Sleep questionnaires for the screening of obstructive sleep apnea in patients with type 2 diabetes mellitus compared with non‐diabetic patients

Pataka, Athanasia; Kalamaras, George; Δασκαλοπούλου, Ε.; Argyropoulou, Paraskevi

doi:10.1111/1753-0407.12835

Cited by 10 publications

(18 citation statements)

References 39 publications

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“…Because OSA is such a relevant phenomenon for the long-term care of complications of T2DM [37], we avoided excluding OSA patients, and we opted to measure the OSA risk , in pursuit of a real-life clinical relevance. The STOP-BANG questionnaire [38], a validated method to evaluate the OSA risk, was chosen. The use of this improved method to appraise the influence of the OSA risk as a confounding factor may have determined the absence of association between long SD and HbA 1c in the present study, in contrast to the studies of Gozashti et al [11] and Tang et al [10].…”

Section: Discussionmentioning

confidence: 99%

Real-World Data in Support of Short Sleep Duration with Poor Glycemic Control, in People with Type 2 Diabetes Mellitus

Martorina

Tavares

2019

Journal of Diabetes Research

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Aims. Sleep duration (SD) has been associated with metabolic outcomes. Is there an independent association between short/long SD and glycemic control (GC) in type 2 diabetes mellitus (T2DM) outpatients, compared to intermediate SD? Employing up-to-date definitions of SD, we comprehensively considered, simultaneously, all known confounding/mediating factors that recently emerged in the literature: age, gender, diet, physical activity, obesity, night pain, nocturnal diuresis, sleep quality, chronotype, sleep apnea, depressive symptoms, alcohol, caffeine, tobacco, number of endocrinologist appointments, T2DM family history, and sleep medication. Methods. A cross-sectional study of 140 consecutive T2DM outpatients, ages 40-65, glycohemoglobin HbA1c goal≤7. We searched for variables (including HbA1c) significantly associated with short (<6 hours) or long (>8 hours) SD, in comparison to intermediate SD (6-8 hours). Results. Higher HbA1c levels increased the chance of belonging to the group that sleeps <6 hours (p≤0.001). Better sleep quality, nocturnal diuresis, and morningness increased the chance of belonging to the group that sleeps >8 hours (p<0.05). Conclusions. There is an independent association between short SD and elevated HbA1c, in real-world T2DM outpatients. Future interventional studies could evaluate weather consistent, long-term sleep extension, from <6 hours to 7–9 hours per 24 hours, improves GC in T2DM outpatients.

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Section: Discussionmentioning

confidence: 99%

Real-World Data in Support of Short Sleep Duration with Poor Glycemic Control, in People with Type 2 Diabetes Mellitus

Martorina

Tavares

2019

Journal of Diabetes Research

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“…While several questionnaires and models have been validated for the clinical prediction of sleep apnea, few have been validated in a population of type 2 diabetes mellitus [11–13]. The snoring, tiredness, observed apnea, high blood pressure, body-mass-index, age, neck circumference and male gender (STOP-Bang) questionnaire and Berlin Questionnaire (BQ) [14] can be cumbersome in clinical practice and require subjective data on sleepiness and third party reporting of snoring [11, 14].…”

Section: Introductionmentioning

confidence: 99%

Neck Grasp Predicts Obstructive Sleep Apnea in Type 2 Diabetes Mellitus

2019

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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.

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“…Chronic ventricular pacing following AVNA can result in pacing‐induced dyssynchrony and impairment of left ventricular function and has been shown to exacerbate fluid shift to the upper airway overnight . In addition, the majority of the PPM and AVNA + DCCV patients (21/22) remained in AF at 6‐month follow‐up and therefore did not experience the haemodynamic benefits of prolonged SR The reduction in overnight oxygenation is the likely explanation for the increase in ESS because increased desaturation overnight has been shown to correlate with ESS . The increase in central apnoeic events is interesting and also implicates disruption of haemodynamics in patients chronically paced.…”

Section: Discussionmentioning

confidence: 99%

“…P value at 6-month follow-up and therefore did not experience the haemodynamic benefits of prolonged SR The reduction in overnight oxygenation is the likely explanation for the increase in ESS because increased desaturation overnight has been shown to correlate with ESS. 31 The increase in central apnoeic events is interesting and also implicates disruption of haemodynamics in patients chronically paced. Oscillation of PaCO 2 around the apnoeic threshold is the key component in CSA development and perpetuation seen in previous studies of heart failure patients.…”

Section: -Month Post-intervention (In Sr)mentioning

confidence: 99%

The effect of atrial fibrillation intervention on nocturnal respiratory events in elderly patients with persistent AF

Eysenck

Sulke

Freemantle

et al. 2019

Clinical Respiratory J

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Background Sleep‐disordered breathing (SDB) and atrial fibrillation (AF) are associated. This study investigated the impact of AF intervention on 6‐month home sleep testing data. Methods Sixty‐seven patients (aged 66 to 86, 53% male) with persistent AF were randomized (1:1:1) to direct current cardioversion (DCCV) (22 patients), permanent pacemaker (PPM) + atrioventricular node ablation (AVNA) + DCCV (22 patients) or AF ablation (23 patients). Baseline and 6‐month multichannel home sleep tests with the Watch‐PAT200 (Itamar Medical Lts., Caesarea, Israel) were recorded. Implantable cardiac monitors (ICMs) (Medtronic Reveal XT, Minneapolis, Minnesota) in the DCCV and AF ablation groups, and PPM Holters in the ‘pace and ablate’ group were utilized to assess cardiac rhythm beat‐to‐beat throughout the study period. Results The prevalence of moderate‐to‐severe SDB [apnoea‐hypopnoea index (AHI) ≥ 15/h] was 60%. At 6 months there was no change in AHI, Epworth sleepiness scale, sleep time, % REM sleep, respiratory desaturation index or central apnoeic events. Twenty‐five patients (15 AF ablation, 9 DCCV and 1 following DCCV post‐AVNA) maintained SR at 6 months confirmed on ICMs in these patients. AHI fell from 29.8 ± 26.6/h to 22.2 ± 20.4/h; P = 0.049. Conclusions SDB is highly prevalent in patients with persistent AF. Restoration of sinus rhythm, and the associated long‐term recovery of haemodynamics, is associated with a significant reduction in AHI. This implicates reversal of fluid shift from the lower limbs to the neck region, a key mechanism in the pathogenesis of SDB.

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Sleep questionnaires for the screening of obstructive sleep apnea in patients with type 2 diabetes mellitus compared with non‐diabetic patients

Abstract: The predictive performance of the questionnaires was similar in both groups, especially in the case of moderate and severe OSA.

Cited by 10 publications

References 39 publications

Real-World Data in Support of Short Sleep Duration with Poor Glycemic Control, in People with Type 2 Diabetes Mellitus

Real-World Data in Support of Short Sleep Duration with Poor Glycemic Control, in People with Type 2 Diabetes Mellitus

Neck Grasp Predicts Obstructive Sleep Apnea in Type 2 Diabetes Mellitus

The effect of atrial fibrillation intervention on nocturnal respiratory events in elderly patients with persistent AF

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