Edmonds P J, Gunasekaran K, Edmonds L C
Vanderbilt University Medical Center, Department of Medicine, 1161 21st Avenue South, Nashville, TN 37232, USA.
Yale New Haven Health, Bridgeport Hospital, Pulmonary Medicine, 267 Grant Street, Bridgeport, CT 06610, USA.
Sleep Disord. 2019 Jul 1;2019:3184382. doi: 10.1155/2019/3184382. eCollection 2019.
Obstructive sleep apnea (OSA) is a common disorder with high morbidity, mortality, and an increasing prevalence in the general population. It has an even higher prevalence among individuals with type 2 diabetes mellitus (DM). The snoring, tiredness, observed apnea, high blood pressure, body-mass-index, age, neck circumference and male gender (STOP-BANG) questionnaire and Berlin Questionnaire can be cumbersome in clinical practice and require subjective data on sleepiness. We proposed prospectively studying a primary care population with type 2 DM comparing neck grasp, neck circumference, and common screening questionnaires to identify OSA.
Persons with a diagnosis of type 2 DM were recruited from a primary care clinic. Participants were screened using Easy Sleep Apnea Predictor (ESAP), STOP-Bang questionnaire, and Berlin questionnaire. A positive ESAP was defined as a 1cm gap when a patient encircled their hands around the neck. All subjects underwent in-laboratory PSG testing.
Forty-three participants were enrolled and the prevalence of OSA was 90.7% (AHI ≥ 5). The median BMI was 38.0. The prevalence of mild OSA by PSG (AHI 5-14) was 27.9%, moderate OSA (AHI 15-29) was 25.6%, and severe OSA (AHI >30) was 37.2%. For mild OSA both ESAP and neck circumference showed 100% specificity.
This study reinforces the need for screening diabetic persons for obstructive sleep apnea. ESAP and neck circumference are useful for identifying persons with type 2 DM who are at risk for OSA. Together these findings could improve recognition of OSA in persons at risk for cardiovascular disease. Trial Registration of "Neck grasp as a predictor of Sleep Apnea," https://clinicaltrials.gov/ct2/show/NCT02474823, Clinical Trials.gov Identifier, is NCT02474823.
阻塞性睡眠呼吸暂停（OSA）是一种常见疾病，在普通人群中的发病率、死亡率较高且患病率不断上升。在2型糖尿病（DM）患者中其患病率更高。打鼾、疲劳、观察到的呼吸暂停、高血压、体重指数、年龄、颈围和男性性别（STOP-BANG）问卷以及柏林问卷在临床实践中可能很繁琐，并且需要关于嗜睡的主观数据。我们前瞻性地研究了患有2型糖尿病的基层医疗人群，比较颈部握力、颈围和常用筛查问卷以识别OSA。
从一家基层医疗诊所招募诊断为2型糖尿病的患者。使用简易睡眠呼吸暂停预测器（ESAP）、STOP-Bang问卷和柏林问卷对参与者进行筛查。当患者双手环绕颈部时，ESAP阳性定义为有1厘米的间隙。所有受试者均接受实验室多导睡眠图（PSG）测试。
招募了43名参与者，OSA患病率为90.7%（呼吸暂停低通气指数[AHI]≥5）。BMI中位数为38.0。PSG显示轻度OSA（AHI 5 - 14）患病率为27.9%，中度OSA（AHI 15 - 29）患病率为25.6%，重度OSA（AHI>30）患病率为37.2%。对于轻度OSA，ESAP和颈围的特异性均为100%。
本研究强化了对糖尿病患者进行阻塞性睡眠呼吸暂停筛查的必要性。ESAP和颈围有助于识别有OSA风险的2型糖尿病患者。这些发现共同可提高对心血管疾病风险人群中OSA的识别。“颈部握力作为睡眠呼吸暂停的预测指标”的试验注册，https://clinicaltrials.gov/ct2/show/NCT02474823，ClinicalTrials.gov标识符为NCT02474823。
