Screening for obstructive sleep apnea syndrome in patients with type 2 diabetes mellitus: a prospective study on sensitivity of Berlin and STOP-Bang questionnaires.
Obstructive sleep apnea (OSA) is highly prevalent in patients with Type 2 diabetes mellitus representing an additional risk factor for already increased cardiovascular mortality. As cardiovascular diseases are the main cause of death in this population, there is a need to identify patients with moderate to severe OSA indicated for treatment. We aimed to evaluate the performance of the Berlin, STOP, and STOP-Bang screening questionnaires in a population of patients with Type 2 diabetes mellitus.



294 consecutive patients with Type 2 diabetes mellitus filled in the questionnaires and underwent overnight home sleep monitoring using a type IV sleep monitor.



Severe, moderate, and mild OSA was found in 31 (10%), 61 (21%), and 121 (41%) patients, respectively. The questionnaires showed a similar sensitivity and specificity for AHI ≥ 15: 0.69 and 0.50 for Berlin, 0.65 and 0.49 for STOP, and 0.59 and 0.68 for STOP-Bang. However, the performance of the STOP-Bang questionnaire was different in men vs. women, sensitivity being 0.74 vs. 0.29 (p < 0.05) and specificity 0.56 vs. 0.82 (p < 0.05).



Even the best-performing Berlin questionnaire failed to identify 31% of patients with moderate to severe OSA as being at high risk of OSA, thus preventing them from receiving a correct diagnosis and treatment. Considering that patients with Type 2 diabetes mellitus are at high risk of cardiovascular mortality and also have a high prevalence of moderate to severe OSA, we find screening based on the questionnaires suboptimal and suggest that OSA screening should be performed using home sleep monitoring devices.
2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Diabetology Practice Diainmed s.r.o., Slunecna 2, Prague, Czech Republic.
Katerina
K
Westlake
2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague, Czech Republic.
Andrea
A
Plihalova
Neurology and Sleep Laboratory, INSPAMED s.r.o., Kubelikova 46, Prague, Czech Republic.
Martin
M
Pretl
Sleep Medicine Department, National Institute of Mental Health, Topolová 748, Klecany, Czech Republic.
Zuzana
Z
Lattova
2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague, Czech Republic. Electronic address: jan.polak@lf3.cuni.cz.
Jan
J
Polak
D000368:Aged; D000704:Analysis of Variance; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000145:classification / Q000150:complications / Q000175:diagnosis*; D011795:Surveys and Questionnaires / Q000592:standards*
Berlin questionnaire; Cardiovascular risk factors; Diabetes; Obstructive sleep apnea; STOP-Bang questionnaire; Screening