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Aimee C Chang, Timothy Patrick Fox, Albert Wu; Obstructive Sleep Apnea Is Not Associated with Diabetic Retinopathy Severity: A Retrospective Analysis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):59. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Recent studies suggest an association between Obstructive Sleep Apnea (OSA) and Diabetic Retinopathy (DR) and Diabetic Macular Edema (DME), though findings are inconsistent. We sought to clarify the relationship between OSA and DR/DME. This study utilized International Classification of Diseases (ICD) codes to determine DR/DME severity and polysomnography reports to measure OSA severity.
A retrospective chart review was performed using a data query tool to identify patients with ICD diagnoses of both DR and OSA from January 1, 2000-October 7, 2016. Using the International Clinical Classification System, DR was classified as none, mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR (PDR). DME was classified as present or absent. Polysomnography reports were also analyzed, and patients were categorized into no, mild, moderate, or severe OSA using the apnea-hypopnea index (AHI). Secondary measures of sleep quality including sleep efficiency, lowest oxygen saturation, and Epworth Sleepiness Scale scores were recorded. Of 901 patients identified, 254 had DR of specified severity (57 none, 88 mild NPDR, 16 moderate NPDR, 7 severe NPDR, 86 PDR). Multinomial logistic regression was used to analyze the association between DR and OSA and secondary sleep measures. Binary logistic regression was used to compare OSA and secondary sleep measures in NPDR and PDR patients. Analysis was adjusted for potential confounders including age, gender, ethnicity, body mass index, diabetes mellitus (DM) duration, hemoglobin A1c percentage, and presence of hypertension, dyslipidemia, and carotid stenosis.
After adjustment, no statistically significant association was seen between OSA and the presence or severity of DR. Against no DR, the AHI odds ratio (OR) was 0.991 (95% CI 0.979-1.003) in mild NPDR, 0.988 (95% CI 0.966-1.010) in moderate NPDR, 1.003 (95% CI 0.977-1.029) in severe NPDR, and 0.993 (95% CI 0.981-1.005) in PDR. Compared to NPDR, PDR patients had a minimally higher arousal index (p=0.042, OR 1.022, 95% CI 1.001-1.044). No association was found between OSA and DME with an AHI OR of 1.002 (95% CI 0.994-1.011).
Findings suggest lack of association between OSA and DR/DME. The correlation observed between DM duration and A1c with OSA and DR/DME suggests that some previous studies with positive findings may have been limited by confounding factors.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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