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Brooke Nesmith, Mark Ihnen, Shlomit Schaal; Poor Responders to Bevacizumab Pharmacotherapy in Age-Related Macular Degeneration and in Diabetic Macular Edema Demonstrate Increased Risk for Obstructive Sleep Apnea. Invest. Ophthalmol. Vis. Sci. 2014;55(13):591.
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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®).
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.
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).
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.
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