Article Text
Abstract
Objective Obstructive sleep apnea (OSA) and diabetes are frequent comorbid conditions. Screening for OSA in patients with diabetes is recommended but the frequency with which this is done in clinical practice is unknown. The objectives of this quality improvement initiative were to identify clinician and patient perceptions regarding OSA and to identify the prevalence of patients at high risk for OSA (HROSA).
Methods A quality improvement initiative was conducted to query clinicians and patients attending a specialty diabetes clinic regarding attitudes and beliefs related to OSA. The Berlin Questionnaire was embedded in patient questionnaires to identify patients as low risk for OSA (LROSA) or HROSA.
Results 35 clinicians completed questionnaires with >80% agreement that OSA contributed to blood pressure (BP), glycemic control, and diabetes complications and that screening is a shared responsibility with other physicians; but only 17% indicated regular screening due predominantly to insufficient time. Of 107 patients (26 type 1 diabetes mellitus (T1DM) and 81 type 2 diabetes mellitus (T2DM)), 30% were aware that OSA could affect diabetes outcomes. The prevalence of known OSA, LROSA, and HROSA was similar in T1DM (15%, 50%, 35%) and T2DM (36%, 33%, 31%, respectively) (p=0.21). 59% of all HROSA patients indicated that OSA screening had never been discussed with them.
Conclusions These results demonstrate that providers, but not patients, are knowledgeable about the importance of OSA screening, but insufficient time is a major barrier to wider screening. Approximately, 30% of patients with T1DM and T2DM were identified as HROSA supporting the need for procedures that improve detection and treatment.
- diabetes mellitus
- obstructive sleep apnea
- clinical practice pattern
- quality improvement
- health beliefs
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Footnotes
Competing interests MTK has served on an advisory board for Novo Nordisk. PJS discloses the following research grant support: RO1 HL107370, RO1 DK096028302, RO1 HL120354301A1, 1UH2HL125103301, 5UL1TR000005309, PA DOH MD3023384 and American Sleep Medicine Foundation and the following industry relations: Philips 3 Respironics, ResMes, Inspire Medical Systems, PinMed, NFL, Emmi Solutions and Jazz Pharmaceuticals. SI, JN and EC have no conflict of interests to declare.
Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Provenance and peer review Not commissioned; internally peer reviewed.