Inverse Cross-sectional and Longitudinal Relationships between Diabetic Retinopathy and Obstructive Sleep Apnea in Type 2 Diabetes

Grauslund, Jakob; Stokholm, Lonny; Thykjær, Anne Suhr; Möller, Sören; Laugesen, Caroline Schmidt; Andresen, J.; Bek, Toke; Cour, Morten la; Heegaard, Steffen; Højlund, Kurt; Kawasaki, Ryo; Hajari, Javad Nouri; Kyvik, Kirsten Ohm; Schielke, Katja Christina; Rubin, Katrine Hass; Rasmussen, Malin Lundberg

doi:10.1016/j.xops.2021.100011

Cited by 6 publications

(8 citation statements)

References 30 publications

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“…In another review study, comprising 16 studies with 2636 patients with T2DM, Leon et al reported an association between OSA and advanced DR in 10 out of 16 studies [25]. Most of the studies included in the two studies had retrospective designs, using heterogenous outcomes for OSA [26]. It is worth noting that the majority of the studies use the apnea-hypopnea index (AHI) as a predictor for development of DR; however, as suggested by Leon et al, nocturnal hypoxemia or apnea-related arousal during sleep maybe better predictors for the development of DR in OSA patients [25].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast Zhu et al showed an increased risk (OR = 2.01, 95% CI = 1.49-2.72) of DR in patients with OSA [24]. Lately, a large Danish register-based study conducted by Grauslund et al, including 153,238 diabetic patients and 746,148 non-diabetic controls, showed a decreased risk (HR, 0.83; 95% CI, 0.74-0.92) of developing DR in diabetic patients with OSA [26]. Later findings by Grauslund et al contradict the conventional pathophysiologic factors in the development of DR including hypoxia, oxidative stress and inflammation [27].…”

Section: Introductionmentioning

confidence: 99%

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The Role of Obstructive Sleep Apnea in Vision-Threatening Diabetic Retinopathy—A National Register-Based Study

Ba-Ali,

Jennum,

Brøndsted

et al. 2023

JPM

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Introduction: we investigated the association between OSA and vision-threatening diabetic retinopathy (VTDR). Methods: we used three nationwide registers to identify subjects with and without OSA and patients with type 1 (T1DM) or type 2 diabetes mellitus (T2DM). The Danish Civil Registration System was used to link OSA with diabetes diagnosis. The primary outcome was the occurrence of VTDR in diabetic patients with and without OSA. The secondary outcome was the prevalence of diabetes mellitus in patients with and without OSA. Results: we included 532,828 diabetic subjects comprising 13,279 patients with OSA (2.5%) and 519,549 without OSA (97.5%). Diabetic patients with OSA had a 57% lower risk of VTDR compared to diabetic patients without OSA (OR 0.43, 95% CI 0.38–0.50, p < 0.0001). Conclusions: our findings indicate that OSA is associated with a lower risk of VTDR. Since we did not adjust our outcomes for diabetes duration, hypertension control and hemoglobin A1c, future studies are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Role of Obstructive Sleep Apnea in Vision-Threatening Diabetic Retinopathy—A National Register-Based Study

Ba-Ali,

Jennum,

Brøndsted

et al. 2023

JPM

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“…The level of DR is graded from 0 to 4 according to the International Clinical Retinopathy Disease Severity Scale (ICDR scale, 0 = no DR, 1–3 = mild, moderate, and severe non-proliferative DR (NPDR) and 4 = proliferative DR (PDR)) [ 11 , 24 ]. Screening is performed predominantly by fundus photography [ 8 ], and individualized screening intervals are used according to national guidelines [ 11 ]. NPR was established in 1977 and comprises information on a patient specific level of hospital in- and outpatient visits as well as received diagnoses and treatments, according to the International Classification of Diseases system [ [25] , [26] , [27] ].…”

Section: Methodsmentioning

confidence: 99%

“…As a result, it leads to micro- and macro vascular damage causing hypoxia in the affected organs as e.g. the eye, causing diabetic retinopathy (DR) [ [4] , [5] , [6] ]; considered the most frequent complication of diabetes [ 7 , 8 ]. Screening of DR reduces the risk of irreversible vision loss [ 9 , 10 ], and screening programs have successfully been implemented in Denmark [ 11 ], among other countries [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Diabetic retinopathy is a predictor of chronic respiratory failure: A nationwide register-based cohort study

Thinggaard

Stokholm

Davidsen

et al. 2023

Heliyon

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“…To indicate systemic disease, we used the Danish National Patient Registry (Schmidt et al, 2015), which contains International Classification of Disease (ICD) version ten codes (World Health 1992) for all hospital‐based contacts during the study. This register was also used to calculate the Charlson Comorbidity Index score (Brusselaers & Lagergren 2017), which we modified by excluding diabetes, as this was present in all patients (Grauslund et al, 2021). Hence, a person without other systemic diseased than diabetes would be given an index score of 0.…”

Section: Methodsmentioning

confidence: 99%

Presence and development of diabetic retinopathy in 153 238 patients with type 2 diabetes in the Danish Registry of Diabetic Retinopathy

Grauslund

Pedersen

Andersen³

et al. 2022

Acta Ophthalmologica

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Purpose The purpose of the study was to evaluate the prevalence and incidence of diabetic retinopathy (DR) along with associated markers in patients with type 2 diabetes in the Danish DR‐screening programme. Methods We included all persons with type 2 diabetes in the Danish Registry of Diabetic Retinopathy, who had attended at least one episode of DR screening in 2013–2018. DR was classified as levels 0–4 indicating increasing severity. Data were linked with various national health registries to retrieve information on diabetes duration, marital status, comorbidity and systemic medication. Results Among 153 238 persons with type 2 diabetes, median age and duration of diabetes were 66.9 and 5.3 years and 56.4% were males. Prevalence and 5‐year incidences of DR, 2‐step‐or‐more progression of DR and progression to proliferative DR (PDR) were 8.8%, 3.8%, 0.7% and 0.2%, respectively. In multivariable models, leading markers of incident DR and progression to PDR were duration of diabetes (HR 1.98, 95% CI 1.87–2.09; HR 2.89, 95% CI 2.34–3.58 per 10 years of duration) and use of insulin (HR 1.88, 95% CI 1.76–2.01; HR 2.40, 95% CI 1.84–3.13), while the use of cholesterol‐lowering medicine was a protecting marker (HR 0.87, 95% CI 0.81–0.93; HR 0.70, 95% CI 0.52–0.93). From 2013 to 2015, 3‐year incidence rates of PDR decreased from 1.22 to 0.45 events per 1000 person‐years. Conclusion Nationally, among Danish individuals with type 2 diabetes attending DR screening, we identified duration of diabetes and use of insulin as the most important predictor for the development of DR, while cholesterol‐lowering medicine was a protective factor.

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Inverse Cross-sectional and Longitudinal Relationships between Diabetic Retinopathy and Obstructive Sleep Apnea in Type 2 Diabetes

Cited by 6 publications

References 30 publications

The Role of Obstructive Sleep Apnea in Vision-Threatening Diabetic Retinopathy—A National Register-Based Study

The Role of Obstructive Sleep Apnea in Vision-Threatening Diabetic Retinopathy—A National Register-Based Study

Diabetic retinopathy is a predictor of chronic respiratory failure: A nationwide register-based cohort study

Presence and development of diabetic retinopathy in 153 238 patients with type 2 diabetes in the Danish Registry of Diabetic Retinopathy

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