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

Research output: Contribution to journalMeeting abstract

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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Obstructive Sleep Apnea
Diabetic Retinopathy
Type 2 Diabetes Mellitus
Continuous Positive Airway Pressure
Light Coagulation
Apnea
Blindness
Chronic Kidney Failure
Observational Studies
Longitudinal Studies
Oxidative Stress

Bibliographical note

Abstracts of the 49th Annual Meeting of the EASD

Cite this

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. / Obstructive sleep apnoea predicts the development of preproliferative and proliferative retinopathy in patients with type 2 diabetes : a longitudinal analysis. In: Diabetologia. 2013 ; Vol. 56, No. S1. pp. S490.
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title = "Obstructive sleep apnoea predicts the development of preproliferative and proliferative retinopathy in patients with type 2 diabetes: a longitudinal analysis",
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.",
author = "A. Tahrani and P. Dodson and A. Ali and N. Raymond and Q. Altaf and H. Wharton and H. Fellows and R. Hampshire and M. Shah and E. Curtis and J. Miah and A. Barnett and M.J. Stevens",
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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, MJ 2013, 'Obstructive sleep apnoea predicts the development of preproliferative and proliferative retinopathy in patients with type 2 diabetes: a longitudinal analysis', Diabetologia, vol. 56, no. S1, 1225, pp. S490. https://doi.org/10.1007/s00125-013-3012-z

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

In: Diabetologia, Vol. 56, No. S1, 1225, 01.09.2013, p. S490.

Research output: Contribution to journalMeeting abstract

TY - JOUR

T1 - Obstructive sleep apnoea predicts the development of preproliferative and proliferative retinopathy in patients with type 2 diabetes

T2 - a longitudinal analysis

AU - Tahrani, A.

AU - Dodson, P.

AU - Ali, A.

AU - Raymond, N.

AU - Altaf, Q.

AU - Wharton, H.

AU - Fellows, H.

AU - Hampshire, R.

AU - Shah, M.

AU - Curtis, E.

AU - Miah, J.

AU - Barnett, A.

AU - Stevens, M.J.

N1 - Abstracts of the 49th Annual Meeting of the EASD

PY - 2013/9/1

Y1 - 2013/9/1

N2 - 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.

AB - 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.

UR - http://link.springer.com/10.1007/s00125-013-3012-z

U2 - 10.1007/s00125-013-3012-z

DO - 10.1007/s00125-013-3012-z

M3 - Meeting abstract

VL - 56

SP - S490

JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

IS - S1

M1 - 1225

ER -