Elevated obstructive sleep apnoea risk score is associated with poor healing of diabetic foot ulcers: a prospective cohort study

• Published in: Diabetic medicine 2018-11, Vol.35 (11), p.1494-1498
• Main Authors: Maltese, G., Fountoulakis, N., Drakatos, P., Shah, D., Patel, K., Sharma, A., Thomas, S., Pengo, M. F., Karalliedde, J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Apnea; Cohort analysis; Cohort Studies; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - physiopathology; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - physiopathology; Diabetic Foot - complications; Diabetic Foot - diagnosis; Diabetic Foot - epidemiology; Diabetic Foot - physiopathology; Feet; Female; Foot diseases; Health risk assessment; Humans; Leg ulcers; Male; Middle Aged; Prognosis; Prospective Studies; Research Design; Risk Factors; Sleep; Sleep apnea; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - epidemiology; Sleep Apnea, Obstructive - physiopathology; Sleep deprivation; Sleep disorders; Ulcers; Wound Healing - physiology
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13780

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