Characterization of Retinal Microvascular Changes in Obstructive Sleep Apnea Using OCT Angiography: Data from the Obstructive Sleep Apnea and Retinal Microvascular NETwork Study.

PURPOSE: To characterize retinal microvascular changes in individuals with obstructive sleep apnea syndrome (OSAS) compared with OSAS-free controls using OCT angiography (OCT-A).

DESIGN

Prospective, single-center cohort study with exposed (OSAS) and unexposed (controls) groups.

PARTICIPANTS

A total of 162 (324 eyes) participants, including 82 (164 eyes) OSAS participants and 80 (160 eyes) healthy controls, were analyzed. Among OSAS participants, 63 received continuous positive airway pressure (CPAP) therapy and were reevaluated at 3 to 6 months and 18 to 24 months.

METHODS

Retinal vessel density (VD) and perfusion density (PD) were quantified in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), as well as the foveal avascular zone (FAZ) and peripapillary region. Multivariable mixed-effects models were used to compare OCT-A parameters between groups, adjusting for age, sex, axial length, hypertension, diabetes, smoking, and vascular diseases. Changes in microvascular parameters associated with CPAP use were evaluated at 3 to 6 months and 18 to 24 months of follow-up.

MAIN OUTCOME MEASURES: The primary outcome was the comparison of retinal microvascular parameters between OSAS participants and OSAS-free controls. Secondary outcomes included microvascular parameters across OSAS severity groups and longitudinal changes after CPAP therapy.

RESULTS

At baseline, OSAS participants exhibited a significant reduction in retinal VD and PD in the DCP compared with OSAS-free controls (β [95% confidence interval] = -0.724 [-1.352 to -0.096], P = 0.024 and -0.020 [-0.033 to -0.007], P = 0.03, respectively). No significant differences were observed in the SCP, FAZ, or peripapillary regions. Retinal VD and PD remained overall similar after CPAP initiation throughout the follow-up when adjusted for treatment compliance.

CONCLUSIONS

This prospective cohort study showed that OSAS was associated with retinal microvascular alterations in the DCP. Retinal microvascular parameters remained similar over follow-up after CPAP initiation.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.