How well are providers in diabetes clinics screening their patients for OSA? What are good tools for screening by history and physical examination?
A study of patients with diabetes, using a validated questionnaire to quantify OSA risk and sleepiness, revealed that 56% of patients reported snoring, 29% had fatigue upon awakening, and 34% reported feeling tired during wake time. The authors of the study concluded that 56% of those questioned were at high risk for OSA. This finding supports a call for greater vigilance in screening for OSA in patients with diabetes given the high prevalence of SDB found in this patient population. Certain screening tools may be helpful toward this end. BMI is proportional to OSA risk. Neck size > 17 inches is the most sensitive physical finding. Some craniofacial changes, such as retrognathia, also place a patient at high risk. Keep in mind a patient with OSA is often unaware of the neurocognitive changes that have developed slowly over time, and thus, he or she may not volunteer a history consistent with OSA, unless directly queried.