Musgrove Park Hospital, Taunton, UK.
Respiration. 2012;84(4):275-82. doi: 10.1159/000334090. Epub 2011 Dec 20.
Diabetic retinopathy and diabetic macular oedema are more prevalent in patients with coexistent obstructive sleep apnoea (OSA).
We assessed if treatment of OSA with continuous positive airway pressure (CPAP) might improve visual acuity (VA).
A total of 35 patients with clinically significant macular oedema (CSMO) and OSA [oxygen desaturation index (ODI) ≥10 or apnoea-hypopnoea index (AHI) ≥15] were identified and agreed to be studied. VA (expressed as the logarithm of the minimum angle of resolution, logMAR), macular thickness, fundal photographs, glycosylated haemoglobin (HbA1c) and rhodopsin mRNA were measured twice at baseline and at 3 and 6 months post-CPAP. Fluorescein angiography and the Epworth Sleepiness Scale (ESS) were obtained once at baseline and at 6 months.
Three patients withdrew before the first trial visit. Thus, a total of 32 patients (17 males) entered the study, and 4 subsequently withdrew; thus 28 completed 6 months of follow-up. Baseline characteristics of the subjects were as follows [mean (SD or inter-quartile range)]: age 66.2 (7.1) years, body mass index 31.7 (6.3), HbA1c 7.4% (1.44) [57.1 (15.7) mmol/mol], AHI 16.5 (11-25), ODI 16.0 (12-25), ESS 6.5 (4.0-12.0) and duration of diabetes 9.5 years (5.0-16.5). Participants were divided into 13 high and 15 low CPAP compliers (≥ and <2.5 h/night over the 6 months, respectively). At 6 months, the adjusted treatment effect on VA of high compliance versus low compliance was 0.11 (95% confidence interval 0.21 to -0.002; p = 0.047), equivalent to a one-line improvement on the logMAR chart. There was no significant improvement in macular oedema or fundal photographs.
This hypothesis-generating, uncontrolled study suggests that ≥2.5 h/night CPAP usage over 6 months in individuals with CSMO and OSA may be associated with improvement in VA. This provides justification for a randomised controlled trial of CPAP therapy in such patients.
患有阻塞性睡眠呼吸暂停（OSA）的患者更易出现糖尿病视网膜病变和糖尿病性黄斑水肿。
我们评估了持续气道正压通气（CPAP）治疗 OSA 是否可以改善视力（VA）。
共确定并同意研究 35 例患有临床显著黄斑水肿（CSMO）和 OSA 的患者[氧减指数（ODI）≥10 或呼吸暂停低通气指数（AHI）≥15]。VA（以最小分辨角对数表示，logMAR）、黄斑厚度、眼底照片、糖化血红蛋白（HbA1c）和视紫红质 mRNA 在基线和 CPAP 后 3 个月和 6 个月时测量两次。荧光素血管造影和 Epworth 嗜睡量表（ESS）在基线和 6 个月时各测量一次。
3 名患者在第一次试验就诊前退出。因此，共有 32 名患者（17 名男性）入组，4 名患者随后退出；因此，28 名患者完成了 6 个月的随访。受试者的基线特征如下[平均值（SD 或四分位距）]：年龄 66.2（7.1）岁，体重指数 31.7（6.3），HbA1c7.4%（1.44）[57.1（15.7）mmol/mol]，AHI16.5（11-25），ODI16.0（12-25），ESS6.5（4.0-12.0）和糖尿病病程 9.5 年（5.0-16.5）。参与者被分为 13 名高 CPAP 依从者和 15 名低 CPAP 依从者（分别为≥和<2.5 小时/夜，持续 6 个月）。6 个月时，高依从性与低依从性的调整治疗效果在 VA 上为 0.11（95%置信区间 0.21 至-0.002；p=0.047），相当于 logMAR 图表上的一行改善。黄斑水肿或眼底照片无明显改善。
这项产生假说的、未对照的研究表明，在患有 CSMO 和 OSA 的个体中，6 个月内每晚使用≥2.5 小时 CPAP 可能与 VA 改善相关。这为 CPAP 治疗此类患者的随机对照试验提供了依据。
