The relationship between high-risk obstructive sleep apnea as identified by STOP-BANG questionnaire and diabetic retinopathy: a case-control observational study at a tertiary center in Jordan

Diabetic retinopathy (DR) remains a leading cause of vision loss worldwide. While metabolic control of blood glucose is the standard of care, obstructive sleep apnea (OSA) has emerged as a potential systemic factor influencing retinal disease. This study investigated the association between OSA risk, as assessed by the STOP-BANG questionnaire, and the presence of DR in a Jordanian cohort. A case-control observational study was conducted at a tertiary center in Jordan, including 300 patients with type 2 diabetes mellitus. Participants were divided into a disease group (moderate non-proliferative DR or worse and/or diabetic macular edema) and a control group (no DR). OSA risk was assessed using the STOP-BANG questionnaire. Clinical data were retrieved from electronic medical records. Multivariate logistic regression models were constructed with sequential adjustment for demographic, metabolic, and vascular factors. High-risk OSA category (as identified by the STOP-BANG questionnaire) was more frequent in the DR group compared with controls (odds ratio [OR]: 2.17; 95% confidence interval [CI]: 1.12–4.24; p = 0.023). This association remained significant after adjustment for age, sex, HbA1c, and duration of diabetes (adjusted OR: 2.12; 95% CI: 1.08–4.16; p = 0.029), and after further adjustment for hypertension and body mass index also (adjusted OR: 2.87; 95% CI: 1.10–7.50; p = 0.032). High-risk OSA category (as identified by the STOP-BANG questionnaire) was associated with DR in unadjusted and partially adjusted analyses. These findings suggest that the relationship between OSA high-risk category and DR is present in our cohort. However, further studies using objective OSA diagnostic methods are warranted.