Obstructive sleep apnoea predicts the development of preproliferative and proliferative retinopathy in patients with type 2 diabetes: a longitudinal analysis

A. Tahrani, P. Dodson, A. Ali, N. Raymond, Q. Altaf, H. Wharton, H. Fellows, R. Hampshire, M. Shah, E. Curtis, J. Miah, A. Barnett, M.J. Stevens

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Abstract

Background and aims: Diabetic Retinopathy (DR) is a leading cause of blindness. OSA is associated with increased oxidative and nitrosative stress and endothelial dysfunction in patients with type 2 diabetes (T2DM). Hence, it is plausible that OSA can promote the development and progression of DR.
Materials and methods: An observational longitudinal study in adults with T2DM. Patients with pre-existing OSA, end-stage renal disease and non-diabetic retinopathy were excluded. OSA (apnoea hypopnea index ≥ 5 events/hour) was assessed by a single overnight home-based cardio-respiratory monitoring (Alice PDX, etc.). DR was assesses using retinal images between 2007 and 2012. Sight threatening retinopathy (STR) was defined as pre-proliferative or proliferative DR, maculopathy or photocoagulation. Advanced DR was defined as pre-proliferative or proliferative DR.
Results: 199 patients were included (57.3% men, 47.7% White Europeans). STR and OSA prevalence were 38.7 % and 62.8% respectively. STR preva-lence was higher in patients with OSA (OSA+) compared to those with-out (OSA-) [48.8% vs. 21.6%, p <0.001]. After adjustment for confounders, OSA remained independently associated with STR (OR 3.7, 95%CI 1.6-8.9, p=0.006, maculopathy (OR 4.5, 1.8-11.4, p=0.002) and advanced DR (OR 3.9, 1.02-15.3, p=0.047). Over 4.4±1 years, more OSA+ patients progressed from no or background DR to advanced DR (15.3% vs. 3%, p=0.01). OSA was an independent predictor of advanced DR development after adjustment (OR 6.6, 95%CI 1.2-35.1, p=0.03). OSA did not predict the development of maculopathy. Patients received continuous positive airway pressure treatment were less likely to develop advanced DR.
Conclusion: OSA is independently associated with STR and predicts the development of preproliferative and proliferative DR. Interventional studies are needed to assess the impact of OSA treatment on DR.Supported by: NIHR (UK) and The UK Novo Nordisk Research Foundation.
Original languageEnglish
Article number1225
Pages (from-to)S490
Number of pages1
JournalDiabetologia
Volume56
Issue numberS1
DOIs
Publication statusPublished - 1 Sep 2013
Event49th Annual Meeting of the EASD - Berlin Messe, Germany
Duration: 4 Oct 2012 → …

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Abstracts of the 49th Annual Meeting of the EASD

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    Tahrani, A., Dodson, P., Ali, A., Raymond, N., Altaf, Q., Wharton, H., Fellows, H., Hampshire, R., Shah, M., Curtis, E., Miah, J., Barnett, A., & Stevens, M. J. (2013). Obstructive sleep apnoea predicts the development of preproliferative and proliferative retinopathy in patients with type 2 diabetes: a longitudinal analysis. Diabetologia, 56(S1), S490. [1225]. https://doi.org/10.1007/s00125-013-3012-z