Abstract
Purpose :
Obstructive sleep apnea (OSA) is a known risk factor for worsening diabetic retinopathy (DR). A study of a VA patient population with OSA has also shown the potential benefit of OSA treatment with a positive airway pressure device (PAP) in preventing DR progression. A limitation to that study was their relatively homogenous patient population. Our study seeks to compare the prevalence of DR in African American (AA) and Latino OSA patients who were treated with a PAP (TP) versus those who were not treated (NP).
Methods :
A retrospective chart review was performed of adult Latino and AA diabetic patients with OSA that was diagnosed via polysomnography or via the STOP-BANG criteria or the Epworth Sleepiness scale at our sleep clinic. Patients not examined at our eye clinic or at our sleep clinic were excluded. Patient race was self-identified. PAP devices were interrogated for appropriate use in patients who claimed full use of their machine. Per previous studies, the threshold for adequate PAP treatment was at least 70% use in overall sleep time. Patients were NP because they were either not prescribed a PAP or did not use the machine. Diabetic retinopathy findings were as described in clinic documentation, while presence of macular edema was assessed by OCT. Odds ratios and p-values were calculated using standard methods.
Results :
Among the 19 patients included, 8 were TP while 11 were NP. 13 patients were Latino, 4 were AA, and 2 identified as “other.” There was no statistically significant difference between the two groups regarding race (p=.1536) average hemoglobin A1c (p=0.2913), total cholesterol (p=0.216), tobacco history (p=0.465), insulin use (0.0932), and average BMI (p=0.439). The NP group had increased odds of having dot-blot hemorrhages (OR=12.25, p=0.0432), retinal hemorrhages (OR=12.25, p=0.0432), and any diabetic retinopathy (OR=8, p=0.0499). The NP group had increased odds of macular edema and of proliferative DR but these data were not statistically significant.
Conclusions :
Our study found greater odds of having diabetic retinopathy in our African American and Latino patients among those who were not treated with a positive airway pressure device. This data may add to the known importance of screening for OSA in DM patients in primary care populations in order to reduce additional morbidity. A larger prospective study is warranted to elucidate the likely vital role of OSA treatment in prevention and control of DR.
This is a 2020 ARVO Annual Meeting abstract.