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Qayim Kaba,1 Felicia Tai,2 Ahmad Al-Awadi,3 Sohel Somani4â 6 1Cardiff University School of Medicine, Cardiff, UK; 2Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; 3Mayo Clinic School of Graduate Medical Education, Jacksonville, FL, USA; 4Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada; 5Uptown Eye Specialists, Brampton, Ontario, Canada; 6William Osler Health Centre, Brampton, Ontario, CanadaCorrespondence: Sohel Somani, Uptown Eye Specialists, 401-7900 Hurontario Street, Brampton, ON, L6Y 0P6, Canada, Email s.somani@utoronto.caPurpose: This prospective cohort study examined the relationship between diabetic macular edema (DME), diabetic retinopathy (DR) and obstructive sleep apnea (OSA) in patients after 1 year of treatment with anti-VEGF injection and/or continuous positive airway pressure (CPAP).Patients and Methods: The study included adults with type 1 or 2 diabetes mellitus with diabetic retinopathy. Polysomnography metrics were measured at baseline. Ophthalmologic metrics were measured at baseline, six-month (6m) and twelve-month (12m) follow-up. All DME+ patients received standard care, and all OSA+ patients were advised continuous positive airway pressure (CPAP). Logistic regression between DR severity and OSA severity was performed. Analysis of variance (ANOVA) was performed between subgroups.Results: Seventy-four eyes of 49 patients with DR were included. Prevalence of OSA was significantly higher in the DME+ group (70.7%) than DME- group (42.4%, p < 0.05). A significantly lower average minimum SaO2 was noted in OSA+DME+ (81.74%) than OSA+DME- eyes (88.23%, p < 0.05). Logistic regression analysis of ophthalmological and sleep metrics showed no correlation between DR and OSA severity. CPAP adherence was 20% (6/30) in the OSA+DME+ cohort and 36% (5/14) in the OSA+DME- cohort. At 12m, CPAP-adherent OSA+DME+ showed significantly lower DR severity score (1.00 ± 0.0) than CPAP non-adherent OSA+DME+ (1.36 ± 0.80, p = 0.042). No significant patterns were noted for visual acuity and mean central retinal thickness.Conclusion: DME is associated with the presence of OSA. Minimum SaO2 is a significant OSA clinical variable for DME. DR severity is not associated with OSA severity. CPAP coupled with intravitreal anti-VEGF therapy may be helpful for reducing DR severity in DME+ eyes. Presence of OSA may diminish intravitreal anti-VEGF efficacy on anatomical (mean CRT) and functional (VA) outcomes of DME.Keywords: diabetes mellitus, diabetic microvascular complications, anti-VEGF injections, continuous positive airway pressure, anti-VEGF, diabetic retinopathy |
