Key result
High-risk OSA shows no significant link to increased diabetic retinopathy prevalence versus low-risk patients.
Why the study?
Intermittent hypoxia from OSA may amplify retinal ischemia and accelerate the onset and progression of DR and PDR, but this association required investigation in Indian T2DM patients.
Does a high risk of obstructive sleep apnea increase the prevalence of diabetic retinopathy in patients with type 2 diabetes mellitus?
Observational (n=85)
No
Does a high risk of obstructive sleep apnea increase the prevalence of diabetic retinopathy in patients with type 2 diabetes mellitus?
Effect estimate: OR 0.78 (95% CI 0.225-2.67)
Absolute Event Rate: 58.33% vs 52.05%
p-value: p=0.686
High risk of obstructive sleep apnea is associated with a non-significant trend toward a higher prevalence of diabetic retinopathy and proliferative diabetic retinopathy in patients with type 2 diabetes.
Non-significant DR trend in high-risk OSA warrants no practice change; hypothesis-generating for prospective OSA-retinopathy trials in T2DM.
Introduction Obstructive sleep apnea (OSA) causes intermittent hypoxia that may amplify retinal ischemia, accelerating the onset and progression of diabetic retinopathy (DR), specifically proliferative diabetic retinopathy (PDR). This study investigates the association between OSA and DR, including PDR, in an Indian cohort of type 2 diabetes mellitus (T2DM) patients. Methods In a prospective observational study conducted from October 2022 to December 2023 at a tertiary care centre, 85 T2DM patients (45 with DR, 40 without DR) underwent OSA screening using the Epworth Sleepiness Scale (ESS). High-risk patients (ESS ≥10) underwent polysomnography (PSG), with OSA severity graded by Apnea-Hypopnea Index (AHI). Results High OSA risk significantly correlated with longer diabetes duration (p=0.033), elevated HbA1c (p=0.030), dyslipidemia (p=0.003), hypertension (p=0.005), neck circumference (p=0.02), and BMI (p<0.001). DR prevalence was higher in high-risk OSA patients (58.33% vs. 52.05%, p=0.686), with a trend toward PDR (57.14% vs. 42%, p=0.943). PSG in nine patients revealed a trend showing greater oxygen desaturation index (ODI) and AHI in the DR group, albeit without statistical significance (p>0.05). Conclusion Though OSA association with DR and PDR remains statistically inconclusive, the results are exploratory and hypothesis-generating. Screening for OSA in resource-limited, busy DR clinics can detect additional risk factors. The novel AHI-sleep parameter trends advocate for further studies to validate OSA as a modifiable risk factor.
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Bhatnagar et al. (2026) conducted an observational in Adults with type 2 diabetes mellitus attending retina clinic in India with and without diabetic retinopathy (n=85). Screening for obstructive sleep apnea using Epworth Sleepiness Scale (ESS) followed by polysomnography (PSG) for high-risk patients (ESS ≥10) vs. Patients with low OSA risk (ESS <10) was evaluated on Prevalence of diabetic retinopathy (DR) and proliferative diabetic retinopathy (PDR) in patients classified as high-risk vs low-risk for obstructive sleep apnea (OSA) by ESS (OR 0.78, 95% CI 0.225-2.67, p=0.686). High-risk OSA patients had a 58.33% prevalence of diabetic retinopathy vs 52.05% in low-risk patients (OR 0.78, p=0.686), showing a non-significant trend toward higher DR prevalence.
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