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PD Samuel, K Fleming, ER Crouch, JC Ware; Evaluation of Retinal Vascular Changes in Patients Diagnosed with Obstructive Sleep Apnea . Invest. Ophthalmol. Vis. Sci. 2002;43(13):512.
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Purpose: Obstructive Sleep Apnea (OSA) is a pulmonary disorder that affects many organ systems. Recent literature has cited some corneal changes that may occur in patients with OSA that are being treated with continuous positive airway pressure (CPAP). Currently there is no literature describing any retinal manifestations of this chronic disorder. In a sub-population of patients with OSA, the principal investigator noticed changes in retinal vasculature. This observation led to the design of the current study which is to determine if OSA has any effects on the retinal vasculature of patients diagnosed with this condition. Method: Double blind, randomized observational series. Population: Patients diagnosed with OSA by polysomnography underwent dilated fundus examination and fundus photography. Exclusion criteria included any conditions that may have predisposed the patients to retinal vascular changes including sickle cell disease, previous history of retinal vein occlusions, history of chronic obstructive pulmonary disease (COPD) or retinopathy of prematurity (ROP) with <36 weeks gestational age or <1500 grams birth weight. One hundred patients will be enrolled by the completion of this study. Results: To date, 20% of subjects (n=5) have documented retinal vascular changes. There is no significant predilection for race, sex, length of diagnosis or degree of obesity. Of interesting note is that 60% (n=3) of the patients with vascular wall changes have documented diabetes and 20% (n=1) have a family history of diabetes. No significant changes in the pattern of the retinal vessels were noted in the remaining 80% (n=20). Conclusion: OSA is a pulmonary disease with a variety of systemic manifestations. Minimal information exists on the ophthalmic manifestations of this disorder. To date, this is the first documented description of this type of retinal vascular changes associated with OSA. Although the sample size is not large enough, at this point to make a significant conclusion, there is a strong suggestion that the combination of OSA and diabetes or a family history of diabetes may be the factors necessary to cause retinal vascular changes. One of the known early findings in diabetics is loss of the pericytes surrounding blood vessels. We are postulating that the loss of these pericytes combined with OSA induced changes in hemoglobin oxygenation may induce the changes that were noted in this study. More patients are currently undergoing evaluation for the completion of this study.
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