Assessment of risk for obstructive sleep apnea by using STOP-BANG questionnaire in type 2 diabetes mellitus

  • A. BamanikarEmail author
  • S. Duggal
  • S. Sharma
  • S. Rana
Original Article



Obstructive sleep apnea (OSA) is a disorder of breathing during sleep. It typically presents as repetitive short episodes of partial or complete stoppage of breathing due to upper airway obstruction during sleep and awakens the person. The association between OSA, type 2 diabetes mellitus (T2DM), and obesity has been suggested in numerous studies. It is expected that the prevalence of OSA will increase with rising number of T2DM. Unfortunately, many of the patients are not aware about OSA and also remain undiagnosed. The questionnaire-based OSA screening for risk stratification is validated in many studies in diverse populations. This approach can help early detection of OSA in T2DM. Hence, the study was undertaken to find out prevalence of OSA in T2DM patients by validated screening questionnaire, STOP-BANG. Objective of the study is to assess the prevalence of OSA among the type 2 diabetic patients attending tertiary care hospital.


This was a questionnaire-based cross-sectional study done in a tertiary care hospital affiliated to a medical college in Maharashtra. The number of respondents were 374 attending diabetic clinic, who were interviewed using STOP-BANG questionnaire and assessed on four symptoms and four signs to stratify the OSA risk.


47.3% of type 2 diabetics had STOP-BANG score ≥ 3, which is high-risk score for OSA


Type 2 diabetics are at risk of OSA and STOP-BANG questionnaire could detect nearly 50%. The screening is simple and can be used in primary care setting. These sub-set of patients can be subjected to gold standard polysomnography at home or in hospital for further management.


Obstructive sleep apnea STOP-BANG Type 2 diabetes 



Authors thank the Department of Community Medicine staff for their guidance in statistical aspects of the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institutional Ethics Committee.


  1. 1.
    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(17):1230–5.CrossRefGoogle Scholar
  2. 2.
    Punjabi NM, Sorkin JD, Katzel LI, Goldberg AP, Schwartz AR, Smith PL. Sleep-disordered breathing and insulin resistance in middle – aged and overweight men. Am J Respir Crit Care Med. 2002;165(5):677–82.CrossRefGoogle Scholar
  3. 3.
    Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165:670–6.CrossRefGoogle Scholar
  4. 4.
    Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:136–43.CrossRefGoogle Scholar
  5. 5.
    The National heart lung and blood institute diseases [Internet]; Accessed 19 Mar 2019
  6. 6.
    Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, et al. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009;32(6):1017–9.CrossRefGoogle Scholar
  7. 7.
    Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137:711–9.CrossRefGoogle Scholar
  8. 8.
    Aronsohn RS, Whitmore H, Van Cauter E, Tasali E. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med. 2010;181:507–13.CrossRefGoogle Scholar
  9. 9.
    McDaid C, Duree KH, Griffin SC, Weatherly HL, Stradling JR, Davies RJ, et al. A systematic review of continuous positive airway pressure for obstructive sleep apnea-hypopnea syndrome. Sleep Med Rev. 2009;13:427–36.CrossRefGoogle Scholar
  10. 10.
    Tuomilehto HP, Seppa JM, Partinen MM, Peltonen M, Gylling H, Tuomilehto JO, et al. Lifestyle intervention with weight reduction. Am J Crit Care Med. 2009;179:320–7.CrossRefGoogle Scholar
  11. 11.
    Johansson K, Neovius M, Lagerros YT, Harlid R, Rosser S, Granath F, et al. Effect of a very lose energy diet on moderate and severe obstructive sleep apnea in obese men: a randomized controlled trial. BMJ. 2009;399:b4609.CrossRefGoogle Scholar
  12. 12.
    Heffner JE, Rozenfeld Y, Kai M, Stephena EA, Brown LK. Prevalence of diagnosed sleep apnea among patients with type 2 diabetes in primary care. CHEST. 2012;141(6):1414–21.CrossRefGoogle Scholar
  13. 13.
    The George Institute for Global Health [Internet]; (DOSA Study). Accessed 19 Mar 2019.
  14. 14.
    Einhorn D, Stewart DA, Erman MK, Gordon N, Philis-Tsimikas A, Casal E. Prevalence of sleep apnea in a population of adults with type 2 diabetes mellitus. Endocr Pract. 2007;13:355–62.CrossRefGoogle Scholar
  15. 15.
    Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7:1311–22.Google Scholar
  16. 16.
    Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217–39.CrossRefGoogle Scholar
  17. 17.
    Gibson GJ. Obstructive sleep apnea syndrome: underestimated and undertreated. Br Med Bull. 2005;72:49–65.CrossRefGoogle Scholar
  18. 18.
    Olson AL, Zwillich C. The obesity hypoventilation syndrome. Am J Med. 2005;118:948–56.CrossRefGoogle Scholar
  19. 19.
    Sharma SK, Ahluwalia G. Epidemiology of adult obstructive sleep apnea syndrome in India. Indian J Med Res. 2010;131:171–5.Google Scholar
  20. 20.
    Udwadia ZF, Doshi AV, Lonkar SG, Singh CI. Prevalence of sleep disordered breathing and sleep apnea in middle-aged urban Indian men. Am J Respir Crit Care Med. 2004;169:168–73.CrossRefGoogle Scholar
  21. 21.
    Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest. 2006;130:149–56.CrossRefGoogle Scholar
  22. 22.
    Vijayan VK, Patial K. Prevalence of obstructive sleep apnea syndrome in Delhi, India. Chest. 2006;130:92S.CrossRefGoogle Scholar
  23. 23.
    Reddy EV, Kadhivaran T, Mishra HK, Sreenivas V, Handa KK, Sinha S, et al. Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: a community-based study. Sleep Med. 2009;10:913–8.CrossRefGoogle Scholar
  24. 24.
    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(5):812–21.CrossRefGoogle Scholar
  25. 25.
    Wang TYS, Ning S, Wang NM. STOP-Bang questionnaire screening for obstructive sleep apnea among Chinese patients with type 2 diabetes mellitus. Arch Med Sci. 2018;14(5):971–8.CrossRefGoogle Scholar
  26. 26.
    Shaw JE, Punjabi NM, Wilding JP, Alberti GMM, Zimmet PZ. Sleep-disordered breathing and type 2 diabetes, a report from the international diabetes federation taskforce on epidemiology and prevention. Diabetes Res Clin Pract. 2008;81(1):2–12.CrossRefGoogle Scholar
  27. 27.
    Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire, a practical approach to screen for obstructive sleep apnea. CHEST. 2016;149(3):631–8.CrossRefGoogle Scholar

Copyright information

© Research Society for Study of Diabetes in India 2019

Authors and Affiliations

  1. 1.Department of MedicineDr. D Y Patil Medical College, Hospital and Research CenterPimpriIndia

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