title: Prevalence of diagnosed sleep apnea among patients with type 2 diabetes in primary care.
abstract: 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, χ(2) = 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.
authors.affiliation: Department of Medicine, Providence Portland Medical Center, Portland; Department of Medicine, Oregon Health and Science University, Portland. Electronic address: John_heffner@mac.com.
authors.forename: John E
authors.initials: JE
authors.lastname: Heffner
authors.affiliation: Providence Medical Group, Portland, OR.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Rozenfeld
authors.affiliation: Department of Medicine, Providence Portland Medical Center, Portland; Department of Medicine, Oregon Health and Science University, Portland.
authors.forename: Mari
authors.initials: M
authors.lastname: Kai
authors.affiliation: Department of Medicine, Providence Portland Medical Center, Portland; Department of Medicine, Oregon Health and Science University, Portland.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stephens
authors.affiliation: Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
authors.forename: Lee K
authors.initials: LK
authors.lastname: Brown
mesh_terms: D015992:Body Mass Index; D016009:Chi-Square Distribution; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*
chemical_list: D006442:Glycated Hemoglobin; D008077:Lipoproteins, LDL; C517652:hemoglobin A1c protein, human