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S.H. Sinclair, C.A. Stafford, B.J. Sirgany; A Putative Relation between Obstructive Sleep Apnea and Diabetic Macular Edema Associated with Nerve Fiber Layer Infarcts . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4312.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe possible relationship in obese diabetics between obstructive sleep apnea syndrome (OSAS) and ischemic retinopathy with diffuse macular edema Methods: Obese diabetics (n=22) in retina clinic admitted symptoms of sleep apnea on survey (mean Epworth score 11.5) were compared with historical cohort of 22 similarly obese diabetics matched for age and diabetes duration, but without symptoms of sleep apnea (mean Epworth score 6.4). All patients underwent complete ocular examination, fundus photography, fluorescein angiography, blood pressure, for HgA1C, CBC, lipid profile, ESR, C reactive protein, and 24 hour urine creatinine clearance and proteinuria. Overnight polysomnography was conducted for Epworth scores > 10. Results: Among the 22 obese diabetics (weight 249+33.5 pounds) in the apnea cohort who underwent polysomnography, 16 demonstrated severe and 6 moderate OSAS. Average of 44.6+21.9 apneic or hypopneic events per hour were recorded during sleep, lasting average 23.3+5.9 seconds, resulting in oxygen desaturations averaging 73.5+9.5%. Retinopathy observed in the apnea cohort manifested multiple nerve-fiber-layer infarcts, at least 3 in each eye in all cases, and more than 6 infarcts in most (average 8+3), often in multiple formative stages. All patients but two, had diffuse macular edema, often with focal areas of macular capillary non-perfusion. In 14 eyes undergoing grid laser photocoagulation, edema did not improve, in most cases progressing over time, developing more areas of intra-retinal leakage. Ten eyes had undergone panretinal photocoagulation for neovascularization--resolution in 3 eyes. Among the cohort without sleep apnea, rare nerve fiber layer infarcts were observed in 5 eyes, and macular edema, noted in 9 eyes, was more focal and resolved with grid laser. One eye with proliferative retinopathy resolved with PRP. Among the additional measured systemic factors, none showed a statistical difference between the cohorts. Conclusions: In obese diabetics, obstructive sleep apnea appears associated with retinopathy that manifests multiple nerve-fiber-layer infarction and diffuse macular edema. It appears important that physicians evaluate diabetics for this syndrome especially if patient is obese, snores, has fragmented sleep patterns, daytime somnolence, hypertension, or manifests patterns of accelerated course of retinopathy similar to patients described.
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