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 Researchers followed adults with type 2 diabetes over about four
years and found that for those with milder eye disease at the start,
having sleep apnea was linked to higher odds that it would become
more advanced.
At the outset of the study, they also found that advanced
“sight-threatening diabetic retinopathy” was already present in 43
percent of people with sleep apnea, compared to just 24 percent of
those without apnea.
"Patients with type 2 diabetes and obstructive sleep apnea (OSA) are
at increased risk of developing advanced retinopathy and also are at
increased risk of greater decline in kidney function, as we found in
a previous publication,” senior study author Dr. Abd A. Tahrani from
University of Birmingham told Reuters Health.
“Hence, diagnosing OSA offers the opportunity to identify a
high-risk group of patients which will allow doctors to apply
preventative treatment strategy to slow the progression of these
complications,” Tahrani said by email.
Diabetic eye disease, or retinopathy, affects as many as 50 percent
of people with diabetes, yet it remains unclear exactly what
contributes to its development or what causes it to get worse.
Past studies have found a link between sleep apnea and damage to
tiny blood vessels that causes kidney and nerve problems in people
with diabetes, the authors note.
Tahrani’s team looked at whether sleep apnea is associated with the
progression of diabetic retinopathy in 230 patients with type 2
diabetes, none of whom had diagnosed respiratory conditions,
including sleep apnea, at the start of the study.
After sleep monitoring was done, 63 percent of the participants were
found to have obstructive sleep apnea.
At the outset, the rates of sight-threatening diabetic retinopathy,
advanced diabetic retinopathy and maculopathy (damage to the part of
the eye responsible for central vision) were already higher in
patients with sleep apnea than in those without sleep apnea.
As time went on, three times as many patients with sleep apnea, 18.4
percent, progressed to more advanced stages of diabetic retinopathy
compared to 6.1 percent of those without sleep apnea, according to
the report in American Journal of Respiratory and Critical Care
Medicine.
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The worse the sleep apnea, the faster the progression of diabetic
retinopathy, researchers found.
Sleep apnea, however, did not appear to be associated with faster
progression of existing sight-threatening diabetic retinopathy or
maculopathy.
On a positive note, sleep apnea treatment with CPAP (continuous
positive airway pressure) slowed the progression to advanced
diabetic retinopathy.
“While the impact of CPAP on retinopathy and other diabetes-related
complications requires further study, CPAP treatment has several
benefits, including lowering the blood pressure, improving
sleepiness, improving quality of life, improving OSA-related
symptoms and reducing the risk of road traffic accidents; hence CPAP
treatment should be considered in patients with type 2 diabetes who
have OSA,” Tahrani said.
"Diabetic retinopathy is mostly caused by diabetes, and more severe
diabetic retinopathy could be promoted by poor blood sugar control
and OSA in type 2 diabetes,” said Dr. Gen-Min Lin from Hualien-Armed
Forces General Hospital and National Dong Hwa University in Hualien,
Taiwan, who recently looked at the association of sleep apnea with
changes in the tiny blood vessels of the retina.
“In some cross-sectional studies, women with more severe OSA were
found to have higher risk of less severe diabetic retinopathy (such
as microaneurysms) than men,” Lin told Reuters Health in an email.
“This sex difference might be related to female sex hormone or
higher grade inflammation status in women.”
SOURCE: http://bit.ly/2utX8Qz American Journal of Respiratory and
Critical Care Medicine, online June 8, 2017.
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