Sleep apnoea and diabetic foot ulceration

NewsBot · Jun 3, 2015

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Undiagnosed severe sleep apnoea and diabetic foot ulceration – a case series based hypothesis: a hitherto under emphasized factor in failure to heal
P. R. J. Vas, R. Ahluwalia, A. B. Manas, C. A. Manu, V. Kavarthapu and M. E. Edmonds
Diabetic Medicine; Accepted Article

Background
Although great progress has been made in managing diabetic foot disease, it continues to carry significant morbidity and mortality. Obstructive sleep apnoea (OSA) and diabetes frequently coexist and recent studies suggest significant under-recognition of OSA in those with diabetes. There are no current reports on the direct clinical impact of OSA on acute or chronic diabetic foot ulcer healing.

Case report
We describe three cases with Type 2 diabetes and a mean BMI of 50 kg/m2 in whom we believe undiagnosed severe OSA may have impeded the rate of recovery of acutely infected foot ulcers. Despite standard care whilst in hospital with optimization of glycaemia, daily wound care, ulcer offloading techniques including casting, it was difficult to achieve satisfactory granulation in the first two cases with previously unrecognized and hence untreated severe OSA (Apnoea–Hypopnea Index > 30) until correction had been achieved through continuous positive airway pressure therapy (CPAP). In the third case, despite all optimization techniques, healing has not been achieved and individuals’ reluctance to consider CPAP may be one possible factor.

Discussion
We observe in three severely obese individuals with diabetes that untreated severe OSA may have contributed to delayed wound healing. We also observed an improvement in two individuals after institution of CPAP therapy. Clinicians managing the diabetic foot should consider investigating the presence of OSA in non-healing or slowly progressive foot ulcers when all other factors have been fully optimized.
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Admin2 · Jun 3, 2015

Related Topics:
Obstructive sleep apnea is associated with diabetic peripheral neuropathy
Diabetes and sleep apnoea

NewsBot · Aug 12, 2015

Obstructive Sleep Apnea and Diabetic Foot: New Responsibilities?
Papanas N, Steiropoulos P
Angiology. 2015 Aug 10. pii: 0003319715599469

(no abstract)

NewsBot · Jul 20, 2018

Elevated obstructive sleep apnoea risk score is associated with poor healing of diabetic foot ulcers: a prospective cohort study.
Maltese G et al
Diabet Med. 2018 Jul 19.

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 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 multivariate 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.
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NewsBot · Aug 12, 2020

Prevalence of Obstructive Sleep Apnea in Patients With Diabetic Foot Ulcers
Lihong Chen et al
Front Endocrinol (Lausanne). 2020 Jul 14;11:416

Objectives: Diabetic foot ulcers (DFUs) are a considerable burden on patients and the healthcare service system. Patients with DFUs have many risk factors that might contribute to obstructive sleep apnea (OSA). The purposes of this study were to assess the prevalence of OSA and associated features in patients with DFUs. Methods: Between July 2017 and June 2019, we recruited 245 consecutive patients who sought for treatment at West China Hospital because of DFUs. Polysomnography data from 127 Patients were included in the final analysis. Results: Of the 127 patients, with a median age of 64 years (interquartile range, 55-73 years; range, 36-86 years) and a mean body mass index (BMI) 24.09 ± 0.37 kg/m2, 91 (72%) were men. The prevalence of OSA [apnea-hypopnea index (AHI) ≧5/h] was 92% in men and 97% in women (P = 0.304). Moderate to severe OSA (AHI ≧15/h) was noted in 44 men (48%) and 26 women (72%) (P = 0.015). The risk factors associated with the severity of OSA were sex, age, smoking, alcohol use, and duration of diabetes. After multivariable adjustment, duration of diabetes and age were independent predictive factors of the severity of OSA. No significant association was observed between BMI, waist circumference, Epworth score, and the severity of OSA. There were no significant associations between OSA and ischemic heart disease, cerebral infarction, hypertension, diabetic retinopathy, diabetic kidney disease, and peripheral artery disease. Conclusions: The prevalence of OSA was high in patients with DFUs, with moderate to severe OSA accounting for more than half of the patients. Age and duration of diabetes were independent predictive factors of the severity of OSA.
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NewsBot · Jul 14, 2022

Does Obstructive Sleep Apnoea Syndrome Influence the Development and Treatment of Diabetic Foot? A Brief Narrative Review
Evanthia Gouveri, Paschalis Steiropoulos, Nikolaos Papanas
Int J Low Extrem Wounds. 2022 Jul 14

Both obstructive sleep apnoea syndrome (OSAS) and diabetes mellitus (DM) are common conditions that often coexist and share many similar risk factors. Diabetic foot is a common complication of DM, which may lead to lower-limb amputation. OSAS is considered a risk factor for type 2 DM (T2DM). There is also evidence that OSAS may be linked with the development, as well as the healing of diabetic foot. Multiple mechanisms triggered by sleep fragmentation and intermittent hypoxaemia in OSAS could contribute to the development of diabetic foot ulcers (DFUs). More interestingly, emerging evidence implies a favourable impact of continuous positive airway pressure (CPAP) treatment on DFU healing. Healing DFUs and minimising recurrence rates remains a challenge for health care professionals. In this context, management of OSAS might prove a useful therapeutic adjunct for DFUS. However, data is still limited and randomised controlled trials are needed to further explore this interesting potential.
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