To evaluate the association between obstructive sleep apnea and diabetic macular edema (DME) in patients with Type II diabetes, using the apnea–hypopnea index and other nocturnal hypoxemia parameters.
This cross-sectional, case–control study included 99 patients with Type II diabetes: the first group included patients with DME (DME+ group) and the second patients without DME (DME− group). Polysomnography was performed in all patients. The two groups were compared, and the risk factors were studied using logistic regression.
The DME+ group comprised 38 patients, and the DME− group comprised 61 patients, aged a mean 68.8 years and 66.3 years (P = 0.27), respectively; mean body mass index was 29.7 and 30.9 (P = 0.16), respectively. The mean apnea–hypopnea index was significantly higher in the DME+ group (43.95 [13.5–87.3]) than in the DME− group (35.18 [3.55–90.7]) (P = 0.034). Patients with DME had more severe obstructive sleep apnea (apnea–hypopnea index >30) than the others: 71% versus 50.8% (P = 0.049). Cumulative time of SPO2 below 90% (CT90%) was independently associated with DME after adjusting for confounding factors, whereas there was no difference between the oxygen desaturation index and minimum O2 saturation.
Severe obstructive sleep apnea (apnea–hypopnea index >30) and parameters of nocturnal hypoxemia (cumulative time of SPO2 below 90%) are associated with DME.
Obstructive sleep apnea, responsible of nocturnal hypoxia, could increase the risk of diabetic macular edema on the diabetic population. This controlled study showed that there is a strong association between severe obstructive sleep apnea (AHI ≥30) and diabetic macular edema on Type II diabetic population. There is also a link between diabetic macular edema and desaturation parameters. Obstructive sleep apnea screening in patients with Type II diabetes seems justified.
*Hospital of Neurology, Ophthalmology, Lyon, France;
†Ophthalmology, Croix-Rousse University Hospital, Lyon, France;
‡Ophthalmology, Desgenettes Military Hospital, Lyon, France; and
§Ezus Lyon, Biostatistique, Lyon, France.
Reprint requests: Anne-Laure Vié, MD, Hospices Civils de Lyon, Service d'Ophtalmologie, Hôpital Neurologique, 59 Boulevard Pinel, 69500 Bron, France; e-mail: email@example.com
L. Kodjikian reports personal fees from Allergan, personal fees from Bayer, personal fees from Alcon, personal fees from Novartis, personal fees from Alimera, and personal fees from Thea, outside the submitted work. H. El Chehab reports personal fees from Bayer, nonfinancial support from Novartis, and nonfinancial support from Zeiss, outside the submitted work. N. Voirin reports personal fees from Ezus Lyon 1, during the study period, and personal fees from ACROPOL association (Association Croix-Roussienne pour Le Progrès en Ophtalmologie), outside the submitted work. P. Denis reports personal fees from Allergan, personal fees from Alimera, and personal fees from Novartis, outside the submitted work. C. Dot reports personal fees from Allergan, personal fees from Bayer, personal fees from Alcon, and personal fees from Novartis, outside the submitted work. The remaining authors have no financial/conflicting interests to disclose.