Poor sleep and hypoxemia may be associated with longer wound healing and more frequent ulcer recurrence in remission

Fascinating work from Chen and coworkers. Perhaps something else we need to focus on that we often acknowledge but frequently neglect!


Sleep-disordered breathing (SDB) is prevalent and associated with increased risk of morbidity and mortality. However, whether SDB has an adverse impact on wound healing in patients with diabetic foot ulcers (DFUs) is uncertain. The purpose of this study was to investigate the association of SDB with wound healing in patients with DFUs.


A total of 167 patients with DFUs were enrolled between July 2013 and June 2019 at West China Hospital to assess the association of SDB with wound healing, ulcer recurrence, and all-cause mortality.


There was no significant association between apnea-hypopnea index and wound healing, while total sleep time (per hour: HR 1.15, 95%CI 1.01-1.30; P=0.029), sleep efficiency (per 10%: HR 1.20, 95%CI 1.04 to 1.37; P=0.012), and wakefulness after sleep onset (per 30min: HR 0.89, 95%CI 0.82-0.97; P=0.008) were associated with wound healing. Total sleep time (per hour: OR 0.71, 95%CI 0.51 to 0.97; P=0.035) and sleep efficiency (per 10%: OR 0.68, 95%CI 0.47 to 0.97; P=0.033) were also associated with ulcer recurrence. Mean oxygen saturation (per 3%: HR 0.68, 95%CI 0.49 to 0.94; P=0.021) and percentage of sleep time with oxygen saturation < 90% (per 10%: HR 1.25, 95%CI 1.03 to 1.53; P=0.026) were significantly associated with mortality.


SDB is highly prevalent in patients with DFUs but its severity, as conventionally measured by AHI, is not associated with wound healing. Sleep fragmentation and hypoxemia are stronger predictors of poor wound healing, high ulcer recurrence and increased risk of death in patients with DFUs.

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