Incidence of sleep apnea in patients with various types of glycemic disturbances

Aims.
To assess the risk for sleep apnea in patients with various types of glycemic disorders by means of Epworth Sleepiness Scale andSleep Apnea Screening Questionnaire.
Materials and Methods.
We examined 744 residents of Mozhaisk Region, that were considered to have high risk for development of type2 diabetes mellitus (T2DM), as estimated by FINDRISK Questionnaire. Patients, who scored 12+ were cleared for participation in this study. Combined score from Epworth Sleepiness Scale and Sleep Apnea Screening Questionnaire was applied for diagnosis of sleep apnea, supplemented with specific questions about snoring and episodes of apnea. Glycemic disorders were diagnosed with standard glucose tolerance test.
Results.
42.7% of examined patients (n=318) were diagnosed with various types of glucose disorders. Prevalence of abdominal obe- sity (according to waist circumference measurement) comprised 59.3% in male patients and 54.1% in females. We observed positive correlation between body mass index (BMI) and snoring ? 0.3 (p=0.0001), BMI and apnea ? 0.2 (p=0.0001), BMI and daytime sleepiness ? 0.1 (p=0.007); we also observed direct correlation between age and snoring ? 0.2 (p=0.0001), as well as age and sleep apnea ? 0.1 (p=0.028). Risk for sleep apnea was found to be 4.7 times higher in patients with arterial hypertension. After adjustment71Диагностика, контроль и лечениеСахарный диабет. 2013;(1):71?77Сахар ный диабетfor age risk of apnea remained 2.8 times higher in patients with T2DM, 1.9 times higher in subjects with impaired glucose tolerance and1.6 times higher in subjects with impaired fasting glycaemia. Relative risk for snoring in patients with various types of glycemic disorders was 1.1-1.2 against normoglycemic controls. We estimated that all types of glycemic disorders increase risk for apnea 1.2?1.6 times.
Conclusion.
Glycemic disorders, body weight excess, obesity and arterial hypertension are risk factors for snoring and sleep apnea. Corresponding patient categories should be screened for sleep apnea by questionnaire survey to identify those in need of further complex examination and treatment.

obstructive sleep apnea, glycemic disorders, diabetes mellitus, fasting hyperglycemia, glucose intolerance, arterial hyper- tension, body mass index, risk factors

1. Botros NA. Obstructive sleep apnea as risk factor for type II dia- betes. ATS 2007 – San Francisco Poster Board № E27; pg A359.

2. Vgontzas AN, Bixler EO, Chrousos GP, Pejovic S. Obesity and sleep disturbances: meaningful sub-typing of obesity. Arch Physiol Biochem. 2008 Oct;114(4):224–236. doi: 10.1080/13813450802521507.

3. Harsch IA, Konturek PC, Koebnick C, Kuehnlein PP, Fuchs FS, Pour Schahin S, Wiest GH, Hahn EG, Lohmann T, Ficker JH. Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment. Eur Respir J. 2003 Aug;22(2):251–257.

4. Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol. 2005 Nov;99(5):1998–2007.

5. Dawson A, Abel SL, Loving RT, Dailey G, Shadan FF, Cronin JW, Kripke DF, Kline LE. CPAP Therapy of Obstructive Sleep Apnea in Type 2 Diabetics Improves Glycemic Control During Sleep. J Clin Sleep Med. 2008 Dec 15;4(6):538–542.

6. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disodered breathing among midlle-age adults. N Engl J Med. 1993 Apr 29;328(17):1230-1235.

7. Древаль АВ, Мисникова ИВ, Барсуков ИА, Пончакова ГВ, Кузнецов АВ. Распространенность сахарного диабета 2 типа и других нарушений углеводного обмена в зависимости от используемых критериев их диагностики. Сахарный диабет.2010;(1):116–121.

8. Мисникова ИВ, Древаль АВ, Барсуков ИА. Новый подход к проведению скрининга для выявления ранних нарушений углеводного обмена. Проблемы эндокринологии. 2011;(1):80–85.

9. Елигулашвили ТС. Неврологические аспекты синдрома апноэ во сне: клинико-физиологическое исследование. Диссертация на соискание ученой степени доктора мед. наук. М; 1998.

10. Stradling JR, Crosby JH. Predictors and prevalence of obstuctive sleep apnoea and snoring in 1001 midlle aged men. Thorax. 1991 Feb;46(2):85–90.

11. Strohl KP, Redline S. Recognition of obstructive sleep apnea. Am J Respir Crit Care Med. 1996 Aug;154(2 Pt 1):279–289.

12. Netzer N, Stoohs R, Netzer C, et al. Sleep-related symptoms in primary care population. Am J Resrir Crit Care Med. 1998; 157: A852.

13. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998 Jul;15(7):539–553.

14. IDF Clinical Guidelines Task Force. Global Guideline for Type 2 Diabetes: recommendations for standard, comprehensive, and minimal care. Diabet Med. 2006 Jun;23(6):579–593.

15. Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O. Sleep-disodered breathing in community-dwelling elderly. Sleep. 1991 Dec;14(6):486–495.

16. Young T. Sleep-disodered breathing in older adults: is it a condition distinct from that in middle-aged adults? Sleep. 1996 Sep;19(7):529–530.

17. Davies RJ, Stradling JR. The epidemiology of sleep apnoea. Thorax. 1996 Aug;51 Suppl 2:S65–70.

18. Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med. 2005 Dec 15;172(12):1590–1595.

19. O'Connor GT, Caffo B, Newman AB, Quan SF, Rapoport DM, Redline S, Resnick HE, Samet J, Shahar E. Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2009 Jun 15;179(12):1159–1164. doi: 10.1164/rccm.200712- 1809OC.

20. Haas DC, Foster GL, Nieto FJ, Redline S, Resnick HE, Robbins JA, Young T, Pickering TG. Age-dependent associations between sleep-disordered breathing and hypertension: importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the Sleep Heart Health Study. Circulation. 2005 Feb 8;111(5):614–621.