The George Institute For Global Health
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Diabetes and Obstructive Sleep Apnea in China (DOSA Study)

Project status: 
Archived
Start date: 
09/2012

Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) are both chronic health conditions which are highly prevalent in the general population. Compared to the general population, studies have reported a much higher prevalence of OSA in patients with T2DM in many other countries.

However, data on the prevalence of OSA in subjects with T2DM in China is scarce. Our aims are to investigate the prevalence of obstructive sleep apnea in hospitalized patients in the department of endocrinology with type 2 diabetes in China, and also to explore the association between OSA and related risk factors, diabetic complications and comorbidities.

This cross-sectional study is the first step in the OSA and diabetes area in China, and would provide basis for the cohort and intervention studies in the future.

Issue

Obstructive sleep apnea (OSA) is a common sleep breathing disorder (SBD) characterized by snoring and the occurrence of apnea during sleep. Patients with OSA often suffer from excessive daytime sleepiness which can potentially result in traffic accidents and other social problems. Moreover, OSA is associated with an increased risk of hypertension, cardiovascular diseases and diabetes.

OSA and type 2 diabetes mellitus (T2DM) are both chronic health conditions which are highly prevalent in the general population. Compared to the general population, studies have reported a much higher prevalence of OSA in patients with T2DM, ranging from 53.9% to 86% (Apnea-Hypopnea Index, AHI>= 5.0/h) in the US, Japan and Hong Kong.

This suggests that OSA is likely to be a common health problem in T2DM patients and that the T2DM population might be an ideal population for opportunistic screening for OSA. However, data on the prevalence of OSA in subjects with T2DM in China is scarce.

The current research team has completed a pilot study in Beijing and a high prevalence of OSA (66.7%, AHI>= 5.0/h) was observed in hospitalized patients with T2DM. To our knowledge, no other study has been reported.

Objectives

  1. Investigate the prevalence of obstructive sleep apnea (OSA) in hospitalized patients in the department of endocrinology with type 2 diabetes in China
  2. Explore the correlation between OSA and diabetic complications and comorbidities

Methods

This was a multi-center, cross-sectional study involving 12 hospitals from six regional cities in China. Each hospital consecutively recruited at least 70 hospitalized patients with T2DM from its word of endocrinology department.

A total of 884 participants were enrolled and administered overnight sleep monitoring with a portable monitor (ApneaLink, ResMed); other information was collected via medical charts and a standardized questionnaire.
In China, 61.7% (545/884) of hospitalized patients with T2DM were comorbid with OSA (Apnea Hyponea Index, AHI>=5). Only 1.5% (8/545) of the patients with two conditions had been previously diagnosed with OSA.

Members of the DOSA Study team

The prevalence of moderate-severe (AHI>=15) and severe OSA (AHI>=30) was estimated to be 26.5% and 11.4%, respectively. Age, sex, obesity, snoring, breath holding in sleep or gasping or choking arousal, sleepiness, hypertension and dyslipidemia were significantly correlated with the severity of OSA. Patients with moderate or severe OSA tended to have better blood glucose control compared to those with mild or no OSA. Except for cardiovascular events in univariate analysis, no significant relationship was found between OSA and diabetes complications.

In conclusion, the prevalence of OSA in hospitalized patients with T2DM is high, indicating the importance of routine screening and treatment of OSA in diabetes management regardless of the causal relationship between OSA and diabetic complications.