Abstract
Objective
Obstructive sleep apnea (OSA) and snoring are known independent risk factors for insulin resistance. Microalbuminuria is an early marker of diabetic nephropathy and an independent risk factor for cardiovascular disease. The aim of our study was to search the prevalence of self-reported snoring and high-risk pre-test OSA diagnosis in diabetic patients and search the influence of snoring on microalbuminuria.
Methods
A total of 237 diabetic patients (mean age, 58.6 ± 12.4 years; 126 males), were asked to complete the Berlin Questionnaire that includes questions about snoring, witnessed apnea, tiredness, history of high blood pressure and/or BMI < 30 kg/m2. Also, their past and current medical records were reviewed for their medications, diabetic control, and complications like neuropathy, retinopathy, and microalbuminuria.
Results
According to the Berlin Questionnaire, a high pre-test probability for the diagnosis of OSA was found in 47.3% of the patients. Snoring was detected in 60.3% of the patients. The mean Epworth Sleepiness Scale score was 7.8 ± 4.6 and 31.6% of the patients reported excessive daytime sleepiness. We found that the both BMI and waist circumferences were significantly associated with snoring and high-risk pre-test OSA. There were no differences for age, gender, fasting glucose, HbA1c, and lipid panels between snorers and non-snorers, and between high-risk pre-test OSA and low-risk pre-test OSA patients. Microalbuminuria was significantly more common in patients who snore. Although snoring was independently associated with microalbuminuria, there were no differences between groups for other microvascular diabetic complications.
Conclusion
Prevalence of OSA-related symptoms was very common in diabetic patients and further prospective studies are needed to elucidate the role of OSA’s effect on diabetic control and complications.
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References
Gislason T, Janson C, Tómasson K (1995) Epidemiological aspects of snoring and hypertension. Sleep Res 4:145–149
Johnson EO, Roth T (2006) An epidemiologic study of sleep-disordered breathing symptoms among adolescents. Sleep 29:1135–1142
Stradling JR, Davies RJ (2004) Obstructive sleep apnoea/hypopnoea syndrome: definitions, epidemiology, and natural history. Thorax 59:73–78
Shepard JW Jr (1992) Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med 13:437–458
Spiegel K, Leproult R, Van Cauter E (1999) Impact of sleep debt on metabolic and endocrine function. Lancet 354:1435–1439
Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS (2002) Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 165:670–676
Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP (2001) The continuing epidemics of obesity and diabetes in the United States. JAMA 286:1195–1200
Brown WV (2008) Microvascular Complications of Diabetes Mellitus: Renal Protection Accompanies Cardiovascular Protection. Am J Cardiol 102(12A):10–13
Flemons WW, Whitelaw WA, Brant R, Remmers JE (1994) Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med 150:1279–1285
Johns MW (1993) Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth sleepiness scale. Chest 103:30–36
West SD, Nicoll DJ, Stradling JR (2006) Prevalence of obstructive sleep apnoea in men with type 2 diabetes. Thorax 61:945–950
Foster GD, Borradaile KE, Sanders MH, Millman R, Zammit G, Newman AB, Wadden TA, Kelley D, Wing RR, Pi-Sunyer FX, Reboussin D, Kuna ST (2009) Sleep AHEAD Research Group of Look AHEAD Research Group. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med 169:1619–1626
Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131:485–491
Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM (2008) Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 108:822–830
Bliwise DL, Nekich JC, Dement WC (1991) Relative validity of self-reported snoring as a symptom of sleep apnea in a sleep clinic population. Chest 99:600–608
Stoohs RA, Blum HC, Haselhorst M, Duchna HW, Guilleminault C, Dement WC (1998) Normative data on snoring: a comparison between younger and older adults. Eur Respir J 11:451–457
Tasali E, Mokhlesi B, Van Cauter E (2008) Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest 133:496–506
Spiegel K, Knutson K, Leproult R, Tasali E, Van Cauter E (2005) Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes. J Appl Physiol 99:2008–2019
Al-Delaimy WK, Manson JE, Willett WC, Stampfer MJ, Hu FB (2002) Snoring as a risk factor for type II diabetes mellitus: a prospective study. Am J Epidemiol 155:387–393
Kohler M (2009) Risk factors and treatment for obstructive sleep apnea amongst obese children and adults. Curr Opin Allergy Clin Immunol 9:4–9
Hornick T, Aron DC (2008) Preventing and managing diabetic complications in elderly patients. Cleve Clin J Med 75:153–158
Girach A, Manner D, Porta M (2006) Diabetic microvascular complications: can patients at risk be identified? A review. Int J Clin Pract 60:1471–1483
Keane W, Brenner BM, de Zeeuw D et al (2003) The risk of develo** end-stage renal disease in patients with type 2 diabetes and nephropathy. Kidney Int 63:1499–1507
Spoelstra-de Man AME, Brouwer CB, Stehouwer CDA, Smulders YM (2001) Rapid progression of albumin excretion is an independent predictor of cardiovascular mortality in patients with type 2 diabetes and microalbuminuria. Diab Care 24:2097–2101
American Thoracic Society (2009). Obstructive sleep apnea, retinopathy linked in diabetes. ScienceDaily. http://www.sciencedaily.com/releases/2009/05/090519172059.htm. Accessed 8 Jan 2010
Pedro RA, Isabel MM, Marc BB, Juan FB, Ester SB (2010) Review of the relationship between renal and retinal microangiopathy in diabetes mellitus patients. Curr Diabetes Rev 6(2):88–101
Masuo K, Rakugi H, Ogihara T, Esler MD, Lambert GW (2010) Cardiovascular and renal complications of type 2 diabetes in obesity: role of sympathetic nerve activity and insulin resistance. Curr Diabetes Rev 6(2):58–67
Laaban JP, Daenen S, Léger D, Pascal S, Bayon V, Slama G, Elgrably F (2009) Prevalence and predictive factors of sleep apnoea syndrome in type 2 diabetic patients. Diabetes Metab 35:372–377
Juuti AK, Hiltunen L, Rajala U, Laakso M, Härkönen P, Hedberg P, Ruokonen A, Keinänen-Kiukaanniemi S, Läärä E (2008) Association of abnormal glucose tolerance with self-reported sleep apnea among a 57-year-old urban population in Northern Finland. Diabetes Res Clin Pract 80:477–482
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Ozol, D., Carlıoğlu, A., Karamanlı, H. et al. Influence of snoring on microalbuminuria in diabetic patients. Sleep Breath 15, 295–300 (2011). https://doi.org/10.1007/s11325-010-0380-1
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DOI: https://doi.org/10.1007/s11325-010-0380-1