International Journal of Scientific and Research Publications, Volume 2, Issue 5, May 2012 1 ISSN 2250-3153 www.ijsrp.org Prevalence and Predictors of Excessive Daytime Sleepiness in Obese Type 2 Diabetic Patients– A Tertiary Centre Experience M.L Patel 1 , Rekha Sachan 2 , A. K. Verma 3 , S.C.Chaudhary 1 Assistant Professor, Department of Medicine, CSM Medical University, Lucknow 1 Associate Professor, Department of Obstetrics & Gynaecology, CSM Medical University, Lucknow 2 Assistant Professor, Department of Pulmonary Medicine, CSM Medical University, Lucknow 3 Abstract Aim: The objective of this study was to determine the prevalence and to evaluate factors associated with excessive daytime sleepiness as a symptom of sleep apnea syndrome (SAS) in type 2 diabetic patients. Material and Methods: The Berlin Sleep Apnea (BSA) questionnaire was administered to 242 consecutive patients with type 2 diabetes and a body mass index (BMI) ≥30kg/m 2 . High or low risk was considered pathologic. Results: Twenty-two percent of diabetic obese patients had excessive daytime sleepiness. Compared with patients without daytime sleepiness, the median HbA1c was increased with 1.3% (p<0.001) in sleepy patients. Waist circumference (odds ratio:1.04, 95% CI (1.01-1.07), BMI (odds ratio: 1.1, 95%CI (1.04-1.18) and HbA1c (odds ratio 1.29, 95%CI (1.07-1.56) were significantly related to the presence of excessive daytime sleepiness. Conclusion: Excessive daytime sleepiness as a symptoms of suspected SAS is highly prevalent in patients with type 2 diabetes and should be systematically screened for, especially among obese individuals with higher waist circumference, higher BMI and higher HbA1c values. Index Terms- Daytime sleepiness, Obesity, Diabetes. I. INTRODUCTION ecently, there has been increasing recognition that sleep- disordered breathing is frequently associated with type 2 diabetes, and the observed association has important clinical and public health implications 1 . A possible explanation for this association is the presence of shared risk factors such as obesity, visceral adiposity and advancing age. Sleep apnea syndrome (SAS) represents a constellation of signs and symptoms caused by repetitive episodes of absence (apnea) or reduction (hypopnea) of the airflow at the nose/ mouth during the sleep, associated with fall in oxygen saturation, arousals and awakenings 2 . Sleep apnea is a general term encompassing two distinct entities, central sleep apnea and obstructive sleep apnea (OSA). OSA syndrome is characterized by the repetitive episodes of upper airway obstruction during sleep, that results in sleep fragmentation (frequent arousals to reestablish breath), recurrent hypoxemia, hypercapnia. These can lead to neurocognitive decline, cardiovascular complications, and eventually death 3 . Excessive daytime sleepiness is usually assumed to be one of the clinical symptoms of sleep disturbances (eg, sleep apnea). Sleep deprivation, sedating medications, certain medical and psychiatric conditions represents other causes of excessive daytime sleepiness 4 . Another cause of the daytime sleepiness in patients with diabetes are the increased levels of inflammatory cytokines 5 . In present, these cytokines are accepted as mediators of sleepiness, and they are closely involved in the pathogenesis of type 2 diabetes 6 . The Berlin Sleep Apnea (BSA) represents a validated questionnaire consist of three categories related to the risk of having sleep apnea. Patients can be classified in to high risk or low risk based on their responses to the individual items and their over all scores in the symptom categories. High risk if there are two or more categories are present. Low risk if there is only one or no categories 7 . The aim of this study was to determine the prevalence of excessive daytime sleepiness as a symptom of sleep apnea syndrome in patients with obesity and type 2 diabetes attending outdoor clinic and to evaluate factors associated with the presence of excessive daytime sleepiness in this group of patients. II. MATERIAL AND METHODS Between July 2009 and June 2011 patients with type 2 diabetes and obesity presenting for routine visit in an outpatient clinic of Diabetes, at CSMMU, Lucknow were participated in the study. All study participants had type 2 diabetes (defined according to World Health Organization Criteria) 8 , a body mass index (BMI) ≥30kg/m 2 and were enrolled in this study after an informed consent. Patients were not included in the study if they had type 1 diabetes, other specific causes of diabetes, current diagnosis of SAS, or refused to sign an informed consent form. The variance was estimated based on a pilot study 9 , which revealed a prevalence of symptomatic sleep apnea of 20%. We calculated that a sample size of 246 patients with type 2 diabetes and obesity will be needed to obtain a 95% confidence interval and ±5% precision, if the estimated prevalence of symptoms of sleep apnea will be at least 20%. After the correction for finite population, we obtained a sample size of 242 patients. The Berlin Sleep Apnea (BSA) represents a validated questionnaire consist of three categories related to the risk of having sleep apnea. Patients can be classified in to high risk or R