The potential association between obstructive sleep apnea and diabetic retinopathy in severe obesity - The role of hypoxemia

Dev Banerjee, Wen Bun Leong, Teresa Arora, Melissa Nolen, Vikas Punamiya, Ron Grunstein, Shahrad Taheri

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Obstructive sleep apnea (OSA) is common in obese patients with type 2 diabetes mellitus (DM) and may contribute to diabetic microvascular complications. Methods: To investigate the association between OSA, hypoxemia during sleep, and diabetic retinal complications in severe obesity. This was a prospective observational study of 93 obese patients mean (SD) age: 52(10) years; mean (SD) body mass index (BMI): 47.3(8.3) kg/m2) with DM undergoing retinal screening and respiratory monitoring during sleep. OSA was defined as apnea-hypopnea index (AHI) of ≥15 events/hour, resulting in two groups (OSA+ vs. OSA-). Results: Forty-six patients were OSA+ : median (95% CI) AHI = 37(23-74)/hour and 47 were OSA-ve (AHI = 7(4-11)/hour). Both groups were similar for ethnicity, BMI, cardiovascular co-morbidities, diabetes duration, HbA1c, and insulin treatment (p>0.05). The OSA+ group was significantly more hypoxemic. There was no significant difference between OSA+ and OSA-groups for the presence of retinopathy (39% vs. 38%). More OSA+ subjects had maculopathy (22% vs. 13%), but this did not reach statistical significance. Logistic regression analyses showed that AHI was not significantly associated with the presence of retinopathy or maculopathy (p>0.05). Whilst minimum oxygen saturation was not significantly associated with retinopathy, it was an independent predictor for the presence of maculopathy OR = 0.79 (95% CI: 0.65-0.95; p<0.05), after adjustment. Conclusions: The presence of OSA, as determined by AHI, was not associated with diabetic retinal complications. In contrast, severity of hypoxemia during sleep (minimum oxygen saturations) may be an important factor. The importance of hypoxia in the development of retinal complications in patients with OSA remains unclear and further studies assessing the pathogenesis of hypoxemia in patients with OSA and diabetic retinal disease are warranted.

Original languageEnglish
Article numbere79521
JournalPLoS One
Volume8
Issue number11
DOIs
Publication statusPublished - 18 Nov 2013
Externally publishedYes

Fingerprint

diabetic retinopathy
sleep apnea
Morbid Obesity
Obstructive Sleep Apnea
Diabetic Retinopathy
hypoxia
obesity
apnea
Apnea
retinal diseases
Diabetes Complications
sleep
Medical problems
Hypoxia
Sleep
body mass index
Body Mass Index
Oxygen
oxygen
Social Adjustment

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

The potential association between obstructive sleep apnea and diabetic retinopathy in severe obesity - The role of hypoxemia. / Banerjee, Dev; Leong, Wen Bun; Arora, Teresa; Nolen, Melissa; Punamiya, Vikas; Grunstein, Ron; Taheri, Shahrad.

In: PLoS One, Vol. 8, No. 11, e79521, 18.11.2013.

Research output: Contribution to journalArticle

Banerjee, Dev ; Leong, Wen Bun ; Arora, Teresa ; Nolen, Melissa ; Punamiya, Vikas ; Grunstein, Ron ; Taheri, Shahrad. / The potential association between obstructive sleep apnea and diabetic retinopathy in severe obesity - The role of hypoxemia. In: PLoS One. 2013 ; Vol. 8, No. 11.
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abstract = "Background: Obstructive sleep apnea (OSA) is common in obese patients with type 2 diabetes mellitus (DM) and may contribute to diabetic microvascular complications. Methods: To investigate the association between OSA, hypoxemia during sleep, and diabetic retinal complications in severe obesity. This was a prospective observational study of 93 obese patients mean (SD) age: 52(10) years; mean (SD) body mass index (BMI): 47.3(8.3) kg/m2) with DM undergoing retinal screening and respiratory monitoring during sleep. OSA was defined as apnea-hypopnea index (AHI) of ≥15 events/hour, resulting in two groups (OSA+ vs. OSA-). Results: Forty-six patients were OSA+ : median (95{\%} CI) AHI = 37(23-74)/hour and 47 were OSA-ve (AHI = 7(4-11)/hour). Both groups were similar for ethnicity, BMI, cardiovascular co-morbidities, diabetes duration, HbA1c, and insulin treatment (p>0.05). The OSA+ group was significantly more hypoxemic. There was no significant difference between OSA+ and OSA-groups for the presence of retinopathy (39{\%} vs. 38{\%}). More OSA+ subjects had maculopathy (22{\%} vs. 13{\%}), but this did not reach statistical significance. Logistic regression analyses showed that AHI was not significantly associated with the presence of retinopathy or maculopathy (p>0.05). Whilst minimum oxygen saturation was not significantly associated with retinopathy, it was an independent predictor for the presence of maculopathy OR = 0.79 (95{\%} CI: 0.65-0.95; p<0.05), after adjustment. Conclusions: The presence of OSA, as determined by AHI, was not associated with diabetic retinal complications. In contrast, severity of hypoxemia during sleep (minimum oxygen saturations) may be an important factor. The importance of hypoxia in the development of retinal complications in patients with OSA remains unclear and further studies assessing the pathogenesis of hypoxemia in patients with OSA and diabetic retinal disease are warranted.",
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AU - Banerjee, Dev

AU - Leong, Wen Bun

AU - Arora, Teresa

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AU - Punamiya, Vikas

AU - Grunstein, Ron

AU - Taheri, Shahrad

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