Relationship between sleep-disordered breathing and iris and/or angle neovascularization in proliferative diabetic retinopathy cases.
OBJECTIVE
To investigate whether sleep-disordered breathing is a risk factor for iris and/or angle neovascularization in patients with proliferative diabetic retinopathy (PDR).


METHODS
Cross-sectional comparative case series.


METHODS
One hundred fifty-one consecutive patients with PDR who underwent surgery in our hospital were divided based on the presence of iris and/or angle neovascularization (NV group, 37 patients) or absence of NV (non-NV group, 114 patients). Pulse oximetry was conducted during the night and the mean SpO(2), 4% oxygen desaturation index (4% ODI times/hour), the lowest SpO(2)% during sleep (lowest SpO(2)), and the cumulative percentage of time at SpO(2) <90% in analysis times (CT90%) were calculated. When the 4% ODI exceeded 5 times/hour, sleep-disordered breathing was diagnosed. The results were compared between the 2 groups. Preoperative systemic parameters also were analyzed by logistic regression to clarify risk factors for the NV group.


RESULTS
A mean total of 50% (62% of the NV group and 46% of the non-NV group) was diagnosed with sleep-disordered breathing. The mean SpO(2) and lowest SpO(2) did not differ significantly between the 2 groups; the 4% ODI (12.3 vs 6.6) and CT90% (3.8 vs 1.7) were significantly higher in the NV group (P=.02, for both comparisons). Logistic regression analysis identified insulin therapy (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.26∼7.20; P=.01); and 4% ODI (OR, 1.09; CI, 1.01∼1.16; P=.02) as risk factors for the NV group.


CONCLUSIONS
In patients with PDR, nocturnal intermittent hypoxia/reoxygenation resulting from sleep-disordered breathing may be a risk factor for iris and/or angle neovascularization.
Department of Ophthalmology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba 285-8741, Japan. tomoaki-s@sakura.med.toho-u.ac.jp
Tomoaki
T
Shiba
Mao
M
Takahashi
Yuichi
Y
Hori
Yoshitsugu
Y
Saishin
Yukihiro
Y
Sato
Takatoshi
T
Maeno
D000368:Aged; D000867:Anterior Chamber / Q000098:blood supply*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D018463:Filtering Surgery; D015355:Glaucoma, Neovascular / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007328:Insulin / Q000627:therapeutic use; D007498:Iris / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000209:etiology*; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000175:diagnosis
D007328:Insulin; D010100:Oxygen