Vas P R J, Ahluwalia R, Manas A B, Manu C A, Kavarthapu V, Edmonds M E
Kings Diabetes Foot Clinic, London, UK.
Department of Orthopaedics, Kings College Hospital, London, UK.
Diabet Med. 2016 Feb;33(2):e1-4. doi: 10.1111/dme.12813.
Although great progress has been made in managing diabetic foot disease, it continues to carry significant morbidity and mortality. Obstructive sleep apnoea (OSA) and diabetes frequently coexist and recent studies suggest significant under-recognition of OSA in those with diabetes. There are no current reports on the direct clinical impact of OSA on acute or chronic diabetic foot ulcer healing.
We describe three cases with Type 2 diabetes and a mean BMI of 50 kg/m(2) in whom we believe undiagnosed severe OSA may have impeded the rate of recovery of acutely infected foot ulcers. Despite standard care whilst in hospital with optimization of glycaemia, daily wound care, ulcer offloading techniques including casting, it was difficult to achieve satisfactory granulation in the first two cases with previously unrecognized and hence untreated severe OSA (Apnoea-Hypopnea Index > 30) until correction had been achieved through continuous positive airway pressure therapy (CPAP). In the third case, despite all optimization techniques, healing has not been achieved and individuals' reluctance to consider CPAP may be one possible factor.
We observe in three severely obese individuals with diabetes that untreated severe OSA may have contributed to delayed wound healing. We also observed an improvement in two individuals after institution of CPAP therapy. Clinicians managing the diabetic foot should consider investigating the presence of OSA in non-healing or slowly progressive foot ulcers when all other factors have been fully optimized.
尽管在糖尿病足病的管理方面已取得巨大进展，但它仍然具有显著的发病率和死亡率。阻塞性睡眠呼吸暂停（OSA）与糖尿病经常并存，最近的研究表明糖尿病患者中OSA的诊断率明显偏低。目前尚无关于OSA对急性或慢性糖尿病足溃疡愈合的直接临床影响的报道。
我们描述了三例2型糖尿病患者，平均体重指数为50kg/m²，我们认为未被诊断出的严重OSA可能阻碍了急性感染性足部溃疡的恢复速度。尽管在住院期间进行了标准治疗，包括优化血糖、每日伤口护理以及采用包括石膏固定在内的溃疡减压技术，但在前两例先前未被识别且因此未得到治疗的严重OSA（呼吸暂停低通气指数>30）患者中，直到通过持续气道正压通气治疗（CPAP）纠正OSA之前，很难实现令人满意的肉芽形成。在第三例中，尽管采取了所有优化技术，但仍未实现愈合，患者不愿考虑CPAP可能是一个因素。
我们观察到，在三名患有糖尿病的严重肥胖个体中，未经治疗的严重OSA可能导致伤口愈合延迟。我们还观察到两名患者在接受CPAP治疗后有所改善。在所有其他因素均已充分优化的情况下，处理糖尿病足的临床医生应考虑对不愈合或进展缓慢的足部溃疡患者进行OSA排查。
