Severe sleep apnea is a risk factor for developing diabetic macular edema, a complication of diabetes that can cause vision loss or blindness, according to researchers at Chang Gung Memorial Hospital in Taiwan.
Diabetic macular edema was also more difficult to treat in patients with severe sleep apnea. While earlier research showed a weak connection between both conditions, evidence is mounting that sleep apnea exacerbates underlying eye disease.
When people with diabetes have poor control over their blood sugar levels, the tiny blood vessels at the back of the eye can become damaged. This condition is called diabetic retinopathy and it’s a leading cause of blindness in the United States.
Sometimes, tiny bulges protrude from the blood vessels, leaking fluid and blood into the retina. This fluid can cause swelling or edema in an area of the retina that allows us to see clearly.
Breathing repeatedly stops and starts with sleep apnea, disrupting sleep and causing blood oxygen levels to drop. This drop in oxygen appears to unleash changes in the body that may play a role in injuring blood vessels. People with sleep apnea are at risk of developing hypertension, heart attacks, stroke, and type 2 diabetes.
Sleep apnea also may contribute to the development and worsening of diabetic retinopathy by increasing insulin resistance, elevating inflammation, and raising blood pressure, all of which can damage the blood vessels at the back of the eye.
The researchers looked at data from all patients diagnosed with diabetic retinopathy over an eight-year period at Chang Gung Memorial Hospital in Taiwan. The rate of severe sleep apnea was significantly higher in patients with diabetic macular edema compared to those without diabetic macular edema, 80.6% versus 45.5%.
Also, the researchers found that the worse the sleep apnea was, the worse the macular edema. Severe sleep apnea additionally was more prevalent in patients who needed more treatment to control their macular edema. These patients required three or more treatments of medical or laser therapy.
“Based on these results, we hope that more medical professionals will approach sleep apnea as a risk factor for diabetic macular edema,” said lead researcher Juifan Chiang, MD. “This could allow for earlier medical intervention so patients can keep more of their vision and preserve their overall health as much as possible.”
The study was presented at AAO 2019, the 123rd Annual Meeting of the American Academy of Ophthalmology.
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