To Screen for Obstructive Sleep Apnoea in Type 2 Diabetes and its Correlation with Hscrp Levels and Microvascular...

The prevalence of OSA is estimated to be 2-4% in the general population but high among diabetics. Since intermittent hypoxia has shown to exert adverse effects on glucose metabolism, OSA increases the risk of developing T2DM and contributes to poor glycemic control. Studies show that people with diabetes with severe OSA had higher HbA1c levels compared to non-apneic people. and implicated that OSA is a pro-inflammatory state wherein inflammatory markers like hsCRP are elevated. This study aims to study the correlation between OSA, hsCRP levels,glycemic control and presence of microvascular complications in diabetics. Material: This cross-sectional study was conducted in the hospitals attached to BMCRI. 100 patients with T2DM fitting the ADA criteria were screened by the STOP-BANG questionnair and were divided into OSA risk groups based on STOP-BANG score: 0-2, 3-4 and 5-8 indicated low, intermediate and high risk respectively. hsCRP levels were estimated. To assess microvascular complications, patients were subjected to Toronto clinical neuropathy score for diabetic neuropathy, fundoscopy for diabetic retinopathy and urine microalbumin creatinine ratio for nephropathy. Observation: Out of the 100 patients, 16 were in high risk, 68 in intermediate risk and 16 in low risk group.
There was a difference in HbA1c between the three OSAgroups indicating poorer glycemic control in high risk group which was statistically significant (p=0.04).
It was seen that mean hsCRP was higher in high risk group for OSA compared to other two groups indicating higher grade of inflammation in the high risk group. There was a statistically significant correlation between STOP BANG score [indicating OSA risk] and hsCRP(r=0.25,p=0.012) and STOP BANG SCORE and microvascular complications -Toronto neuropathy score [for diabetic neuropathy] (r=0.346,p=0.0004), UMCR [for diabetic nephropathy] (r=0.44,p=0.00001) and presence and absence of diabetic retinopathy(r=0.35,p=0.003). Conclusion: All diabetic patients should be screened for OSA which is simple and inexpensive. Those who fall in intermediate risk and high risk category showed poor glycemic status and more advanced microvascular complications. They should be subjected to polysomnography and treated for OSA to improve clinical outcomes.
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