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172

VOLUME 11 NUMBER 4 • NOVEMBER 2014

LEARNING FROM PRACTICE

SA JOURNAL OF DIABETES & VASCULAR DISEASE

The Epworth Sleepiness scale is a validated questionnaire to

assess the severity of sleepiness symptoms and is a simple screening

tool that could be used for patients suspected of SDB. However,

it should be borne in mind that although hypersomnolence

symptoms may relate to micro-arousals and to changes in sleep

architecture, it is non-specific and not always associated with OSA.

Therefore it is not sufficiently discriminating to diagnose OSA.

24

Depending on services available, a referral for sleep studies or to

the relevant sleep team for further assessment may be necessary.

Lifestyle recommendations such as weight reduction for overweight

or obese patients, smoking cessation, avoidance of sedatives,

decreasing alcohol consumption and proper sleep hygiene may be

recommended.

The treatment of OSA aims to reduce daytime sleepiness. CPAP is

recommended as a treatment option for individuals with moderate

or severe symptomatic OSA given the effects on bloodpressure,

implications for quality of life and driving safety.

25

There is evidence

that non-sleepy OSA patients treated with CPAP have not shown

effective decreases in blood pressure and it is possible that non-

sleepy asymptomatic OSA patients may face a different level of risk

from those who are sleepy.

26

This study has several limitations. Despite public announcements

of the survey and engaging the help of organisations including the

ABCD, the YDEF and Diabetes UK, which has an estimated 6 000

professional members (Richard Elliot, personal communication, 17

June 2014), there were only 62 respondents, so there is likely to

be a significant non-response bias given the limited sample size. A

higher response rate using a validated questionnaire would increase

confidence in the generalisability of the findings.

Nevertheless awareness of OSA and taking it into consideration

as part of our holistic patient assessment are very important.

Conflict of interest

None

Acknowledgements

We thank Dr Richard Elliot, Diabetes UK for

assisting in the conduct of the research. We also thank Diabetes

UK, the Association of British Clinical Diabetologists, and the Young

Diabetologists and Endocrinologists’ Forum (YDEF) for supporting

this project.

Funding

This research was supported by the University of Liverpool,

University Hospital Aintree and St Helens & Knowsley Teaching

Hospitals NHS Trust.

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Key messages

• OSA is a common co-morbidity in diabetes and obesity

• A history of snoring, excessive daytime somnolence and

witnessed apnoeic events may be suggestive of OSA

• A pro-active approach is encouraged to identify patients at

risk of OSA