Prevalence of obstructive sleep APNEA risk status among ambulatory type 2 diabetes mellitus patients at Moi Teaching and Referral Hospital

Abstract

Background: Obstructive Sleep Apnoea (OSA) is a prevalent yet under-diagnosed sleep-related breathing disorder associated with considerable metabolic and cardiovascular morbidity. In patients with Type 2 Diabetes Mellitus (T2DM), the coexistence of OSA exacerbates glycemic dysregulation and amplifies the risk of diabetic complications. Despite the global evidence highlighting this bidirectional relationship, data from Kenyan diabetic populations remain limited. Objectives: To determine the prevalence of OSA risk status and associated factors among ambulatory T2DM patients attending the diabetes outpatient clinic at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya, using the Berlin Questionnaire. Methods: A hospital-based cross-sectional study was conducted in 334 adult T2DM patients. Participants were systematically sampled and screened for risk of OSA using the Berlin Questionnaire. Data on sociodemographic variables, metabolic markers such as glycated hemoglobin A1C (HbA1c), anthropometric indices such as Body Mass Index (BMI), neck circumference and anatomical factors such as nasal obstruction, and Mallampati score were collected. Bivariate analyses and multivariate logistic regression were performed to identify independent predictors of high OSA risk, with significance set at p < 0.05. Results: The prevalence of OSA risk status was 41.3%, highlighting a substantial burden among patients with type 2 diabetes mellitus. Poor glycemic conrol (HBA1C > 8%) was independently associated with more than a two-fold increase in the odds of high OSA risk, while overweight status conferred a 1.5-fold higher likelihood of OSA risk. Anatomical abnormalities such as deviated nasal septum and nasal polyps, as well as advancing age above 50 years and higher Mallampati scores, were significantly associated with OSA risk. In contrast, hypertension demonstrated an inverse association with OSA risk, suggesting a potential protective effect, although this finding may reflect residual confounding or limitations within the regression Conclusion: Nearly half of patients with type 2 diabetes mellitus at MTRH were at high risk for obstructive sleep apnoea, with significant associations observed between poor glycemic control, overweight status, nasal obstruction and elevated Mallampati scores. These findings are consistent with international evidence of demonstrating a multifactorial interraction between metabolic and anatomical determinants of OSA risk among populations with type 2 diabetes.. Recommendations: Incorporating routine screening for obstructive sleep apnea (OSA) into standard diabetes care. In addition, further research is required to develop and assess practical, cost-effective and evidence-based strategies for the screening and management of OSA.