OSA underdiagnosed among primary care diabetes patients

By Ingrid Grasmo

Obstructive sleep apnea (OSA) is commonly underdiagnosed in patients with Type 2 diabetes in primary care, suggest study findings.

OSA is significantly more prevalent among patients with diabetes relative to the general population, with an estimated 70-90% of patients displaying apnea-hypoapnea indices of more than five per hour.

"The impact of underdiagnosis of OSA for the subset of patients with [Type 2 diabetes mellitus] in primary care practices may have particular clinical significance because of the frequent coexistence of these two conditions and the potentially negative effects of untreated OSA on glycemic control," say John Heffner (Providence Portland Medical Center, Oregon, USA) and colleagues.

Over an 18-month period during 2009 to 2010, Heffner and team identified a total of 16,066 patients with diabetes with one or more primary care office visits among 27 primary care ambulatory practices.

Of the identified patients with diabetes, 18% were diagnosed with OSA. This figure increased to 23% among patients who were obese (body mass index [BMI] of 30 kg/m² or above).

Estimation of OSA prevalence in diabetes from eight previously published studies (n=1673) revealed that, on average, 81.6% of patients were diagnosed with OSA. The researchers say this is a cause for concern, given that the 18% prevalence for primary care "is far less than expected based on published studies."

A similar finding was seen when the researchers restricted their analysis to obese patients, with an OSA prevalence of 87.0% compared with the identified 23.0% in primary care.

Further analysis revealed that BMI was a significant predictor for OSA, with odds for having OSA among patients with a BMI over 40 kg/m² increased nearly 12-fold compared with patients with a BMI of 18.5-24.9 kg/m².

Primary care providers were found to be more likely to diagnose OSA in male patients and in those with increasing obesity; lower serum low-density lipoprotein and glycated hemoglobin values; chronic vascular, cardiac, and pulmonary diseases; hypertension; and opioid use.

Writing in Chest, the team concludes: "Early detection of OSA in patients with [Type 2 diabetes mellitus] presents a novel opportunity to treat sleep-related breathing disorders and prevent intermittent hypoxia and other sleep-related disturbances that impair glycemic control and promote diabetes-related end-organ vascular damage."

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