Effect of obstructive sleep apnoea on diabetic retinopathy and maculopathy: a systematic review and meta‐analysis

Leong, Wen B.; Jadhakhan, Ferozkhan; Taheri, Shahrad; Chen, Yen-Fu; Adab, Peymané; Thomas, G. Neil

doi:10.1111/dme.12817

Cited by 59 publications

(50 citation statements)

References 31 publications

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“…More recently, Leong et al performed a systematic review and meta-analysis of the effect of OSA on DR and maculopathy [72]. In the systematic review, they included 16 studies: one longitudinal, the rest cross-sectional, and all the studies listed above were included, except for the two which were published later [68,70].…”

Section: Diabetic Retinopathy (Dr)mentioning

confidence: 99%

“…In a review article from 2005, Sinclair and colleagues commented that to control DR, prompt detection was necessary, along with the management of "common systemic comorbid conditions such as hypertension, hyperlipidemia, anemia, obstructive sleep apnea, and smoking--all of which tend to accelerate its course and increase its severity" [73]. In their recent systematic review and metaanalysis, Leong et al also concluded that the effect of CPAP on DR and diabetic macular oedema needed assessment through randomised controlled trials [72].…”

Section: Cpap and Diabetic Retinopathymentioning

confidence: 99%

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Obstructive sleep apnoea

West

Turnbull

2018

Eye

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Obstructive sleep apnoea (OSA) is increasing in prevalence due to rising obesity. While OSA is a disorder primarily of the upper airway during sleep, its pathophysiological impact on other body systems is increasingly recognised. There has been interest in the prevalence of OSA in different ophthalmic conditions and possible causation has been postulated. As OSA is common, it can be expected that people with co-existent OSA will be found in any ophthalmic disease population studied. To determine with confidence the significance of finding patients with OSA in a particular cohort requires a well matched control group, ideally matched for age, obesity, gender and co-morbidities. Only if one can say with certainty that the prevalence of OSA is higher in a group with a particular co-existent ophthalmic disease can we begin to speculate about possible mechanisms for the overlap in these conditions. Possible mechanisms for how OSA might affect the eye are discussed in this review. The current literature is reviewed with respect to diabetic retinopathy, glaucoma, floppy eyelid syndrome, non-arteritic ischaemic optic neuropathy, keratoconus and AMD. Associations with OSA have been found, but robust prospective studies using multi-channel sleep studies to diagnose OSA are lacking. Gaps remain in the evidence and in our knowledge. It is hoped that this review will highlight the need for ophthalmologists to consider OSA in their patients. It also makes recommendations for future research, especially to consider whether therapies for OSA can also be effective for ophthalmic disorders.

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Section: Diabetic Retinopathy (Dr)mentioning

confidence: 99%

Section: Cpap and Diabetic Retinopathymentioning

confidence: 99%

Obstructive sleep apnoea

West

Turnbull

2018

Eye

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“…There has been increasing evidence on the relationship between OSA and increased risk or severity of DR [7,8]. Longitudinal data have also shown that OSA is a risk factor for DR progression and that treatment with continuous positive airway pressure reduced this risk [6].…”

Section: Discussionmentioning

confidence: 99%

“…To this end, sleep and sleep disturbances such as obstructive sleep apnea (OSA) have recently surfaced as a potential modifiable risk factor for DR. While OSA has been relatively more established as a risk factor for DR [6][7][8], evidence on associations between sleep duration and DR have been lacking and inconsistent [9][10][11][12]. Furthermore, these four studies were based on self-reported sleep duration that is subject to recall bias.…”

mentioning

confidence: 99%

The associations of objectively measured sleep duration and sleep disturbances with diabetic retinopathy

Chew

Tan

Lamoureux

et al. 2020

Diabetes Research and Clinical Practice

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“…27 Patients with mild reduction in arterial hemoglobin saturation due to sleep apnoea have more severe retinopathy than those whose airways do no obstruct at night. Positive pressure ventilation in such patients also reduces the rate of progression of DR. [28][29][30][31][32] Does illuminating the retina reduce the risk of progression of retinopathy?…”

Section: Evidence That Oxygen Supplementation Improves Visual Functiomentioning

confidence: 99%

Spare the rods and spoil the retina: revisited

Sivaprasad

Arden

2015

Eye

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Visual function improves with oxygen inhalation in people with diabetes even in the absence of visible retinopathy. Rods consume the most oxygen in the retina due to the high metabolic activity required to maintain the dark current. Therefore, Arden hypothesized that in diabetes where oxygen supply may also be affected due to the changes in retinal vasculature, prevention of dark adaptation may be a viable option to prevent or decrease the rate of progression of diabetic retinopathy. Animal experiments have proven that the absence of rods decreases the development of retinal neovascularisation. The same principle applies to panretinal photocoagulation, an established treatment for proliferative diabetic retinopathy. Recently, a few clinical studies have also shown that preventing dark adaptation by suppressing rods with 500-nm light source at night decreases the rate of progression of early diabetic retinopathy and maculopathy in the short-term. We await the results of a large two-year multi-centre trial (CLEOPATRA trial) to evaluate the long-term effects of decreasing dark adaptation by applying a 500-nm light source as a mask over eyes with non-central diabetic macular oedema.

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Effect of obstructive sleep apnoea on diabetic retinopathy and maculopathy: a systematic review and meta‐analysis

Abstract: There is a need for large cohort studies with long-term follow-up data to examine the long-term effects of obstructive sleep apnoea and other sleep variables on advanced retinal disease in diabetes.

Cited by 59 publications

References 31 publications

Obstructive sleep apnoea

Obstructive sleep apnoea

The associations of objectively measured sleep duration and sleep disturbances with diabetic retinopathy

Spare the rods and spoil the retina: revisited

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