Evaluation of retinal fiber thickness and visual pathways with optic coherence tomography and pattern visual evoked potential in different clinical stages of obstructive sleep apnea syndrome

Multidimensional sleep health and diabetic retinopathy: Systematic review and meta-analysis

Diabetic retinopathy (DR) is one of the most prevalent microvascular diabetic complications. Poor sleep health and obstructive sleep apnea (OSA) are risk factors for diabetes and poor glycemic control. Recent studies have suggested associations between poor sleep health/OSA and DR. Furthermore, there have been suggestions of melatonin dysregulation in the context of DR. We conducted a systematic review and meta-analysis exploring the associations between multidimensional sleep health (duration, satisfaction, efficiency, timing/regularity and alertness), OSA and melatonin with DR. Forty-two studies were included. Long, but not short sleep, was significantly associated with DR, OR 1.41 (95%CI 1.21, 1.64). Poor sleep satisfaction was also significantly associated with DR, OR 2.04 (1.41, 2.94). Sleep efficiency and alertness were not associated with DR, while the evidence on timing/regularity was scant. Having OSA was significantly associated with having DR, OR 1.34 (1.07, 1.69). Further, those with DR had significantly lower melatonin/melatonin metabolite levels than those without DR, standardized mean difference -0.94 (-1.44, -0.44). We explored whether treating OSA with continuous positive airway pressure (CPAP) led to improvement in DR (five studies). The results were mixed among studies, but potential benefits were observed in some. This review highlights the association between poor multidimensional sleep health and DR.

Association of self-reported snoring with decreased retinal thickness and vessel density

Purpose: Self-reported snoring has been reported to influence nerves and vessels. However, there are few direct evidences of snoring related to nerves and microvessels defects. Therefore, we evaluated the association of self-reported snoring with retinal structure and microcirculation.

Methods: A total of 2,622 participants were recruited from the Jidong eye cohort study (JECS). Physical examinations, laboratory tests, and questionnaires were recorded. We also used optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) to assess the retinal structure and microvascular network. Snoring was defined as “never,” “occasionally,” and “frequently or more severe” according to self-reported frequency.

Results: The prevalence of snoring were 84.6% (n = 983) and 45.0% (n = 657) in males and females, respectively. Compared with never snoring group, the retinal thickness increased in “occasionally” (p < 0.001) and “frequently or more severe” groups (p = 0.001), while no difference was found between snoring groups (p = 0.14). Superficial retinal capillary plexus (RCP) vessel density was lower in “frequently or more severe” group than in “never” (p < 0.001) and “occasionally” snoring groups (p < 0.001). After adjusting for confounders, “frequently or more severe” snoring was significantly associated with thinner total retinal thickness [β = −2.79 (95% CI: −5.27, −0.30)] and lower superficial RCP vessel density [β = −0.71 (95% CI: −1.19, −0.23)].

Conclusion: Our research showed self-reported snoring was associated with thinner retinal thickness and lower superficial RCP vessel density. The findings of our study emphasize the need for self-reported snoring assessments in determining retinal structure and microcirculation impairment.

Ocular Complications of Obstructive Sleep Apnea

Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is characterized by repetitive episodes of paused breathing during sleep, which in turn induces transient nocturnal hypoxia and hypercapnia. The high prevalence of OSA and its associated health consequences place a heavy burden on the healthcare system. In particular, the consequent episodic oxygenic desaturation/reoxygenation series and arousals from sleep in patients with OSA have the potential to trigger oxidative stress, elevated systemic inflammatory responses, and autonomic dysfunction with sympathetic activation. Given these adverse side-effects, OSA is highly correlated to many eye diseases that are common in everyday ophthalmic practices. Some of these ocular consequences are reversible, but they may permanently threaten a patient’s vision if not treated appropriately. Here, this article seeks to review the ocular consequences and potential pathophysiologic associations in patients with OSA. Understanding these OSA-related eye diseases may help clinicians provide comprehensive care to their patients.

RETRACTED ARTICLE: Evaluation of macular thickness and visual pathways using optic coherence tomography and pattern visual evoked potential in different clinical stages of obstructive sleep apnea syndrome

AIM

The present study aimed to investigate and compare possible changes in amplitude and latency of pattern visual evoked potentials (PVEP) and thickness of quadrants of the macula (TQM) using optic coherence tomography (OCT).

MATERIALS AND METHODS

According to polysomnography examinations, 30 mild, 30 severe, 30 controls were included in the study after approval from the ethics committee.

RESULTS

No significant difference was found in age and gender between the groups (p = 0.184 and p = 0.954). Significant difference was found between external and internal superior TQM, mean thickness of ganglion cell layer in comparison of all three groups (p = 0.011, p = 0.047, p = 0.030). In comparison between severe OSAS and control groups, significant difference was found in internal nasal, internal superior and external superior TQM (p = 0.048, p = 0.033, p = 0.014) while no significant difference was found TQM in comparison between the mild OSAS and control groups. In comparison between the group of severe OSAS and controls, significant increase was found in P100 as well as N145 latencies whereas only P100 latency was found to increase when mild OSAS was compared with controls. No significant correlation was found between TQM and PVEP parameters in mild and severe OSAS patients.

DISCUSSION

Latency and amplitude of PVEP altered in OSAS because edema and inflammation was remarkable in mild as well as severe stages of the disease. Furthermore, thinning in the macula was observed only in severe stages of the disease, explained with level of atrophy and exposure to extended hypoxia.

Links between obstructive sleep apnea and glaucoma neurodegeneration

In the last few years, the possible link between obstructive sleep apnea (OSAS) and glaucoma, has attracted the interest of many scientists, especially in those forms of primary open angle glaucoma (POAG) and normal tension glaucoma (NTG), in which a progression of the disease occurs, even though intraocular pressure (IOP) is in the range of normality. The increased prevalence of POAG or NTG in patients affected by OSAS, and vice versa, has stimulated interest in the pathogenetic mechanisms that could trigger these two diseases. Hypoxia generated by apnea/hypopnea cycles has been identified as the main cause of many changes in the vascular and neurological systems, which alter the functioning not only of the optic nerve, but also of the whole organism. However, many other factors could be involved, like mechanical factors, obesity, hormonal imbalance and other sleep disorders. Furthermore, the demonstration of typical glaucomatous or glaucoma-like changes in the anatomy or function of the optic nerve and retinal nerve fiber layer by sensitive specific and diagnostic methods, such as perimetry, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA) and electrophysiological exams keeps interest high for this field of study. For this reason, further investigations, hopefully a source of stronger scientific evidences, are needed.