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Observational Study
. 2017 Oct 1;196(7):892-900.
doi: 10.1164/rccm.201701-0175OC.

Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study

Quratul A Altaf  1   2   3 , Paul Dodson  3   4   5 , Asad Ali  6 , Neil T Raymond  7 , Helen Wharton  3   4 , Hannah Fellows  3   4 , Rachel Hampshire-Bancroft  3   4 , Mirriam Shah  3   4 , Emma Shepherd  3   4 , Jamili Miah  3   4 , Anthony H Barnett  1   2   3 , Abd A Tahrani  1   2   3
Affiliations
Observational Study

Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study

Quratul A Altaf et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Obstructive sleep apnea (OSA) is associated with several pathophysiological deficits found in diabetic retinopathy (DR). Hence, it's plausible that OSA could play a role in the pathogenesis of sight-threatening DR (STDR).

Objectives: To assess the relationship between OSA and DR in patients with type 2 diabetes and to assess whether OSA is associated with its progression.

Methods: A longitudinal study was conducted in diabetes clinics within two U.K. hospitals. Patients known to have any respiratory disorder (including OSA) were excluded. DR was assessed using two-field 45-degree retinal images for each eye. OSA was assessed using a home-based multichannel cardiorespiratory device.

Measurements and main results: A total of 230 patients were included. STDR and OSA prevalence rates were 36.1% and 63.9%, respectively. STDR prevalence was higher in patients with OSA than in those without OSA (42.9% vs. 24.1%; P = 0.004). After adjustment for confounders, OSA remained independently associated with STDR (odds ratio, 2.3; 95% confidence interval, 1.1-4.9; P = 0.04). After a median (interquartile range) follow-up of 43.0 (37.0-51.0) months, patients with OSA were more likely than patients without OSA to develop preproliferative/proliferative DR (18.4% vs. 6.1%; P = 0.02). After adjustment for confounders, OSA remained an independent predictor of progression to preproliferative/proliferative DR (odds ratio, 5.2; 95% CI confidence interval, 1.2-23.0; P = 0.03). Patients who received continuous positive airway pressure treatment were significantly less likely to develop preproliferative/proliferative DR.

Conclusions: OSA is associated with STDR in patients with type 2 diabetes. OSA is an independent predictor for the progression to preproliferative/proliferative DR. Continuous positive airway pressure treatment was associated with reduction in preproliferative/proliferative DR. Interventional studies are needed to assess the impact of OSA treatment on STDR.

Keywords: diabetic retinopathy; maculopathy; obstructive sleep apnea.

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Figures

Figure 1.
Figure 1.
Flow diagram of the study. *After excluding patients with the condition at baseline to assess progression. COPD = chronic obstructive pulmonary disease; DR = diabetic retinopathy; OSA = obstructive sleep apnea; STDR = sight-threatening diabetic retinopathy.
See this image and copyright information in PMC

Comment in

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