Obstructive sleep apnea (OSA) is common in type 2 diabetes (T2D), but its relationship with diabetic foot ulcer (DFU) severity and healing outcomes remains unclear. A cross-sectional matched case-control study published in the Frontiers in Endocrinology evaluated STOP-Bang-defined OSA risk in patients with and without DFU. 

The analysis included 73 patients with T2D and active DFU and 73 matched T2D controls without DFU. Matching was performed for age, glycated hemoglobin (HbA1c), body mass index (BMI), and smoking status. OSA risk was assessed using the STOP-Bang questionnaire as both a continuous score and a categorical low versus moderate/high-risk classification. 

In unadjusted analyses, patients with DFU had higher mean STOP-Bang scores than controls (4.3 ± 2.0 vs 3.2 ± 2.2; p=0.004). Intermediate/high OSA risk was also more frequent in the DFU group (83.6% vs 60.3%; p=0.002). These differences were attenuated after adjustment for sex imbalance between groups. 

Among patients with DFU, moderate/high STOP-Bang-defined OSA risk was more common in those with greater ulcer severity (97.1% vs 71.8%; p=0.004). Median wound healing time was longer in patients with moderate/high OSA risk than in those with low risk (120 vs 65 days; p=0.032). 

Multivariable logistic regression showed that higher WIfI ulcer severity was associated with male sex, poorer metabolic control, and higher STOP-Bang category. The findings suggest that higher STOP-Bang-defined OSA risk may be associated with greater DFU severity and delayed wound healing in patients with T2D.