title: Sex-Specific Association of Obstructive Sleep Apnea With Retinal Microvascular Signs: The Multi-Ethnic Study of Atherosclerosis.
abstract: Obstructive sleep apnea (OSA) is a common condition affecting more men than women. The relationship of OSA with microvascular disease is unclear, complicated by possible sex difference. Assessment of the relationship of OSA with retinal microvascular signs in men and women may provide insights into such a relationship.
  
  
  
  We examined the sex-specific cross-sectional association of OSA severity with retinal vascular calibers in 1808 participants, and with specific retinopathy signs in 1831 participants from a sample of 2060 participants aged 54 to 93 years who underwent successful polysomnography in the Multi-Ethnic Study of Atherosclerosis, 2010-2012. OSA severity was defined by the apnea-hypopnea index (events/h) as none (<5), mild (5-14.9), moderate (15-29.9), and severe (≥30). As compared to no OSA, moderate/severe OSA in men was associated with retinal arteriolar narrowing (odds ratio [OR] and 95% CI for the narrowest quartile: 1.65 [1.00-2.71]) and retinal venular widening (1.80 [1.07-3.04] for the widest quartile), but not in women (odds ratio: 1.10 [0.67-1.81] and 0.91 [0.58-1.43], respectively) after adjusting for age, race/ethnicity, body mass index, pack-years of cigarette smoking, alcohol intake, hypertension duration, diabetes mellitus duration, HbA1c levels, lipid profile, micro-/macroalbuminuria, estimated glomerular filtration rate, β-blockers use, antihypertensive therapy, and lipid-lowering therapy. In contrast, severe OSA was associated with retinal microaneurysms in women, but not in men (odds ratio: 3.22 [1.16-8.97] and 0.59 [0.27-1.30], respectively).
  
  
  
  The associations of OSA severity with retinal microvascular signs may differ by sex. Whether these findings were related to sex differences in OSA exposure needs further investigation.
authors.affiliation: Department of Preventive Medicine, Northwestern University, Chicago, IL Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan gen-min.lin@northwestern.edu farmer507@yahoo.com.tw.
authors.forename: Gen-Min
authors.initials: GM
authors.lastname: Lin
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, MA Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WS.
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.affiliation: Department of Preventive Medicine, Northwestern University, Chicago, IL.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Colangelo
authors.affiliation: Division of Epidemiology and Clinical Applications, NIH Intramural Research Program, National Eye Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Cotch
authors.affiliation: National University of Singapore and Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Graduate Medical School, National University of Singapore, Singapore.
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WS.
authors.forename: Barbara E K
authors.initials: BE
authors.lastname: Klein
authors.affiliation: Department of Medicine, University of Pittsburgh, PA.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Patel
authors.affiliation: Departments of Medicine and Epidemiology, Columbia University, New York, NY.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Shea
authors.affiliation: Department of Preventive Medicine, Northwestern University, Chicago, IL.
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D016017:Odds Ratio; D017286:Polysomnography; D012171:Retinal Vessels / Q000473:pathology*; D012720:Severity of Illness Index; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000503:physiopathology; D014652:Vascular Diseases / Q000453:epidemiology* / Q000473:pathology
keywords: apnea‐hypopnea index; epidemiology; microvascular dysfunction; obstructive sleep apnea; retinal vascular calibers; retinopathy; sex‐specific