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Original Research: SLEEP MEDICINE |

Prevalence and Recognition of Obstructive Sleep Apnea in Chinese Patients With Type 2 Diabetes Mellitus

David C. L. Lam, MBBS, PhD, FCCP; Macy M. S. Lui, MBBS; Jamie C. M. Lam, MD, FCCP; Liza H. Y. Ong, MBBS; Karen S. L. Lam, MBBS, MD; Mary S. M. Ip, MBBS, MD, FCCP
Author and Funding Information

From the Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.

Correspondence to: Mary S. M. Ip, MBBS, MD, FCCP, University Department of Medicine, Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Rd, Hong Kong, ROC; e-mail: msmip@hkucc.hku.hk


Drs D. Lam and Lui contributed equally to the work as co-first authors.

Funding/Support: This study was supported by the Sleep and Respiratory Fund, University of Hong Kong.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(5):1101-1107. doi:10.1378/chest.10-0596
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Background:  Obstructive sleep apnea (OSA) is associated with disorders of glucose metabolism. Previous studies revealed a high prevalence of OSA among subjects with type 2 diabetes mellitus (DM). The aims of this study were to determine the prevalence of OSA and associated clinical factors in Chinese patients with DM.

Methods:  All records of the DM clinic at a teaching hospital in Hong Kong were screened between January 2007 and June 2008. Inclusion criteria for patients were Chinese, aged 18 to 75 years, with type 2 DM. Patients with unstable medical illnesses, gestational diabetes, or on renal replacement therapy were excluded.

Results:  Of 3,489 records screened, 1,859 subjects were eligible. A random sample of 663 (mean age, 58.2 ± 10.8; mean BMI, 26.0 ± 4.6), except six with known OSA, were invited for polysomnography (PSG). Of 165 subjects on which PSG was performed, OSA was diagnosed (apnea-hypopnea index [AHI] ≥ 5.0/h) in 89 subjects (53.9%, median Epworth Sleepiness Scale, 6 [interquartile range 3, 10]). Fifty-four (32.7%) had moderate/severe OSA (AHI ≥ 15/h). The estimated OSA prevalence in this diabetic cohort was 17.5% (24.7% in men, 10.3% in women). Regression analysis identified that AHI was associated independently with higher BMI, advanced age, male sex, and higher diastolic BP (R2 = 29.6%). The adjusted OR of requiring three or more antihypertensive drugs in moderate/severe OSA was 2.48 (95% CI, 1.05-5.87). No association between glycemic control (HbA1c) and sleep was identified.

Conclusions:  In conclusion, OSA is more prevalent in Chinese adults with DM than in the general population. A high index of suspicion for OSA in patients with DM is warranted, because they may not have overt daytime sleepiness.

Trial registry:  ClinicalTrials.gov; No.: NCT01172093; URL: www.clinicaltrials.gov

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