Skip to main content
SpringerLink
Log in

Obstructive sleep apnea and excessive daytime sleepiness among patients with type 2 diabetes mellitus: a single-center study from Iran

  • Original Article
  • Published:
International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) are common in patients with type 2 diabetes mellitus (T2DM). This study was aimed to evaluate the prevalence and risk factors of the OSA and EDS among Iranian patients with T2DM. We conducted a cross-sectional study on randomly selected 173 patients with T2DM aged 30 to 65. We assessed daytime sleepiness using the Epworth sleepiness scale and risk of OSA using the STOP-BANG questionnaire. Further information was demographic and anthropometric characteristics plus metabolic profile. Of all, 122 (74 %) patients were at high risk for OSA and 78 (45 %) patients suffered from EDS. Patients at high risk for OSA were older and had higher BMI, waist circumference, neck circumference, systolic, and diastolic blood pressure. In addition, men were significantly at a higher risk for OSA than women. Logistic regression revealed that age, male sex, and neck circumference were independent predictors of risk for OSA. The only independent predictor of EDS was age. Patients with T2DM are at high risk for OSA; also, daytime sleepiness is highly prevalent in this population. Our results indicated that the evaluation of OSA, EDS, and their risk factors should be included in the clinical management of patients with T2DM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177:1006–14.

    Article  PubMed Central  PubMed  Google Scholar 

  2. The Report of an American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22:667–89.

    Google Scholar 

  3. AlGhanim N, Comondore VR, Fleetham J, Marra CA, Ayas NT. The economic impact of obstructive sleep apnea. Lung. 2008;186:7–12.

    Article  PubMed  Google Scholar 

  4. Mannarino MR, Di Filippo F, Pirro M. Obstructive sleep apnea syndrome. Eur J Intern Med. 2012;23:586–93.

    Article  PubMed  Google Scholar 

  5. Skarfors ET, Selinus KI, Lithell HO. Risk factors for developing non-insulin dependent diabetes: a 10 year follow up of men in Uppsala. BMJ. 1991;303:755–60.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Meslier N, Gagnadoux F, Giraud P, Person C, Ouksel H, Urban T, et al. Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J. 2003;22:156–60.

    Article  CAS  PubMed  Google Scholar 

  7. King HAR, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.

    Article  CAS  PubMed  Google Scholar 

  8. West SD, Nicoll DJ, Stradling JR. Prevalence of obstructive sleep apnoea in men with type 2 diabetes. Thorax. 2006;61:945–50.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Kashine S, Kishida K, Funahashi T, Nakagawa Y, Otuki M, Okita K, et al. Characteristics of sleep-disordered breathing in Japanese patients with type 2 diabetes mellitus. Metabolism. 2010;59:690–6.

    Article  CAS  PubMed  Google Scholar 

  10. Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab. 2005;90:4510–5.

    Article  CAS  PubMed  Google Scholar 

  11. Brooks B, Cistulli PA, Borkman M, Ross G, McGhee S, Grunstein RR, et al. Obstructive sleep apnea in obese noninsulin-dependent diabetic patients: effect of continuous positive airway pressure treatment on insulin responsiveness. J Clin Endocrinol Metab. 1994;79:1681–5.

    CAS  PubMed  Google Scholar 

  12. American Diabetes Association. Standards of medical care in diabetes—2011. Diabetes Care. 2011;34:S11–61.

    Article  PubMed Central  Google Scholar 

  13. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812–21.

    Article  PubMed  Google Scholar 

  14. Sadeghniiat Haghighi K, Montazeri A, Khajeh Mehrizi A, Aminian O, Sedaghat M. Diagnostic accuracy of the STOP, STOP-BANG and simplified STOP-BANG for detection of obstructive sleep apnea in sleep clinics. Proceedings of the X World Congress on Sleep Apnea (WCSA). 2012.

  15. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–55.

    CAS  PubMed  Google Scholar 

  16. Sadeghniiat Haghighi K, Montazeri A, Khajeh Mehrizi A, Aminian O, Rahimi Golkhandan A, Saraei M, et al. The Epworth Sleepiness Scale: translation and validation study of the Iranian version. Sleep Breath. 2013;17:419–26.

    Article  PubMed  Google Scholar 

  17. Iyer SR. Sleep and type 2 diabetes mellitus—clinical implications. JAPI. 2012;60:43.

    Google Scholar 

  18. Coughlin SR, Mawdsley L, Mugarza JA, Wilding JP, Calverley PM. Cardiovascular and metabolic effects of CPAP in obese males with OSA. Eur Respir J. 2007;29:720–7.

    Article  CAS  PubMed  Google Scholar 

  19. Shim U, Lee H, Oh JY, Sung YA. Sleep disorder and cardiovascular risk factors among patients with type 2 diabetes mellitus. Korean J Intern Med. 2011;26:277–84.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.

    Article  CAS  PubMed  Google Scholar 

  21. Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O. Sleep-disordered breathing in community-dwelling elderly. Sleep. 1991;14:486–95.

    PubMed Central  CAS  PubMed  Google Scholar 

  22. Pillar G, Shehadeh N. Abdominal fat and sleep apnea: the chicken or the egg? Diabetes Care. 2008;31:303–9.

    Article  Google Scholar 

  23. Barone MT, Menna-Barreto L. Diabetes and sleep: a complex cause-and-effect relationship. Diabetes Res Clin Pract. 2011;91:129–37.

    Article  PubMed  Google Scholar 

  24. Xie A, Skatrud JB, Puleo DS, Morgan BJ. Exposure to hypoxia produces long-lasting sympathetic activation in humans. J Appl Physiol. 2001;91:1555–62.

    CAS  PubMed  Google Scholar 

  25. Chaput JP, Despres JP, Bouchard C, Tremblay A. Short sleep duration is associated with reduced leptin levels and increased adiposity: results from the Quebec family study. Obesity. 2007;15:253–61.

    Article  CAS  PubMed  Google Scholar 

  26. Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141:846–50.

    Article  PubMed  Google Scholar 

  27. O’Connor C, Thornley KS, Hanly PJ. Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med. 2000;161:1465–72.

    Article  PubMed  Google Scholar 

  28. Haight JS, Djupesland PG. Nitric oxide (NO) and obstructive sleep apnea (OSA). Sleep Breath. 2003;7:53–62.

    Article  PubMed  Google Scholar 

  29. Weiss JW, Liu Y, Li X, Ji ES. Nitric oxide and obstructive sleep apnea. Respir Physiol Neurobiol. 2012;184:192–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None

Author information

Authors and Affiliations

  1. Occupational Sleep Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Khosro Sadeghniiat-Haghighi, Ahmad Khajeh-Mehrizi & Farhad Fathi

  2. Center for Research on Occupational Diseases, Tehran University of Medical Sciences, Tehran, Iran

    Khosro Sadeghniiat-Haghighi

  3. Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Reza Mohajeri-Tehrani & Bagher Larijani

  4. School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

    Farzad Saremi-Rasouli

  5. Brain and Spinal Injury Repair (BASIR) Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Mahsa Ghajarzadeh

Authors
  1. Khosro Sadeghniiat-Haghighi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammad Reza Mohajeri-Tehrani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmad Khajeh-Mehrizi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Farhad Fathi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Farzad Saremi-Rasouli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mahsa Ghajarzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bagher Larijani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmad Khajeh-Mehrizi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sadeghniiat-Haghighi, K., Mohajeri-Tehrani, M.R., Khajeh-Mehrizi, A. et al. Obstructive sleep apnea and excessive daytime sleepiness among patients with type 2 diabetes mellitus: a single-center study from Iran. Int J Diabetes Dev Ctries 35 (Suppl 2), 189–193 (2015). https://doi.org/10.1007/s13410-014-0281-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13410-014-0281-0

Keywords

Search

Navigation