June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Retinal vessel density changes in treated and untreated obstructive sleep apnoea
Author Affiliations & Notes
  • Anna Britton
    The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
  • Angela Schulz
    Department of Ophthalmology, Macquarie University Hospital, North Ryde BC, New South Wales, Australia
  • Georgina Luscombe
    School of Rural Health, The University of Sydney Faculty of Medicine and Health, Orange, New South Wales, Australia
  • Jessica Tong
    The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
  • Brendon Wong
    The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
  • Claude Farah
    Respiratory Department, Macquarie University Hospital, North Ryde BC, New South Wales, Australia
  • Stuart L Graham
    Department of Ophthalmology, Macquarie University Hospital, North Ryde BC, New South Wales, Australia
  • Clare Fraser
    The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
  • Footnotes
    Commercial Relationships   Anna Britton, None; Angela Schulz, None; Georgina Luscombe, None; Jessica Tong, None; Brendon Wong, None; Claude Farah, None; Stuart Graham, None; Clare Fraser, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2476. doi:
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      Anna Britton, Angela Schulz, Georgina Luscombe, Jessica Tong, Brendon Wong, Claude Farah, Stuart L Graham, Clare Fraser; Retinal vessel density changes in treated and untreated obstructive sleep apnoea. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2476.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Obstructive sleep apnoea (OSA) is a risk factor for vascular disease including stroke. Studies have shown OSA alters the retinal arterioles and veins, however studies on the microvasculature have yielded conflicting results and none have assessed the effect of continuous positive airways pressure (CPAP) on retinal vessel density. This prospective cohort study sought to examine the impact of varying severities of OSA on retinal vessel density using optical coherence tomography angiography (OCT-A) and whether CPAP treatment attenuates this change.

Methods : 67 adult patients underwent diagnostic polysomnography and retinal vessel imaging between April 2015 – December 2016. Patients were stratified into four clinical severity groups based on their apnoea-hypopnoea index (AHI, events/hour): controls (<5), mild (≥5 to <15), moderate (≥15 to <30), and severe OSA (≥30). Following their sleep study a subset of patients were offered CPAP at the discretion of a sleep physician. At a 24-month follow up, patients had OCT-A scans taken on Spectralis OCT-A (Heidelberg Engineering, Germany). Vessel density was analysed on images of the macula and optic nerve head (ONH) using ImageJ software. Exclusion criteria included the presence of glaucoma, prior optic neuropathy or retinopathy and media opacities.

Results : Of the 67 participants (45 males; mean age 62.3), there were 9 controls, 16 mild, 18 moderate and 24 severe OSA participants. Vessel density was negatively correlated with clinical severity by AHI but this did not reach statistical significance at the superficial vascular complex (SVC), deep vascular complex (DVC) or optic nerve head (ONH) (p = 0.072, 0.206, 0.294, respectively). However, for those not using CPAP, vessel density was significantly and negatively correlated by AHI at the macula (SVC p = 0.010, DVC p = 0.049). Compliant CPAP use abolishes this trend. Vessel density was also significantly and negatively correlated by AHI for diabetic patients in the cohort (SVC p = 0.013, DVC p = 0.042).

Conclusions : Our results show that retinal vessel density is negatively correlated with AHI in untreated individuals and that adequate use of CPAP abolishes this trend. Untreated OSA in combination with diabetes has the propensity to significantly worsen vascular outcomes.

This is a 2021 ARVO Annual Meeting abstract.

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