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Elevated obstructive sleep apnoea risk score is associated with poor healing of diabetic foot ulcers: a prospective cohort study
Author(s) -
Maltese G.,
Fountoulakis N.,
Drakatos P.,
Shah D.,
Patel K.,
Sharma A.,
Thomas S.,
Pengo M. F.,
Karalliedde J.
Publication year - 2018
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13780
Subject(s) - medicine , diabetic foot , prospective cohort study , cohort , cohort study , foot (prosody) , diabetes mellitus , surgery , endocrinology , linguistics , philosophy
Aims To assess the prevalence of risk factors for obstructive sleep apnoea in people with diabetic foot ulcers and to determine whether this risk predicts diabetic foot ulcer healing. Methods We studied 94 consecutive people (69% men) with diabetic foot ulcers (Type 2 diabetes, n =66, Type 1 diabetes, n =28) attending a university hospital foot unit. All participants were screened for obstructive sleep apnoea using the STOP ‐ BANG questionnaire, with a score ≥4 identifying high risk of obstructive sleep apnoea. The primary outcome was poor diabetic foot ulcer healing, defined as diabetic foot ulcer recurrence (diabetic foot ulcers which healed and re‐ulcerated in same anatomical position) and/or diabetic foot ulcer persistence (no evidence of healing on clinical examination). All participants were evaluated at 12 months. Results Of the 94 participants, 60 (64%) had a STOP ‐ BANG score ≥4. Over 12 months, 27 participants with a score ≥4 had poor diabetic foot ulcer healing as compared to seven with a score <4 (45% vs 20.5%; P =0.025). A STOP ‐ BANG score ≥4 significantly increased the relative risk of poor healing more than twofold, independently of other risk factors in multivariable analyses. Conclusions There is a high prevalence of features and risk of obstructive sleep apnoea in people with diabetic foot ulcers. A STOP ‐ BANG score ≥4 predicts poor diabetic foot ulcer healing. Obstructive sleep apnoea may be a potential, modifiable risk factor/treatment target to improve diabetic foot ulcer outcomes.