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Obstructive sleep apnoea is associated with diabetes in sleepy subjects
  1. P E Ronksley1,
  2. B R Hemmelgarn1,2,
  3. S J Heitman1,2,
  4. P J Hanly2,
  5. P D Faris1,
  6. H Quan1,
  7. W H Tsai1,2
  1. 1
    Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada
  2. 2
    Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Canada
  1. Correspondence to Dr W H Tsai, Departments of Medicine and Community Health Sciences, Rockyview General Hospital, 7007 14th St SW, Calgary, Alberta, Canada, T2V 1P9; tsai{at}


Background: Although obstructive sleep apnoea (OSA) has been linked to insulin resistance and glucose intolerance, it is unclear whether there is an independent association between OSA and diabetes mellitus (DM) and whether all patients with OSA are at risk. The objective of this study was to determine the association between OSA and DM in a large cohort of patients referred for sleep diagnostic testing.

Methods: A cross-sectional analysis of participants in a clinic-based study was conducted between July 2005 and August 2007. DM was defined by self-report and concurrent use of diabetic medications (oral hypoglycaemics and/or insulin). Sensitivity analysis was performed using a validated administrative definition of diabetes. OSA was defined by the respiratory disturbance index (RDI) using polysomnography or ambulatory monitoring. Severe OSA was defined as an RDI ⩾30/h. Subjective sleepiness was defined as an Epworth Sleepiness Scale score ⩾10.

Results: Complete data were available for 2149 patients. The prevalence of DM increased with increasing OSA severity (p<0.001). Severe OSA was associated with DM following adjustment for patient demographics, weight and neck circumference (odds ratio (OR) 2.18; 95% CI 1.22 to 3.89; p<0.01). Following a stratified analysis, this relationship was observed exclusively in sleepy patients (OR 2.59 (95% CI 1.35 to 4.97) vs 1.16 (95% CI 0.31 to 4.37) in non-sleepy patients).

Conclusions: Severe OSA is independently associated with DM in patients who report excessive sleepiness. Future studies investigating the impact of OSA treatment on DM may wish to focus on this patient population.

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  • Funding This study was supported by operating grants from the Alberta Heritage Foundation for Medical Research and the Calgary Health Region. BRH and HQ are supported by New Investigator Awards from the Canadian Institutes of Health Research and by Population Health Investigator Awards from the Alberta Heritage Foundation for Medical Research. PER is supported by the Achievers in Medicine Graduate Scholarship.

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

  • Ethics approval This study was approved by the ethics review board of the University of Calgary.