Abstract
Purpose:
To investigate the risk of obstructive sleep apnea (OSA) in patients with exudative age-related macular degeneration (AMD) or diabetic macular edema (DME) who have poor response to anti-vascular endothelial growth factor (VEGF) therapy with bevacizumab (Avastin®).
Methods:
Two groups of patients were included in the case-control study - AMD group and DME group. AMD group included patients with a diagnosis of AMD who were further categorized into three sub-groups: non-exudative, exudative, or poor response exudative. DME group included patients with a diagnosis of non-proliferative diabetic retinopathy (NPDR) and clinically significant diabetic macular edema (CSDME). Patients were further categorized into three sub-groups based upon the number of intravitreal injections of bevacizumab received: 1 injection, 2 or more consecutive injections, and 3 or more consecutive injections. Patients in both groups were compared to age-matched controls. All patients completed the Berlin Questionnaire, a screening questionnaire for OSA, to assess their risk of OSA. The main outcome measure was the calculated risk of OSA for each group.
Results:
In the AMD group, of the 103 patients, 56 (54.37%) had non-exudative AMD and 47 (45.63%) had exudative AMD, of which 14 (29.79%) had poor response exudative AMD. The poor response exudative AMD group was at a significantly higher risk for OSA (p<0.05) in comparison to all other groups. In the DME group, of the 30 patients with cystoid macular edema (CME) on optical coherence tomography (OCT) imaging, 4 (19%) received only 1 injection, 18 (81.82%) received 2 or more consecutive injections, and 16 (72.73%) received 3 or more consecutive injections. The risk of OSA increased significantly with increasing number of injections (p<0.05).
Conclusions:
Patients with exudative AMD and DME who have poor response to therapy with intravitreal anti-VEGF therapy with bevacizumab have a significantly higher risk for OSA in comparison to age-matched controls. Poor responders to anti-VEGF therapy should be screened to assess their risk for OSA.
Keywords: 412 age-related macular degeneration •
505 edema •
748 vascular endothelial growth factor