Prevalence of diagnosed sleep apnea among patients with type 2 diabetes in primary care

Chest. 2012 Jun;141(6):1414-1421. doi: 10.1378/chest.11-1945. Epub 2011 Nov 17.


Background: Although up to 90% of patients with type 2 diabetes mellitus (T2DM) have obstructive sleep apnea (OSA), the rate at which primary care providers diagnose OSA in patients with diabetes has not been assessed.

Methods: A retrospective, population-based, multiclinic study was performed to determine the proportion of patients with T2DM managed in primary care clinics who were given a diagnosis of OSA and to identify factors associated with an OSA diagnosis. Electronic health records of adult patients with a diagnosis of T2DM were reviewed for a coexisting diagnosis of OSA, and the diagnostic prevalence of OSA was compared with the expected prevalence.

Results: A total of 16,066 patients with diabetes with one or more primary care office visits in 27 primary care ambulatory practices during an 18-month period from 2009 to 2010 were identified. Analysis revealed that 18% of the study population received an OSA diagnosis, which is less than the 54% to 94% prevalence reported previously. The 23% prevalence of OSA among obese study patients was lower than the expected 87% prevalence. In a logistic model, male sex, BMI, several chronic conditions, and lower low-density lipoprotein levels and hemoglobin A1c identified patients more likely to carry an OSA diagnosis (likelihood ratio, χ(2) = 1,713; P < .0001).

Conclusions: Primary care providers underdiagnose OSA in patients with T2DM. Obese men with comorbid chronic health conditions are more likely to receive a diagnosis of OSA. Efforts to improve awareness of the association of OSA with T2DM and to implement OSA screening tools should target primary care physicians.

Publication types

  • Multicenter Study

MeSH terms

  • Body Mass Index
  • Chi-Square Distribution
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / physiopathology*
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Lipoproteins, LDL / blood
  • Logistic Models
  • Male
  • Middle Aged
  • Oregon / epidemiology
  • Prevalence
  • Primary Health Care
  • Retrospective Studies
  • Risk Factors
  • Sex Factors
  • Sleep Apnea Syndromes / diagnosis
  • Sleep Apnea Syndromes / epidemiology*
  • Sleep Apnea Syndromes / physiopathology*


  • Glycated Hemoglobin A
  • Lipoproteins, LDL
  • hemoglobin A1c protein, human