{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T22:51:53Z","timestamp":1790549513240,"version":"4.1.0"},"reference-count":11,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,1,18]],"date-time":"2016-01-18T00:00:00Z","timestamp":1453075200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Although great progress has been made in managing diabetic foot disease, it continues to carry significant morbidity and mortality. Obstructive sleep apnoea (<jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content>) and diabetes frequently coexist and recent studies suggest significant under\u2010recognition of <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content> in those with diabetes. There are no current reports on the direct clinical impact of <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content> on acute or chronic diabetic foot ulcer healing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case report<\/jats:title><jats:p>We describe three cases with Type\u00a02 diabetes and a mean <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> of 50\u00a0kg\/m<jats:sup>2<\/jats:sup> in whom we believe undiagnosed <jats:italic>severe <\/jats:italic><jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content> 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 <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content> (Apnoea\u2013Hypopnea Index\u00a0&gt;\u00a030) until correction had been achieved through continuous positive airway pressure therapy (<jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content>). In the third case, despite all optimization techniques, healing has not been achieved and individuals\u2019 reluctance to consider <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content> may be one possible factor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>We observe in three severely obese individuals with diabetes that untreated severe <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content> may have contributed to delayed wound healing. We also observed an improvement in two individuals after institution of <jats:styled-content style=\"fixed-case\">CPAP<\/jats:styled-content> therapy. Clinicians managing the diabetic foot should consider investigating the presence of <jats:styled-content style=\"fixed-case\">OSA<\/jats:styled-content> in non\u2010healing or slowly progressive foot ulcers when all other factors have been fully optimized.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.12813","type":"journal-article","created":{"date-parts":[[2015,5,29]],"date-time":"2015-05-29T17:21:17Z","timestamp":1432920077000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Undiagnosed severe sleep apnoea and diabetic foot ulceration \u2013 a case series based hypothesis: a hitherto under emphasized factor in failure to heal"],"prefix":"10.1111","volume":"33","author":[{"given":"P. R. J.","family":"Vas","sequence":"first","affiliation":[{"name":"Kings Diabetes Foot Clinic London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Ahluwalia","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Kings College Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. B.","family":"Manas","sequence":"additional","affiliation":[{"name":"Kings Diabetes Foot Clinic London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. A.","family":"Manu","sequence":"additional","affiliation":[{"name":"Kings Diabetes Foot Clinic London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Kavarthapu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Kings College Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. E.","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Kings Diabetes Foot Clinic London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,1,18]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12545"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP.13.4.355"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043104"},{"key":"e_1_2_8_5_1","first-page":"229","article-title":"Treating obstructive sleep apnea improves essential hypertension and quality of life","volume":"65","author":"Silverberg DS","year":"2002","journal-title":"Am Fam Physician"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2105124"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1389-9457(02)00130-2"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.27986"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201112-2135OC"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00111208"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2008.10.005"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1152\/physiol.00045.2008"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fdme.12813","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fdme.12813","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.12813","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T17:18:45Z","timestamp":1696353525000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.12813"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,1,18]]},"references-count":11,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2016,2]]}},"alternative-id":["10.1111\/dme.12813"],"URL":"https:\/\/doi.org\/10.1111\/dme.12813","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,1,18]]},"assertion":[{"value":"2015-05-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-01-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}