Nuffield Department of Medicine, University of Oxford, Oxford, UK.
NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
Graefes Arch Clin Exp Ophthalmol. 2022 Jul;260(7):2129-2139. doi: 10.1007/s00417-022-05596-8. Epub 2022 Feb 24.
Retinal microvascular endothelial dysfunction is thought to be of importance in the development of ocular vascular diseases. Obstructive sleep apnoea (OSA) causes macrovascular endothelial dysfunction, but the effect of OSA on retinal microvascular endothelial function is not known. We aimed to determine the effect of OSA on retinal microvascular function.
We conducted a multi-centre, double-blind, randomised, parallel, controlled trial in patients with known moderate-to-severe OSA, established on continuous positive airway pressure (CPAP). Participants were randomised to 14 nights of either continued CPAP or sham CPAP to generate a return of OSA. Retinal vascular responses to flickering light were measured using dynamic vessel analysis both at baseline and after 14 nights of intervention. The primary outcome was the change from baseline to follow-up in the area under the curve of the arteriolar response to flickering light, sham CPAP versus continued CPAP.
Nineteen patients were randomised to sham CPAP, and 18 patients were randomised to continued CPAP. There was no significant effect of CPAP withdrawal and return of OSA on retinal responses, with a change in the area under the curve of the arteriole response to flickering light of + 3.8 arbitrary units (95% CI - 10.6 to + 18.2, p = 0.59), sham CPAP versus continued CPAP.
CPAP withdrawal and a return of OSA had no significant effect on retinal microvascular responses. This contrasts with the effect of CPAP withdrawal on macrovascular endothelial function and suggests that OSA has different effects on macrovascular and microvascular endothelial function. ISRCTN 78082983, 23/10/2014, Prospectively registered.
视网膜微血管内皮功能障碍被认为在眼部血管疾病的发展中具有重要意义。阻塞性睡眠呼吸暂停（OSA）会导致大血管内皮功能障碍，但 OSA 对视网膜微血管内皮功能的影响尚不清楚。我们旨在确定 OSA 对视网膜微血管功能的影响。
我们在已知患有中重度 OSA 的患者中进行了一项多中心、双盲、随机、平行、对照试验，这些患者通过持续气道正压通气（CPAP）进行了治疗。参与者被随机分配到 14 个晚上的 CPAP 治疗或假 CPAP 治疗，以恢复 OSA。在基线和干预 14 天后，使用动态血管分析测量闪烁光下视网膜血管的反应。主要结局是闪烁光下视网膜小动脉反应的曲线下面积从基线到随访的变化，假 CPAP 与 CPAP 治疗相比。
19 名患者被随机分配到假 CPAP 组，18 名患者被随机分配到 CPAP 治疗组。CPAP 撤离和 OSA 恢复对视网膜反应没有显著影响，闪烁光下小动脉反应的曲线下面积变化为+3.8 个任意单位（95%CI-10.6 至+18.2，p=0.59），假 CPAP 与 CPAP 治疗相比。
CPAP 撤离和 OSA 恢复对视网膜微血管反应没有显著影响。这与 CPAP 撤离对大血管内皮功能的影响形成对比，表明 OSA 对大血管和微血管内皮功能有不同的影响。ISRCTN78082983，2014 年 10 月 23 日，前瞻性注册。
