1. ESAP study (simple neck grasp) as a predictor of OSA in Patients with Type 2 Diabetes Kulothungan Gunasekaran MBBS, Peter Edmonds BS, Jennifer Victory RN CCRC, Catherine Gilmore RN CCRC, Lee Edmonds MD Mary Imogene Bassett Hospital, Cooperstown, NY, United States.
Introduction
ESAP
Results
OSA is a common disorder affecting 3-7% of the adult population which often goes undiagnosed.
OSA is independently associated with alterations in glucose metabolism and places patients at an increased risk of the development of type 2 diabetes
It is often missed in a busy practice. A
Polysomnogram Results n %
Negative for OSA (AHI<5) 4
9.30
Positive for OSA (AHI≥5 ) 39
90.70
Screening Test
Sensitivity
Specificity
Positive Predictive Value
Negative Predictive Value
ESAP
56.4
75.0
95.7
15.0
Stop-Bang ≥ 3
87.2
0.0
89.5
Berlin High Risk
79.5
88.6
BMI ≥ 35
69.2
96.4
20.0
Neck Circumference
48.7
100.0
16.7
HST
25.0
Objectives
Our previous pilot study on the use of self neck grasp, ESAP (Easy Sleep Apnea Predictor), showed a positive maneuver (unable to wrap hands completely around neck) to be 100% predictive of sleep apnea in a sleep clinic population.
We now would like to compare ESAP to other tests used to diagnose and screen for Sleep Apnea in type 2 diabetics. The tests will included Home Sleep Testing, sleep questionnaires Berlin and STOP-BANG and polysomnogram (PSG).
The goal is to show that ESAP is a reliable method and would aid in early diagnosis and treatment of the diabetic population.
The easy sleep apnea predictor is performed by touching the thumbs in the anterior of the neck and encircling the neck with the digits in the posterior
Subject Characteristics
Conclusion
High prevalence of OSA in Type 2 diabetics  (about 90%)
80% of OSA is undiagnosed; ESAP is helpful for recognition of disease (PPV)
ESAP is objective, and very easy
Neck circumference is better, slightly more difficult to do
All diabetics should be screened for OSA n %
Male 20
46.51
Female 23
53.49
BMI≤35 15
34.88
BMI>35 28
65.12
Snoring
Unsure 5
11.63 No 1
2.33
Yes 37
86.05
ESAP (+)
ESAP (-)
Stop-Bang ≥ 3 38
88.37
Stop-Bang<3
Berlin High Risk 35
81.40
Berlin Low Risk 8
18.60
Neck Circumference (+) 19
44.19
Neck Circumference (-) 24
55.81
HST (+) 27
62.79
HST (-) 16
37.21
Methods B
Participants were randomly recruited from Endocrinology clinic during their routine visit.
Visit 1: Consented, ESAP test, Berlin Sleep Questionnaire & STOP-BANG questionnaire and data collection.
Visit 2 : PSG
Visit 3: Home sleep study (HST)
References
1-Foster, et al. Diabetes Care June 2009 vol. 32 no
2-Leong, Wen Bun et al. 'Hypoxemia And Glycemic Control In Type 2 Diabetes Mellitus With Extreme Obesity'. The Journal of Clinical Endocrinology & Metabolism 99.9 (2014): E1650-E1654. Web.
3-Cass AR, et al. 'Risk Of Obstructive Sleep Apnea In Patients With Type 2 Diabetes Mellitus. Fam Med. 2013 Jul- Aug;45(7):
4-SR, Iyer. 'Sleep And Type 2 Diabetes Mellitus- Clinical Implications. J Assoc Physicians India. 2012 Oct;60:42-7.
5- Tamura, A., Kawano, Y., Watanabe, T. and Kadota, J. (2008). Relationship between the severity of obstructive sleep apnea and impaired glucose metabolism in patients with obstructive sleep apnea. Respiratory Medicine, 102(10), pp
Inclusion Criteria:
18 – 70 years old regardless of gender
Confirmed diagnosis of Type 2 diabetes
Exclusion Criteria:
Unstable Heart failure ,COPD
Neuromuscular disease
Mental disorders which would interfere with following directions
Persons who are already diagnosed with OSA or persons who have been using CPAP or BiPAP.
Special thanks to:
Ms. Melissa Scribani for her assistance with statistical analysis and the
E. Donnall Thomas Committee for guidance and funding.
*neck circumference >16 inches for females, >17 inches for males