Neck Grasp Predicts Obstructive Sleep Apnea in Type 2 Diabetes Mellitus

P J Edmonds, K Gunasekaran, L C Edmonds, P J Edmonds, K Gunasekaran, L C Edmonds

Abstract

Aims: Obstructive sleep apnea (OSA) is a common disorder with high morbidity, mortality, and an increasing prevalence in the general population. It has an even higher prevalence among individuals with type 2 diabetes mellitus (DM). The snoring, tiredness, observed apnea, high blood pressure, body-mass-index, age, neck circumference and male gender (STOP-BANG) questionnaire and Berlin Questionnaire can be cumbersome in clinical practice and require subjective data on sleepiness. We proposed prospectively studying a primary care population with type 2 DM comparing neck grasp, neck circumference, and common screening questionnaires to identify OSA.

Methods: Persons with a diagnosis of type 2 DM were recruited from a primary care clinic. Participants were screened using Easy Sleep Apnea Predictor (ESAP), STOP-Bang questionnaire, and Berlin questionnaire. A positive ESAP was defined as a 1cm gap when a patient encircled their hands around the neck. All subjects underwent in-laboratory PSG testing.

Results: Forty-three participants were enrolled and the prevalence of OSA was 90.7% (AHI ≥ 5). The median BMI was 38.0. The prevalence of mild OSA by PSG (AHI 5-14) was 27.9%, moderate OSA (AHI 15-29) was 25.6%, and severe OSA (AHI >30) was 37.2%. For mild OSA both ESAP and neck circumference showed 100% specificity.

Conclusions: This study reinforces the need for screening diabetic persons for obstructive sleep apnea. ESAP and neck circumference are useful for identifying persons with type 2 DM who are at risk for OSA. Together these findings could improve recognition of OSA in persons at risk for cardiovascular disease. Trial Registration of "Neck grasp as a predictor of Sleep Apnea," https://ichgcp.net/clinical-trials-registry/NCT02474823, Clinical Trials.gov Identifier, is NCT02474823.

Figures

Figure 1
Figure 1
(a) Easy sleep apnea predictor (ESAP) entails placing both thumbs together at the anterior of the neck and encircling the fingers in the posterior. (b) Positive ESAP is shown. The patient is unable to encircle their neck resulting in at least a 1cm gap between fingertips. (c) Negative ESAP is shown. The patient is able to encircle their neck defined as touching fingertips in the posterior neck. Figures reproduced with author permission [17].

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Source: PubMed

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