Bridging the Gap: The Role of Continuous Positive Airway Pressure Therapy in Diabetic Retinopathy Associated With Obstructive Sleep Apnea–A Perspective

Background: Obstructive sleep apnea (OSA) is a highly prevalent, yet under-diagnosed sleep disorder and has a strong association with type 2 diabetes and diabetic retinopathy (DR). Vascular abnormalities, nocturnal glucose dysregulation, impaired blood flow, and hypoxia during OSA induce oxidative stress and promote the inflammatory pathways which increase the VEGF factor levels, leading to the progression of DR. Aims: To date, continuous positive airway pressure (CPAP) is the most effective, gold-standard treatment for patients with moderate to severe OSA. However, the implications of CPAP for the treatment of DR due to OSA is still a topic of ongoing debate. Conclusion: Evidence suggests that the administration of CPAP therapy led to a reduction in retinal exudates and optical coherence tomography indices for retinal edema and also exhibited improvement in glycemic control, sleepiness, and overall health-related quality of life. Nevertheless, there are limited studies present that have evaluated the impact of CPAP therapy on DR in patients with OSA and well-designed studies are needed to confirm CPAP's therapeutic effect on DR despite these findings. Moreover, concerns regarding its long-term safety, adherence challenges, and inconsistent study designs limit definitive conclusions about CPAP's efficacy in managing DR. This indicates the need for future studies to advocate for enhanced CPAP adherence strategies, refined diagnostic criteria for OSA, and large-scale clinical trials to explore CPAP's therapeutic role in DR. Addressing these challenges could revolutionize clinical practices, optimize patient outcomes, and establish CPAP as a cornerstone in the integrated management of OSA and DR.