM and 20 age and sex-matched controls were studied. Randomly selected T2DM subjects of age 20 to 75 years both sex with obesity, BMI>25 kg/m2, clinical history suggestive of OSA, Epworth score>6, Positive Berlin questionnaires were included in the study. Acute and unstable medical condition e.g. CHF, CRF, COPD, Recent stroke, Acute ACS, Pregnant women were excluded.Results: In the study OSA was prevalent in the diabetic population (54%), Mean age of the study population was 54.96±9.35 years. OSA was found to be increased with increasing age with maximum prevalence in ≥60 year’s age group. OSA was more prevalent in the male population (64.29%), in urban population. Snoring, observed sleep apnoea, restless sleep/insomnia, excessive daytime sleepiness and non-refreshing sleep were significantly associated with OSA. (P<0.001). Prevalence of OSA was more in high BMI group (≥35 kg/m2), OSA increased with increase in neck circumference. OSA was more in subjects with uncontrolled diabetes (blood sugar>200 mg/dl), smokers and alcoholics.Conclusions: This study shows that OSA has a high prevalence in subjects with T2DM and identify several factors that may be associated with its presence in the diabetic population. OSA can be usefully and easily assessed in an outpatient setting by using a portable device such as Apnea Link. Clinicians should increase patients' awareness of the signs and symptoms of OSA and refer for sleep studies when appropriate. Once diagnosed, patients should be encouraged to adhere to CPAP treatment in order to halt progression and prevent complications.