Abstract
Purpose :
To report the relationship of documented continuous positive airway pressure (CPAP) compliance and cotton-wool spots (CWS) in patients with obstructive sleep apnea (OSA) and diabetic retinopathy (DR).
Methods :
A random sample of patients diagnosed with any stage of DR between January 1, 2015 and December 31, 2019 were selected from billing codes. Dilated funduscopic exam (DFE) findings and medical history were confirmed via chart review.
Results :
CWS were present in 11/19 patients with no documentation of CPAP compliance, compared to 1/19 patients with documentation of CPAP compliance (91.7% vs. 8.3%, p = <0.001). Logistic regression to adjust for age confirmed fewer CWS with CPAP compliance (p = 0.03). Documented CPAP compliance was more common in older patients (68.4±7.4 vs. 58.4±12.8, p = 0.006) and in patients without insulin dependence (76.9% vs. 36.0%, p = 0.01). When comparing those with and without documented CPAP compliance, respectively, there was no association with gender (68.4% vs. 73.7% male, p = 0.72); stage of non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) (52.6% vs. 42.1% mild NPDR, 21.1% vs. 31.6% moderate NPDR, 5.2% vs. 15.8% in severe NPDR, and 21.1% vs. 10.5% in PDR; p = 0.50); presence of diabetic macular edema (10.5% vs. 15.8%, p = 0.63); hemoglobin A1C (7.8±1.6 vs. 8.7±2.0, p = 0.16); BMI (33.2±5.8 vs. 33.4±5.5, p = 0.90); smoking status (63.2% vs. 63.2% in non-smokers, 31.6% vs. 31.6% in prior smokers, and 5.2% vs. 5.2% in active smokers, p = 1.00); of a history of hyperlipidemia (94.7% vs. 73.7%, p = 0.06), cardiovascular disease (52.6% vs. 42.1%, p = 0.51), or other breathing-related disorder (15.8% vs. 5.3%, p = 0.28).
Conclusions :
Documented CPAP compliance is associated with fewer CWS in patients with DR. These findings suggest that CWS may be associated with untreated OSA in patients with DR.
This is a 2020 ARVO Annual Meeting abstract.