Neck Grasp Predicts Obstructive Sleep Apnea in Type 2 Diabetes Mellitus

Abstract

Aims. Obstructive sleep apnea (OSA) is a common disorder with high morbidity, mortality, and an increasing prevalence in the general population. It has an even higher prevalence among individuals with type 2 diabetes mellitus (DM). The snoring, tiredness, observed apnea, high blood pressure, body-mass-index, age, neck circumference and male gender (STOP-BANG) questionnaire and Berlin Questionnaire can be cumbersome in clinical practice and require subjective data on sleepiness. We proposed prospectively studying a primary care population with type 2 DM comparing neck grasp, neck circumference, and common screening questionnaires to identify OSA. Methods. Persons with a diagnosis of type 2 DM were recruited from a primary care clinic. Participants were screened using Easy Sleep Apnea Predictor (ESAP), STOP-Bang questionnaire, and Berlin questionnaire. A positive ESAP was defined as a 1cm gap when a patient encircled their hands around the neck. All subjects underwent in-laboratory PSG testing. Results. Forty-three participants were enrolled and the prevalence of OSA was 90.7% (AHI ≥ 5). The median BMI was 38.0. The prevalence of mild OSA by PSG (AHI 5-14) was 27.9%, moderate OSA (AHI 15-29) was 25.6%, and severe OSA (AHI >30) was 37.2%. For mild OSA both ESAP and neck circumference showed 100% specificity. Conclusions. This study reinforces the need for screening diabetic persons for obstructive sleep apnea. ESAP and neck circumference are useful for identifying persons with type 2 DM who are at risk for OSA. Together these findings could improve recognition of OSA in persons at risk for cardiovascular disease. Trial Registration of “Neck grasp as a predictor of Sleep Apnea,” https://clinicaltrials.gov/ct2/show/NCT02474823, Clinical Trials.gov Identifier, is NCT02474823.

Effect of Glucose Improvement on Nocturnal Sleep Breathing Parameters in Patients with Type 2 Diabetes: The Candy Dreams Study

“…Our results, in which the amelioration of sleep breathing parameters was not related to the Epworth score support the hypothesis that screening should be generalized to all patients. Together with questionnaires, neck circumference and neck grasp are also useful for identifying patients with type 2 diabetes who are at risk of OSA in the primary care setting [33]. However, there is still a long way to go before we have biological markers that can help us in this matter [34].…”

Assessment of Neck Grasp as a Screening Tool for Identifying Obstructive Sleep Apnea in Community-Dwelling Older Adults

“…As previously noticed, only 2 studies have addressed the value of neck grasp for predicting OSA. 15 , 16 Both studies were conducted by the same group of investigators. The age of participants in 1 of them ranged from 29 to 81 years, and the other only mentioned that participants were aged 18 years or older.…”

“…In this view, 2 small series have shown 100% specificity of neck grasp for identifying subjects with OSA. 15 , 16 However, these results have not been replicated in other populations/ethnic groups. Taking the opportunity of a well-established cohort of community-dwellers living in rural Ecuador, this study aimed to assess the independent association between neck grasp and OSA as well as the diagnostic accuracy of neck grasp for predicting OSA in older adults of Amerindian ancestry.…”

Is Mallampati scoring and PPNC an easier and better predictor for Obstructive Sleep Apnea (OSA)?

“…Mallampatti scoring and neck circumference have been found to be associated with difficult intubation in patients with OSA (28). Patients with mild OSA, neck circumference showed 100% specificity in a study from USA (29). Neck circumference normally increases with height and PPNC is used as a correction for this parameter.…”