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Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study.

Altaf, Quratul A and Dodson, Paul and Ali, Asad and Raymond, Neil T and Wharton, Helen and Fellows, Hannah and Hampshire-Bancroft, Rachel and Shah, Mirriam and Shepherd, Emma and Miah, Jamili and Barnett, Anthony H and Tahrani, Abd A (2017) Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study. American journal of respiratory and critical care medicine, 196 (7). pp. 892-900. ISSN 1535-4970. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: http://www.atsjournals.org/doi/abs/10.1164/rccm.20...

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.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WF Respiratory system. Respiratory medicine
WK Endocrine system. Endocrinology
WW Eyes. Ophthalmology
Divisions: Ambulatory Care > Diabetes
Ambulatory Care > Ophthalmology
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Depositing User: Mrs Yolande Brookes
Date Deposited: 23 Nov 2017 12:15
Last Modified: 23 Nov 2017 12:15
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1489

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