Decreased Peripapillary and Macular Vascular Densities in Patients with Moderate/Severe Obstructive Sleep Apnea/Hypopnea Syndrome

Abstract

Pei-Wen Lin,1– 3 Hsin-Ching Lin,2– 6 Chun-Tuan Chang,4 Meng-Chih Lin,2,3,7 Michael Friedman,8,9 Anna M Salapatas9 1Division of Glaucoma, Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 3College of Medicine, Chang Gung University, Taoyuan, Taiwan; 4Institute of Healthcare Management, Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan; 5Institute of Biomedical Science, National Sun Yat-sen University, Kaohsiung, Taiwan; 6Department of Otolaryngology, Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 8Department of Otolaryngology, Division of Sleep Surgery, Rush University Medical Center, Chicago, IL, USA; 9Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, IL, USACorrespondence: Hsin-Ching Lin, Tel [phone] ext.2533, Fax [phone], Email [email protected]; [email protected]: To compare peripapillary and macular vascular densities (PVDs and MVDs) between patients with obstructive sleep apnea/hypopnea syndrome (OSA) and control subjects with symptoms of sleep-related breathing disorders only by swept-source optical coherence tomography angiography (OCTA).Participants and Methods: In this prospective study, 192 participants underwent a full-night polysomnography to determine OSA severity and subsequently received OCTA measurements as well as AngioTool software analysis.Results: A total of 146 patients with OSA (51 mild, 43 moderate, 52 severe) and 24 control subjects (apnea/hypopnea index, AHI < 5) were enrolled. PVDs and MVDs in the superficial and choroidal layers were significantly different among the four groups. When participants with simple snoring/mild OSA (AHI < 15) were grouped together and compared with moderate/severe OSA (AHI ≥ 15), PVDs were significantly lower for the latter group in the superficial layer (p = 0.0003), deep layer (p = 0.004), and choroidal layer (p = 0.003). MVDs were also lower for the moderate/severe OSA group in the superficial (p = 0.012) and choroidal layer (p = 0.004). Negative correlations were identified between AHI and PVDs in the superficial layer (ρ = − 0.257, p = 0.0007), deep layer (ρ = − 0.197, p = 0.0102) and choroidal layer (ρ = − 0.220, p = 0.0039) and between AHI and MVDs in the superficial layer (ρ = − 0.199, p = 0.0094) and choroid layer (ρ = − 0.186, p = 0.0152).Conclusion: PVDs and MVDs were significantly lower in patients with moderate/severe OSA as compared to subjects with simple snoring/mild OSA. Furthermore, decreased PVDs and MVDs significantly correlated with OSA severity.Keywords: peripapillary vascular density, macular vascular density, peripapillary retinal nerve fiber layer, swept-source optical coherence tomography angiography, snoring, obstructive sleep apnea/hypopnea syndrome

Keywords

• peripapillary vascular density
• macular vascular density
• peripapillary retinal nerve fiber layer
• swept-source optical coherence tomography angiography
• snoring
• obstructive sleep apnea/hypopnea syndrome.