阻塞性睡眠呼吸暂停对糖尿病视网膜病变进展和全身并发症的影响。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2024-07-31 DOI:10.1016/j.ajo.2024.07.021

Ehsan Rahimy , Euna B. Koo , Karen M. Wai , Cassie A. Ludwig , Andrea L. Kossler , Prithvi Mruthyunjaya

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引用次数: 0

摘要

目的：评估伴有阻塞性睡眠呼吸暂停（OSA）的非增殖性糖尿病视网膜病变（NPDR）患者发生糖尿病视网膜病变进展和全身血管事件（包括死亡）的风险：设计：回顾性队列研究：方法：使用 TriNetX（美国马萨诸塞州剑桥市）进行电子病历查询。确定了有或没有 OSA 的 NPDR 患者。患有增殖性疾病（PDR）、糖尿病性黄斑水肿（DME）或曾接受过眼部干预（玻璃体内注射、激光或玻璃体旁切除术）的患者将被排除在外。为控制基线人口统计学和合并症，进行了倾向评分匹配。在1年、3年和5年时，对进展为视力威胁并发症（VTC）、需要眼部干预和全身性事件的比率进行了测量：经过倾向评分匹配后，对每组的 11931 名患者进行了分析。在 1 年时，OSA 组群中发生 PDR 的风险较高（RR：1.34，PC 结论：DR 进展率较高：OSA 患者的 DR 发展为 VTC、需要眼科干预和全身并发症（包括死亡）的比率增加。我们强调需要改进对 NPDR 和潜在 OSA 患者的筛查措施。

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Impact of Obstructive Sleep Apnea on Diabetic Retinopathy Progression and Systemic Complications

Purpose

To evaluate the risk of diabetic retinopathy progression and systemic vascular events, including death, in patients with nonproliferative diabetic retinopathy (NPDR) with obstructive sleep apnea (OSA).

Design

Retrospective cohort study.

Methods

Electronic chart query using TriNetX, an electronic health records network comprising data from over 124 million patients. Patients with NPDR with and without OSA were identified. Patients were excluded if they had a history of proliferative disease (proliferative diabetic retinopathy), diabetic macular edema, or prior ocular intervention (intravitreal injection, laser, or pars plana vitrectomy). Propensity score matching was performed to control for baseline demographics and comorbidities. The rate of progression to vision-threatening complications, need for ocular intervention, and systemic events was measured at 1, 3, and 5 years.

Results

A total of 11 931 patients in each group were analyzed after propensity score matching. There was an elevated risk of proliferative diabetic retinopathy in the OSA cohort at 1 (risk ratio [RR]: 1.34, P < .001), 3 (RR: 1.31, P < .001), and 5 years (RR: 1.28, P < .001). There was an elevated risk of diabetic macular edema in the OSA group at all time points: 1 (RR: 1.31, P < .001), 3 (RR: 1.19, P<.001), and 5 years (RR: 1.18, P < .001). With respect to ocular interventions, there was an increased risk of intravitreal injection in patients with OSA at 1 (RR: 1.59, P < .001), 3 (RR: 1.58, P < .001), and 5 years (RR: 1.54, P < .001), and similar trends were noted with laser photocoagulation, but not vitrectomy. Regarding systemic events, patients with NPDR with OSA had a greater risk of stroke (1 year RR: 1.80, P < .001; 3 years RR: 1.56, P < .001; and 5 years RR: 1.49, P < .001), myocardial infarction (1 year RR: 1.51, P < .001; 3 years RR: 1.46, P < .001; and 5 years RR: 1.43, P < .001), and death (1 year RR: 1.31, P < .001; 3 years RR: 1.19, P < .001; and 5 years RR: 1.15, P < .001).

Conclusions

There is an increased rate of diabetic retinopathy progression to vision-threatening complications, need for ocular intervention, and systemic complications, including death, for patients with OSA. We emphasize the need for improved screening measures of patients with NPDR and potential OSA.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.