Predictive Value of Clinical and Questionnaire Based Screening Tools of Obstructive Sleep Apnea in Patients With Type 2 Diabetes Mellitus

Abstract

Background Obstructive 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. Methods In 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. Results The 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. Conclusion This 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.

Timely diagnosis and correction of obstructive sleep apnea and sleep and wake rhythm disorders in the management of cardiometabolic health in patients with type 2 diabetes mellitus

“…Дневные симптомы включают утреннюю головную боль, чрезмерную дневную сонливость, раздражительность, снижение памяти и концентрации внимания [7]. Для скрининга ОАС в клинической практике широко используются опросники, самыми популярными из которых являются Берлинский опросник, шкала сонливости Эпворта и опросник STOP-BANG [8].…”

Associations of Chronic Diabetes Complications and Cardiovascular Risk with the Risk of Obstructive Sleep Apnea in Patients with Type 2 Diabetes

“…What is more, this sleep disorder associates functional and structural metabolic disorders. As a result, this condition is a major public health problem [ 2 , 3 ].…”

“…The risk factors for OSA include: retrognathia, family history of OSA, cardiovascular diseases (treatment-resistant hypertension, atrial fibrillation, congestive heart failure, stroke), acromegaly, Down syndrome, polycystic ovary syndrome, obesity (especially stage 2 and 3 obesity) and type 2 diabetes mellitus (T2DM) [ 6 ]. T2DM and OSA are two conditions that increase their mutual risk [ 2 , 7 ]. It was estimated that in patients with T2DM, OSA has a prevalence of 50–80% [ 8 , 9 ].…”

Obstructive sleep apnea risk and its associated factors among type 2 diabetes mellitus patients at wolkite university specialized hospital, Wolkite, Southern Ethiopia, 2021. A comparative cross-sectional study

“…So, utilizing another simple and economical screening tool for the identification of OSA at-risk patients is of special public health concern to reduce the OSA-related burdens. Several clinical predictors and questionnaires are also used to screen for or diagnose OSA, some of which include Berlin questionnaire, Epworth sleepiness scale, and STOP-BANG questionnaire [ 12 ].…”

“…The Berlin Questionnaire has been used expansively in clinical and epidemiologic research internationally to screen OSA risk and there is high consistency between results of high-risk OSA by the Berlin Questionnaire, and OSA by the parameters of PSG for the early identification of OSA among T2DM patients [12][13][14][15].…”