Nw2013 rcopt retinopathies in sleep apnea09
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Nw2013 rcopt retinopathies in sleep apnea09
- 2. ο Many names ο ο ο OSA : Obstructive Sleep Apnea OSAHS : Obstructive Sleep Apnea/ Hypopnea Syndrome SDB : sleep disordered breathing
- 3. ο Chronic transient apnea/ hypopnea ο chronic recurrent ischemia ο develop organ problems/ aggravate some other diseases
- 4. ο ο ο ο ο Floppy eyelid syndrome Glaucoma NAION Disc edema +/- blunt eye injury ο - CSCR - DR progression - RVO
- 5. ο ο ο 1. Retinal findings in OSA 2. Risk for other specific retinal diseases 3. Retinopathies in pts with known systemic disease
- 6. ο 1. Retinal findings in OSA ο 2. Risk for other specific retinal diseases 3. Retinopathies in pts with known systemic disease ο
- 7. ο ο In patients without known systemic disease fundus findings ο ο ο ο ο ο Disc swelling/ NAION Thin NFL/ glaucoma AV nicking, focal arteriolar narrowing Microaneurysms, exudates, ME, retinal hemorrhage Venous beading NVD, NVE
- 8. Sleep disordered breathing and retinal microvascular diameter Shankar et al. Atherosclerosis 2012 -Wisconsin -476 pts sleep cohort study
- 9. Sleep disordered breathing and retinal microvascular diameter Shankar et al. Atherosclerosis 2012 - apnea-hypopnea index (AHI) - <5 events/ h 5-14.9 events/ h 15> events/ h -Outcomes - Retinal arteriolar narrowing - - mean retinal arteriolar diameter <141.0 mcm Retinal venular widening - mean retinal venular diameter >223.0 mcm
- 10. Sleep disordered breathing and retinal microvascular diameter Shankar et al. Atherosclerosis 2012 Results -higher AHI - positively assoc. With retinal venular dilation - (P=0.045) - OR (compared to AHI<5 group) - AHI5-14.9 e/h 1.31 (0.75-2.28) - AHI>15 e/h 2.08 (1.03-2.16) independent of BMI, HT, DM, lipid levels - - no assoc. Between AHI and retinal arteriolar narrowing (P=0.72)
- 11. ο Retinal Vascular Tortuosity in OSA ο Mohsenin et al. Clinical Ophthalmology 2013. ο Yale, Connecticut, USA 9 pts + 7 ctrls Fundus photo with Image J Digital analysis software ο ο
- 12. ο Retinal Vascular Tortuosity in OSA ο Mohsenin et al. Clinical Ophthalmology 2013. ο Results : tortuosity were more in OSA group Tortousity P At 10 DD Arteriolar Not sig 0.016 Venous 0.001 0.028 total ο P At 5 DD 0.011 0.004 Independent of age, gender, BMI, DM and lipid levels
- 13. ο Sleep-disordered Breathing is not Associated with the presence of retinal microvascular abnormalities: The Sleep Heart Health Study ο Lori B. et al. Sleep. 2004 U of Minnesota, U of Wisconsin, JHU, U of C, U of Pittsburgh ο ο ο ο ο 2927 pts Retinopathy can be found more in pts with high respiratory disturbance index (RDI) But after adjustment for age, BMI, HT, DM ο not significant Do not demonstrate any relation between OSA and retinal microangiopathy
- 14. ο CWS in a patient with sleep apnea syndrome ο ο ο ο ο Kitagawa K. J Med Sci. 2003 A 55 yrs old japanese woman with OSA CWS in 2 eyes Treated with nasal continuous positive airway pressure during sleep CWS disappeared
- 15. ο 1. Retinal findings in OSA ο 2. Risk for other specific retinal diseases ο 3. Retinopathies in pts with known systemic disease
- 16. ο 2. Risk for other specific retinal diseases ο CSR
- 17. ο ο bilateral CSCR in a case resolved within a week of starting apnea treatment Moghimi S et al. Sleep Med. 2012
- 18. ο ο bilateral CSCR in a case resolved within a week of starting apnea treatment Moghimi S et al. Sleep Med. 2012 ο After treatment ο OSA ο increase cathecholamine
- 19. ο ο CSCR and risk for OSA Thellea K et al. Sleep Breath. 2007. ο ο ο Retrospective case-control 29 CSCR pts and 29 matched controls Increased risk for OSA ο ο ο 58.6% of CSCR cases 31.0% of control Odds ratio =3.67 ο (95%CI 1.02-13.14, P=0.046)
- 20. ο OSA in patients with CSCR ο Patrik Kloos. Graefes Arch Clin Exp Ophthalmol. 2008 ο ο ο 56 consecutive pts with CSCR 22% of CSCR patients were confirmed diag as OSA Switzerland population c OSA 2-4%
- 21. ο 2. Risk for other specific retinal diseases ο RVO
- 22. ο Obstructive Sleep Apnea among Pts with RVO Glacet-Bernard et al. Arch Ophthalmol. 2010. ο Association between OSA and RVO ο ο ο ο Higher than expected prevalence of OSA in pts with RVO Dysfunction in the autoregulation of 3 major blvs (PCA, CRA, OA)
- 23. ο Sleep apnea and risk of retinal vein occlusion: a nationwide population-based study of Taiwanese Chou KTet al. Am J Ophthalmol. 2012 ο 5965 sleep apnea patients vs 29 669 controls ο
- 24. ο Sleep apnea and risk of retinal vein occlusion: a nationwide population-based study of Taiwanese Chou KTet al. Am J Ophthalmol. 2012 ο tendency of sleep apnea patients toward RVO ο ο ο 1.94-fold increase ο ο (P = .048, log-rank test) (95% confidence interval, 1.03 to 3.65; P = .041) independent of age, gender, and co-morbidities
- 25. ο ο ο 1. Retinal findings in OSA 2. Risk for other specific retinal diseases 3. Retinopathies in pts with known systemic disease
- 26. ο DM and DR
- 27. ο ο ο Obstructive sleep apnoea is associated with the development and progression of diabetic retinopathy, independent of conventional risk factors and novel biomarkers for diabetic retinopathy Rudrappa et al. Br J Ophthalmol 2012 31 Obese DM pts ο ο 17 OSA 16 non-OSA
- 28. ο ο ο ο Obstructive sleep apnoea is associated with the development and progression of diabetic retinopathy, independent of conventional risk factors and novel biomarkers for diabetic retinopathy Rudrappa et al. Br J Ophthalmol 2012 Results OSA group ο ο ο ο ο Worse retinopathy score (p=0.04) but not maculopathy score (p=0.15) More PDR (N=4 vs 0; Ο2 4.8; p=0.01). multiple regression analysis ο only OSA is an independent significant predictor of the total retinopathy scores (p=0.008)
- 29. ο ο ο ο ο ο ο Abnormal sleep patterns in subjects with type II DM and its effect on diabetic microangiopathies R Raman et al. Acta Diabetol. 2012 1,414 DM patients, 136 controls Chennai, India Age > 40Yrs old Population base cross sectional survey Look for abnormal sleep pattern(ASP), DR
- 30. ο Abnormal sleep patterns in subjects with type II DM and its effect on diabetic microangiopathies R Raman et al. Acta Diabetol. 2012 ο Results ο ο ο No association of ASP with DR in both genders Find association of ASP with DN
- 31. ο ο Sleep Apnea in Patients with Diabetic Retinopathy Mason et al. Retina 2012 ο ο ο Oxford 195 DM pts Pts with CSME ο ο ο ο Home sleep study (ApneaLink; ResMed) Compared with control OCT/ fundus photo Results ο ο 54% had an o2 desaturation index>10 31% had an apnea-hypopnea index >15
- 32. ο Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes ο Aronson et al. Am J Respir Crit Care Med 2010. ο Performed polysomnography and measured HbA1C in 60 DM type 2 pts ο Results ο ο 77% DM pts had OSA (Apnea-hypopnea index >=5) Increase severity of OSA is associated with poorer glucose control
- 33. ο ο ο ο Nocturnal intermittent Serious Hypoxia and Reoxygenation in PDR Cases Shiba et al. Am J Ophthalmol 2010 68 NPDR and 151 PDR Conduct pulse oximetry overnight
- 34. Nocturnal intermittent Serious Hypoxia and Reoxygenation in PDR Cases Shiba et al. Am J Ophthalmol 2010 ο ο ο Results NPDR PDR P 4%O2 desaturation index 4.9 7.8 .007 Lowest SpO2 87.0 82.4 .0006 Cumulative % time spent at SpO2<90% 0.8 2.2 .0006
- 35. ο ο ο Nocturnal intermittent Serious Hypoxia and Reoxygenation in PDR Cases Shiba et al. Am J Ophthalmol 2010 Conclusion ο Nocturnal hypoxia (SDB) is a risk factor for PDR development
- 36. ο 1. Retinal findings in OSA ο AV nicking, focal arteriolar narrowing ? ο Microaneurysms, exudates, ME, retinal hemorrhage Venous dilatation, tortuousity ο ο 2. Risk for other specific retinal diseases ο ο ο CSCR CRVO 3. Retinopathies in pts with known systemic disease ο DR ο ο ο More often More aggressive HT?