Quratul A Altaf1,2,3, Paul Dodson3,4,5, Asad Ali6, Neil T Raymond7, Helen Wharton3,4, Hannah Fellows3,4, Rachel Hampshire-Bancroft3,4, Mirriam Shah3,4, Emma Shepherd3,4, Jamili Miah3,4, Anthony H Barnett1,2,3, Abd A Tahrani1,2,3. 1. 1 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom. 2. 2 Centre of Endocrinology, Diabetes, and Metabolism, Birmingham Heath Partners, Birmingham, United Kingdom. 3. 3 Department of Diabetes and Endocrinology and. 4. 4 Heart of England Diabetic Retinopathy Screening Centre, Heart of England NHS Foundation Trust, Birmingham, United Kingdom. 5. 5 School of Life and Health Sciences, Aston University, Birmingham, United Kingdom. 6. 6 Department of Respiratory Medicine, University Hospital of Coventry and Warwickshire, Coventry NHS Trust, United Kingdom; and. 7. 7 Epidemiology, Research Design and Statistical Consulting (ERDASC), Leicestershire, United Kingdom.
Abstract
RATIONALE: Obstructive sleep apnea (OSA) is associated with several pathophysiological deficits found in diabetic retinopathy (DR). Hence, it's plausible that OSA could play a role in the pathogenesis of sight-threatening DR (STDR). OBJECTIVES: To assess the relationship between OSA and DR in patients with type 2 diabetes and to assess whether OSA is associated with its progression. METHODS: A longitudinal study was conducted in diabetes clinics within two U.K. hospitals. Patients known to have any respiratory disorder (including OSA) were excluded. DR was assessed using two-field 45-degree retinal images for each eye. OSA was assessed using a home-based multichannel cardiorespiratory device. MEASUREMENTS AND MAIN RESULTS: A total of 230 patients were included. STDR and OSA prevalence rates were 36.1% and 63.9%, respectively. STDR prevalence was higher in patients with OSA than in those without OSA (42.9% vs. 24.1%; P = 0.004). After adjustment for confounders, OSA remained independently associated with STDR (odds ratio, 2.3; 95% confidence interval, 1.1-4.9; P = 0.04). After a median (interquartile range) follow-up of 43.0 (37.0-51.0) months, patients with OSA were more likely than patients without OSA to develop preproliferative/proliferative DR (18.4% vs. 6.1%; P = 0.02). After adjustment for confounders, OSA remained an independent predictor of progression to preproliferative/proliferative DR (odds ratio, 5.2; 95% CI confidence interval, 1.2-23.0; P = 0.03). Patients who received continuous positive airway pressure treatment were significantly less likely to develop preproliferative/proliferative DR. CONCLUSIONS: OSA is associated with STDR in patients with type 2 diabetes. OSA is an independent predictor for the progression to preproliferative/proliferative DR. Continuous positive airway pressure treatment was associated with reduction in preproliferative/proliferative DR. Interventional studies are needed to assess the impact of OSA treatment on STDR.
RATIONALE: Obstructive sleep apnea (OSA) is associated with several pathophysiological deficits found in diabetic retinopathy (DR). Hence, it's plausible that OSA could play a role in the pathogenesis of sight-threatening DR (STDR). OBJECTIVES: To assess the relationship between OSA and DR in patients with type 2 diabetes and to assess whether OSA is associated with its progression. METHODS: A longitudinal study was conducted in diabetes clinics within two U.K. hospitals. Patients known to have any respiratory disorder (including OSA) were excluded. DR was assessed using two-field 45-degree retinal images for each eye. OSA was assessed using a home-based multichannel cardiorespiratory device. MEASUREMENTS AND MAIN RESULTS: A total of 230 patients were included. STDR and OSA prevalence rates were 36.1% and 63.9%, respectively. STDR prevalence was higher in patients with OSA than in those without OSA (42.9% vs. 24.1%; P = 0.004). After adjustment for confounders, OSA remained independently associated with STDR (odds ratio, 2.3; 95% confidence interval, 1.1-4.9; P = 0.04). After a median (interquartile range) follow-up of 43.0 (37.0-51.0) months, patients with OSA were more likely than patients without OSA to develop preproliferative/proliferative DR (18.4% vs. 6.1%; P = 0.02). After adjustment for confounders, OSA remained an independent predictor of progression to preproliferative/proliferative DR (odds ratio, 5.2; 95% CI confidence interval, 1.2-23.0; P = 0.03). Patients who received continuous positive airway pressure treatment were significantly less likely to develop preproliferative/proliferative DR. CONCLUSIONS: OSA is associated with STDR in patients with type 2 diabetes. OSA is an independent predictor for the progression to preproliferative/proliferative DR. Continuous positive airway pressure treatment was associated with reduction in preproliferative/proliferative DR. Interventional studies are needed to assess the impact of OSA treatment on STDR.
Authors: S Harding; R Greenwood; S Aldington; J Gibson; D Owens; R Taylor; E Kohner; P Scanlon; G Leese Journal: Diabet Med Date: 2003-12 Impact factor: 4.359
Authors: Kathryn C B Tan; Wing-Sun Chow; Jamie C M Lam; Bing Lam; Richard Bucala; John Betteridge; Mary S M Ip Journal: Sleep Date: 2006-03 Impact factor: 5.849
Authors: Amin Amin; Asad Ali; Quratul A Altaf; Milan K Piya; Anthony H Barnett; Neil T Raymond; Abd A Tahrani Journal: J Clin Sleep Med Date: 2017-04-15 Impact factor: 4.062
Authors: Abd A Tahrani; Asad Ali; Neil T Raymond; Safia Begum; Kiran Dubb; Quratul-Ain Altaf; Milan K Piya; Anthony H Barnett; Martin J Stevens Journal: Diabetes Care Date: 2013-09-23 Impact factor: 19.112
Authors: Hind El Ouardighi; Kris G Poppe; Pierre Kleynen; Lidia Grabzcan; Flora Veltri; Anne Violette Bruyneel; Pham Anh Hong Nguyen; Marie Bruyneel Journal: Sleep Breath Date: 2022-02-09 Impact factor: 2.816
Authors: James Patrick Smith; Luke G Cyr; Laura K Dowd; Kyla S Duchin; Priscilla A Lenihan; Jennifer Sprague Journal: Optom Vis Sci Date: 2019-11 Impact factor: 1.973