The development of a sleep apnea screening program in Romanian type 2 diabetic patients: a pilot study

To determine the feasibility of a sleep apnea screening program in Romanian patients with type 2 diabetes and obesity attending outpatient clinic of a diabetes center (the standard for routine care in Romania). The Epworth Sleepiness Scale was administered to 80 consecutive patients with type 2 diabetes and a body mass index (BMI) ≥30 kg/m2. Patients with a score >10 at this scale were referred to polysomnography for a sleep study. Overall, 20% of these patients had excessive daytime sleepiness (Epworth Sleepiness Scale >10), and in all of these cases, obstructive sleep apnea was confirmed. Of these patients, 33.3% had moderate OSA (AHI = 15–30 events/h of sleep), and 58.3% had severe OSA (AHI ≥30 events/h of sleep). Individuals with OSA were more frequent males, have higher BMI, higher waist circumference, and lower HDL-cholesterol compared with non-apneic subjects. Hb A1c, diabetes duration, and age were not statistically different between the two groups. OSA odds increased 1.1 times with every 1-cm increase in abdominal circumference (95%CI: 1.01–1.13) and 1.2 times with every kg/m2 increase in BMI (95%CI: 1.05–1.38). These associations remained statistically significant even after adjustment for age and sex. The prevalence of OSA in the sampled population was high. These findings suggest the need for more data regarding prevalence of obstructive sleep apnea in Romanian patients with type 2 diabetes. Furthermore, associations found may form a basis to develop specific recommendations for screening of sleep apnea in patients with type 2 diabetes from Romania.