Prevalence of Diagnosed Sleep Apnea Among Patients With Type 2 Diabetes in Primary Care

• Published in: Chest Vol. 141; no. 6; pp. 1414 - 1421
• Main Authors: Heffner, John E., MD, FCCP, Rozenfeld, Yelena, MPH, Kai, Mari, MD, Stephens, Elizabeth A., MD, Brown, Lee K., MD, FCCP
• Format: Journal Article
• Language: English
• Published: Northbrook, IL American College of Chest Physicians 01-06-2012
• Subjects: Biological and medical sciences; Body Mass Index; Cardiology. Vascular system; Chi-Square Distribution; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycated Hemoglobin A - analysis; Humans; Lipoproteins, LDL - blood; Logistic Models; Male; Medical sciences; Middle Aged; Oregon - epidemiology; Pneumology; Prevalence; Primary Health Care; Pulmonary/Respiratory; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Risk Factors; Sex Factors; Sleep Apnea Syndromes - diagnosis; Sleep Apnea Syndromes - epidemiology; Sleep Apnea Syndromes - physiopathology; Endocrinopathy; Type 2 diabetes; Human; Nervous system diseases; Sleep apnea syndrome; Prevalence; Respiratory disease; Metabolic diseases; Patient; Care; Primary; Anesthesia; Circulatory system; Diagnosis; Cardiology
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.11-1945

Background Although up to 90% of patients with type 2 diabetes mellitus (T2DM) have obstructive sleep apnea (OSA), the rate at which primary care providers diagnose OSA in patients with diabetes has not been assessed. Methods A retrospective, population-based, multiclinic study was performed to determine the proportion of patients with T2DM managed in primary care clinics who were given a diagnosis of OSA and to identify factors associated with an OSA diagnosis. Electronic health records of adult patients with a diagnosis of T2DM were reviewed for a coexisting diagnosis of OSA, and the diagnostic prevalence of OSA was compared with the expected prevalence. Results A total of 16,066 patients with diabetes with one or more primary care office visits in 27 primary care ambulatory practices during an 18-month period from 2009 to 2010 were identified. Analysis revealed that 18% of the study population received an OSA diagnosis, which is less than the 54% to 94% prevalence reported previously. The 23% prevalence of OSA among obese study patients was lower than the expected 87% prevalence. In a logistic model, male sex, BMI, several chronic conditions, and lower low-density lipoprotein levels and hemoglobin A1c identified patients more likely to carry an OSA diagnosis (likelihood ratio, χ2 = 1,713; P < .0001). Conclusions Primary care providers underdiagnose OSA in patients with T2DM. Obese men with comorbid chronic health conditions are more likely to receive a diagnosis of OSA. Efforts to improve awareness of the association of OSA with T2DM and to implement OSA screening tools should target primary care physicians.