Prevalence and Associations of Obstructive Sleep Apnea in South Asians and White Europeans with Type 2 Diabetes: A Cross-Sectional Study.
OBJECTIVE
To assess and compare obstructive sleep apnea (OSA) prevalence in South Asians and White Europeans with type 2 diabetes mellitus (T2DM). Secondary aims included exploring possible causes for observed ethnic differences.


METHODS
A cross-sectional study of patients with T2DM recruited from secondary care diabetes clinics. OSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/h using home-based, multi-channel respiratory monitoring.


RESULTS
Two hundred thirty-four patients (105 South Asian and 129 White Europeans) were studied. The prevalence of mild, moderate, and severe OSA in South Asians was 36.2% (n = 38/105), 9.5% (n = 10/105), and 5.7% (n = 6/105) respectively. After adjustment, OSA was associated with a higher body mass index in South Asians. OSA was significantly less common in South Asians compared to White Europeans (51.4% [54/105] versus 75.2% [97/129],P< .001). OSA was also less severe in South Asians compared to White Europeans (median [interquartile range]: AHI 5.1 [1.4-11.5] versus 8.5 [5.0-20.7] events/h,P< .001; time spent with oxygen saturations < 90% 0.5 [0.0-2.9]% versus 4.0 [0.7-14.4]%,P< .001). Logistic regression showed that only obesity measures explained the ethnic differences in OSA.


CONCLUSIONS
South Asians with T2DM are at considerable risk of OSA. OSA in South Asians was associated with obesity. However, OSA prevalence was lower in South Asians than in White Europeans. Obesity measures accounted for the observed ethnic differences. Examining factors contributing to ethnic differences will be important to inform screening and treatment strategies.
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.
Amin
A
Amin
Department of Respiratory Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom.
Asad
A
Ali
Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.
Quratul A
QA
Altaf
Department of Diabetes, Derby Teaching Hospitals NHS Foundation NHS Trust, Derby, United Kingdom.|Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Milan K
MK
Piya
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.|Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.|Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom.
Anthony H
AH
Barnett
Independent Epidemiology and Statistical Consultant, Epidemiology, Research Design and Statistical Consulting (ERDASC), Leicestershire, United Kingdom.
Neil T
NT
Raymond
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.|Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.
Abd A
AA
Tahrani
D001208:Asia / Q000453:epidemiology; D044466:Asian People / Q000706:statistics & numerical data*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D044465:White People / Q000706:statistics & numerical data*
ethnicity; obesity; sleep apnea; type 2 diabetes