High prevalence of undiagnosed obstructive sleep apnoea in older adults with suboptimally-controlled type 2 diabetes and comorbid insomnia

Prim Care Diabetes. 2025 Dec 27:S1751-9918(25)00234-7. doi: 10.1016/j.pcd.2025.12.003. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to explore the prevalence of and clinical factors that identify obstructive sleep apnoea (OSA) in older adults with suboptimally-controlled type 2 diabetes (T2D) and comorbid insomnia.

METHODS: In this cross-sectional analysis, participants had age≥ 60 years, HbA_1c7.5-10 % and comorbid insomnia [insomnia severity index (ISI)> 14] with no prior history of OSA. All participants had home sleep apnoea testing done to measure apnoea-hypopnea index (AHI) and completed questionnaires including self-reporting of habitual snoring (≥3 nights/week), Four-Variable Screening Tool (FVST) comprising sex, body mass index (BMI), blood pressure and frequency of snoring, and excessive daytime sleepiness (EDS) [Epworth Sleepiness Scale (ESS) score ≥ 10]. Mild, moderate, and severe OSA were defined by AHI 5 to < 15, ≥ 15 to < 30, and ≥ 30 events/hour respectively.

RESULTS: Among 93 participants(mean age: 68.3 ± 4.8 years, 46 % men, BMI:24.8 ± 3.7 kg/m²), 87 % had OSA (43 % moderate-to-severe OSA) and 41.8 % had EDS. A diagnosis of OSA was associated with BMI[odd ratio(OR)1.233(95 %CI:1.015-1.498),p = 0.035], habitual snoring[8.107(2.192-29.977), p = 0.002], and FVST[1.386(1.132-1.698), p = 0.002]. The cut-off value of FVST≥ 5 or ESS≥ 10 had 100 % sensitivity and 20.8 (9.8-31.7)% specificity to detect moderate-to-severe OSA.

CONCLUSIONS: Older adults with suboptimally-controlled T2D and comorbid insomnia had high prevalence of undiagnosed OSA with FVST and EDS as potentially useful screening tools.

PMID:41457001 | DOI:10.1016/j.pcd.2025.12.003