title: Sleep apnea and retinal signs in cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis.
abstract: OBJECTIVE
  The aim of the study was to examine the relationship between sleep apnea, retinal vascular caliber and retinopathy, and their impact on cardiovascular disease (CVD) risk.
  
  
  METHODS
  A multi-ethnic cohort of 5,803 participants was examined based on standardized grading of retinal vascular caliber and retinopathy from digital fundus photographs, self-reported physician-diagnosed sleep apnea (PDSA), and incident cardiovascular events.
  
  
  RESULTS
  In women, PDSA was associated with narrower arterioles (regression coefficient [β] -5.76; 95 % confidence Interval [CI] -8.51, -3.02) after adjusting for cardio-metabolic risk factors. The incident rate ratio (IRR) of CVD was also associated with narrower arterioles (IRR for highest versus lowest tertile 1.91; 95 % CI 1.08, 3.38). In men, PDSA was not associated with arteriolar caliber. However, incident CVD was associated with narrower arterioles (IRR 1.67; 95 % CI 1.10, 2.52), wider venules (IRR 1.71; 95 % CI 1.13, 2.59) and PDSA (IRR 2.03, 95 % CI 1.17, 3.51). The IRR of CVD in men with PDSA increased minimally to 2.06 (95 % CI 1.18, 3.56) after adjustment for retinal arteriolar and venular caliber. Combining women and men, the IRR of CVD was 3.41 (95 % CI 1.79, 6.50) in those with both PDSA and narrower retinal arterioles.
  
  
  CONCLUSIONS
  Sleep apnea was associated with narrower retinal arterioles in women but not in men. However, sleep apnea was also associated with incident CVD in men. These suggest potential gender differences in susceptibility to microvascular disease in association with sleep apnea.
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore. merwynchew@gmail.com.|Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. merwynchew@gmail.com.|Department of Ophthalmology, National University Health System, Singapore, Singapore. merwynchew@gmail.com.
authors.forename: Merwyn
authors.identifier: http://orcid.org/0000-0002-3136-4769
authors.initials: M
authors.lastname: Chew
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Jing
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Ophthalmology and Visual Science, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.affiliation: Department of Ophthalmology and Visual Science, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Klein
authors.affiliation: Division of Epidemiology and Clinical Research, National Eye Institute, NIH, Bethesda, MD, USA.
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Cotch
authors.affiliation: Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.|Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.|Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.|Department of Ophthalmology, National University Health System, Singapore, Singapore.
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.|Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Ning
authors.initials: N
authors.lastname: Cheung
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian; D050197:Atherosclerosis / Q000175:diagnosis* / Q000208:ethnology*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D005451:Fluorescein Angiography; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D008297:Male; D055806:Microvessels / Q000502:physiology*; D008875:Middle Aged; D011446:Prospective Studies; D012171:Retinal Vessels / Q000503:physiopathology*; D012307:Risk Factors; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000208:ethnology*; D013223:Statistics as Topic; D014661:Vasoconstriction / Q000502:physiology*; D044465:White People
keywords: Cardiovascular disease; Microcirculation; Retinal imaging; Retinal vascular caliber; Retinopathy; Sleep apnea