Retinal vascular manifestations of obstructive sleep apnea

Abstract

Purpose of review The aim of this article is to summarize up-to-date research on the effects of obstructive sleep apnea (OSA) on retinal vascular conditions. Recent findings OSA is associated with the development of diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy. The severity of OSA and biomarkers such as the apnea–hypopnea index (AHI) correlate with the severity of retinal disease. Dysregulation of circadian locomotor output cycles kaput (CLOCK) genes that govern circadian rhythm is associated with development of proliferative retinal disease. Summary OSA and retinal vascular disease have a high cost burden on the healthcare system. OSA creates systemic changes and hypoxic conditions that may incite or exacerbate retinal vascular diseases. Retinal changes may be the first clinical manifestation of otherwise undiagnosed OSA, so it is important to refer patients with new-onset retinal vascular disease for appropriate sleep testing.

Assessment of the Effectiveness of Obstructive Sleep Apnea Treatment Using Optical Coherence Tomography to Evaluate Retinal Findings

“…As recently reviewed by D'Souza & Kappor [48], OSAS demonstrated a significant association with retinal vascular disorders. It is associated with the development of diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy.…”

Peripheral retinal neovascularization in a patient with obstructive sleep apnea

“…While it is possible that OSA-induced nocturnal hypoxemia can cause sufficient retinal hypoxia to independently cause neovascularization, the more likely pathway is potentiation of other comorbid ischemic etiologies. 6 The combination of diabetic microvascular compromise and OSA-induced nocturnal hypoxemia may predispose to a higher incidence of diabetic retinopathy, and accordingly, a recent meta-analysis showed significantly increased risk of diabetic retinopathy with comorbid OSA. 7 Additionally, increased endothelial damage and vascular stasis associated with OSA may heighten the risk for retinal venous occlusion.…”

“… 7 Additionally, increased endothelial damage and vascular stasis associated with OSA may heighten the risk for retinal venous occlusion. 6 …”

Disruption of Circadian Rhythm Genes in Obstructive Sleep Apnea Patients—Possible Mechanisms Involved and Clinical Implication

“…Circadian clock disruption is also a potential mechanism of diabetes complications, such as diabetic retinopathy development. The excessive CLOCK-dependent expression of DEC2 and VEGF [ 80 ] leads to incorrect neovascularization and in consequence diabetic retinopathy. Moreover, VEGF translation is powered by HIF-1α [ 81 ] (see Figure 5 ).…”