Blegen Halward M J, Justin Grant A, Bishop Bradley A, Cox Anthony R, Aden James K, Wedel Marissa L, Hobbs Samuel D
Department of Ophthalmology, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA.
Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA.
J Vitreoretin Dis. 2021 Mar 1;5(6):495-500. doi: 10.1177/2474126421989576. eCollection 2021 Nov-Dec.
This work reports the association of obstructive sleep apnea (OSA) and cotton-wool spots (CWS) seen in patients with nonproliferative diabetic retinopathy (DR).
A random sample of patients diagnosed with DR between January 1, 2015 and December 31, 2018, were selected from medical-billing codes. Dilated funduscopic examination findings and medical history were analyzed by reviewing medical records.
CWS were present in 12 of 118 patients without OSA, compared with 11 of 32 patients with OSA (10.2% vs 34.4%, respectively; = .002). OSA was more common in men (68.8%, = .03) and associated with a higher body mass index (30.0 ± 5.0 without OSA vs 33.6 ± 5.5 with OSA, < .001). When comparing those with and without OSA, there was no association with age; glycated hemoglobin A; stage of DR; insulin dependence; presence of diabetic macular edema; smoking status; or a history of hypertension, hyperlipidemia, cardiovascular disease, or other breathing disorder.
The presence of OSA is associated with CWS in patients with DR, as well as male sex and a higher body mass index. Further research is needed to determine the ophthalmologist's role in the timely referral of patients with CWS for OSA evaluation.
本研究报告了非增殖性糖尿病视网膜病变（DR）患者中阻塞性睡眠呼吸暂停（OSA）与棉絮斑（CWS）之间的关联。
从医疗计费代码中选取2015年1月1日至2018年12月31日期间被诊断为DR的患者随机样本。通过查阅病历分析散瞳眼底检查结果和病史。
118例无OSA的患者中有12例出现CWS，而32例有OSA的患者中有11例出现CWS（分别为10.2%和34.4%；P = 0.002）。OSA在男性中更常见（68.8%，P = 0.03），且与较高的体重指数相关（无OSA者为30.0±5.0，有OSA者为33.6±5.5，P < 0.001）。比较有和无OSA的患者时，发现其与年龄、糖化血红蛋白A、DR分期、胰岛素依赖、糖尿病性黄斑水肿的存在、吸烟状况或高血压、高脂血症、心血管疾病或其他呼吸障碍病史均无关联。
DR患者中OSA的存在与CWS相关，同时也与男性性别和较高的体重指数有关。需要进一步研究以确定眼科医生在及时转诊有CWS的患者进行OSA评估方面的作用。
