Obstructive sleep apnea and retinopathy in patients with type 2 diabetes: a longitudinal study

Quratul A. Altaf, Paul Dodson, Asad Ali, Neil T. Raymond, Helen Wharton, Hannah Fellows, Rachel Hampshire-Bancroft, Mirriam Shah, Emma Shepherd, Jamili Miah, Anthony H. Barnett, Abd A. Tahrani

Research output: Contribution to journalArticle

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 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.

Original languageEnglish
Pages (from-to)892-900
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume196
Issue number7
Early online date1 Oct 2017
DOIs
Publication statusE-pub ahead of print - 1 Oct 2017

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Obstructive Sleep Apnea
Type 2 Diabetes Mellitus
Longitudinal Studies
Diabetic Retinopathy
Continuous Positive Airway Pressure
Odds Ratio
Confidence Intervals

Bibliographical note

Copyright © 2017 American Thoracic Society.

Funding: National Institute for Health Research via a research training fellowship (RTF/01/094) and clinician scientist award (CS-2013-13-029) (A.A.T.).

Keywords

  • diabetic retinopathy
  • maculopathy
  • obstructive sleep apnea

Cite this

Altaf, Quratul A. ; Dodson, Paul ; Ali, Asad ; Raymond, Neil T. ; Wharton, Helen ; Fellows, Hannah ; Hampshire-Bancroft, Rachel ; Shah, Mirriam ; Shepherd, Emma ; Miah, Jamili ; Barnett, Anthony H. ; Tahrani, Abd A. / Obstructive sleep apnea and retinopathy in patients with type 2 diabetes : a longitudinal study. In: American Journal of Respiratory and Critical Care Medicine. 2017 ; Vol. 196, No. 7. pp. 892-900.
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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 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.",
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Altaf, QA, Dodson, P, Ali, A, Raymond, NT, Wharton, H, Fellows, H, Hampshire-Bancroft, R, Shah, M, Shepherd, E, Miah, J, Barnett, AH & Tahrani, AA 2017, 'Obstructive sleep apnea and retinopathy in patients with type 2 diabetes: a longitudinal study', American Journal of Respiratory and Critical Care Medicine, vol. 196, no. 7, pp. 892-900. https://doi.org/10.1164/rccm.201701-0175OC

Obstructive sleep apnea and retinopathy in patients with type 2 diabetes : a longitudinal study. / Altaf, Quratul A.; Dodson, Paul; Ali, Asad; Raymond, Neil T.; Wharton, Helen; Fellows, Hannah; Hampshire-Bancroft, Rachel; Shah, Mirriam; Shepherd, Emma; Miah, Jamili; Barnett, Anthony H.; Tahrani, Abd A.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 196, No. 7, 01.10.2017, p. 892-900.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Obstructive sleep apnea and retinopathy in patients with type 2 diabetes

T2 - a longitudinal study

AU - Altaf, Quratul A.

AU - Dodson, Paul

AU - Ali, Asad

AU - Raymond, Neil T.

AU - Wharton, Helen

AU - Fellows, Hannah

AU - Hampshire-Bancroft, Rachel

AU - Shah, Mirriam

AU - Shepherd, Emma

AU - Miah, Jamili

AU - Barnett, Anthony H.

AU - Tahrani, Abd A.

N1 - Copyright © 2017 American Thoracic Society. Funding: National Institute for Health Research via a research training fellowship (RTF/01/094) and clinician scientist award (CS-2013-13-029) (A.A.T.).

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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 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.

AB - 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 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.

KW - diabetic retinopathy

KW - maculopathy

KW - obstructive sleep apnea

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