title: Relationship between sleep disordered breathing and diabetic retinopathy: Analysis of 136 patients with diabetes.
abstract: OBJECTIVE
  Sleep disordered breathing (SDB) is associated with poor glycemic control. However, whether SDB contributes to diabetic microangiopathies, especially diabetic retinopathy (DR), is unknown. The aim of this study was to assess the relationship between SDB and DR.
  
  
  METHODS
  Between January 2010 and November 2012, 136 patients underwent a sleep test and were divided into two groups according to the presence or absence of DR. Sleep test results and known risk factors for DR were compared between groups. Optic fundi were examined using indirect ophthalmoscope or retinal photographs and diagnosed by experienced ophthalmologists. Multivariate stepwise (backward) logistic regression analysis was performed to assess factors associated with DR.
  
  
  RESULTS
  Ninety-nine patients without DR (NDR) and 37 patients with DR were assessed. Patients in the DR group had significantly longer duration of diabetes, were more likely to have hypertension and cardiovascular disease (CVD), and were more likely to be taking angiotensin converting enzyme inhibitors or angiotensin receptor blockers (p=0.000 for each). In the multivariate backward logistic regression analysis, minimum SO2 (odds ratio [OR], 0.89; p=0.001), HbA1c (OR, 1.40; p=0.021), duration of diabetes (OR, 1.23; p<0.001), and history of CVD (OR, 8.96; p=0.008) remained significant.
  
  
  CONCLUSIONS
  Minimum SO2 values were associated with DR independent from glycemic control level, duration of diabetes, and history of CVD. This finding suggests that SDB may contribute to the development of DR not through frequency, but due to the degree of intermittent hypoxia.
authors.affiliation: Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan. Electronic address: toranishi@gmail.com.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishimura
authors.affiliation: Sleep Center, Toranomon Hospital, Tokyo, Japan; Cardio-Respiratory Sleep Medicine, Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kasai
authors.affiliation: Sleep Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Haruko
authors.initials: H
authors.lastname: Tamura
authors.affiliation: Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan.
authors.forename: Azusa
authors.initials: A
authors.lastname: Yamato
authors.affiliation: Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan.
authors.forename: Daijiro
authors.initials: D
authors.lastname: Yasuda
authors.affiliation: Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Nagasawa
authors.affiliation: Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Okubo
authors.affiliation: Sleep Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Narui
authors.affiliation: Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan.
authors.forename: Yasumichi
authors.initials: Y
authors.lastname: Mori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult
keywords: Diabetic angiopathies; Diabetic retinopathy; Intermittent hypoxia; Retinal disease; Sleep apnea syndrome; Sleep disorders