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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