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Original Research: SLEEP DISORDERS |

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

John E. Heffner, MD, FCCP; Yelena Rozenfeld, MPH; Mari Kai, MD; Elizabeth A. Stephens, MD; Lee K. Brown, MD, FCCP
Author and Funding Information

From the Department of Medicine (Drs Heffner, Kai, and Stephens), Providence Portland Medical Center, Portland; the Department of Medicine (Drs Heffner, Kai, and Stephens), Oregon Health and Science University, Portland; and Providence Medical Group (Ms Rozenfeld), Portland, OR; and the Department of Internal Medicine (Dr Brown), University of New Mexico School of Medicine, Albuquerque, NM.

Correspondence to: John E. Heffner, MD, FCCP, Providence Portland Medical Center, 5050 NE Hoyt St, Ste 540, Portland, OR 97213; e-mail: John_heffner@mac.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1414-1421. doi:10.1378/chest.11-1945
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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.

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