Decreased Peripapillary and Macular Vascular Densities in Patients with Moderate/Severe Obstructive Sleep Apnea/Hypopnea Syndrome

Figures & data

Figure 1 (A) Peripapillary scan in the superficial layer. (B) The resulting images of peripapillary scan in superficial layer after AngioTool analysis. (C) Macular scan in the superficial layer. (D) The resulting images of macular scan in superficial layer after AngioTool analysis.

Table 1 Demographic Data of All Participants Grouped According to the Apnea/Hypopnea Index (AHI, /hr.)

	Control (N = 24)	Mild OSA (N = 51)	Moderate OSA (N = 43)	Severe OSA (N = 52)	p value
Age (years)	35.0 (31.5~46.0)	38.0 (32.3~45.5)	39.0 (32.3~46.0)	40.0 (35.0~46.0)	0.725
Sex (Male/Female)	7/17	31/20	31/12	51/1	<0.0001*
BMI (kg/m^2)	23.4 (21.0~25.3)	24.1 (22.5~26.0)	25.6 (23.8~27.4)	28.4 (26.1~31.1)	<0.0001*
ESS	7 (6~8)	8 (5~12)	10 (7~13)	9 (6~13)	0.128
AHI (/hr)	2.7 (1.1~3.6)	9.0 (6.5~11.7)	20.4 (16.8~24.2)	58.9 (45.9~69.5)	<0.0001*
AHI in REM (/hr)	3.1 (0 ~12.9)	17.4 (9.6~22.9)	37.5 (24.3~51.0)	56.8 (41.9~68.3)	<0.0001*
Arousal index	9.1 (4.7~12.1)	9.5 (5.3~17.3)	23.4 (12.7~32.1)	41.6 (25.3~59.5)	<0.0001*
Longest Apnea (sec)	21.4 (17.4~33.9)	24.1 (17.3~39.2)	44.4 (31.5~59.5)	59.2 (41.2~79.1)	<0.0001*
mO2(%)	96.5 (94.9~97.1)	95.8 (95.2~96.3)	95.2 (94.4~96.1)	93.0 (91.7~94.7)	<0.0001*
LSaO2 (%)	90.5 (87.0~93.5)	89.0 (85.3~91.0)	82.5 (78.0~88.0)	74.0 (63.0~78.0)	<0.0001*
ODI (/hr)	1.4 (0.5~2.4)	4.7 (3.0~7.1)	12.5 (7.3~15.4)	53.8 (37.0~65.8)	<0.0001*

Notes: Continuous data were expressed as median (interquartile range) compared using Kruskal–Wallis Test and categorical data by chi-square test. *Statistically significant.

Abbreviations: OSA, obstructive sleep apnea/hypopnea syndrome; BMI, body mass index; ESS, Epworth Sleepiness Scale; AHI, apnea-hypopnea index; REM, rapid eye movement; mO₂, mean saturation of oxygen; LSaO₂, lowest saturation of oxygen; ODI, oxygen desaturation index.

Table 2 Ophthalmologic Examination Data of All Participants Grouped According to the Apnea/Hypopnea Index (AHI, /hr)

	Control (n = 24)	Mild OSA (n = 51)	Moderate OSA (n = 43)	Severe OSA (n = 52)	p value
SE (diopters)	−2.00 (−5.25~-0.75)	−3.38 (−5.50~-1.00)	−2.25 (−4.50~-0.50)	−2.63 (−5.00~-0.75)	0.515
IOP (mmHg)	14.0 (13.0~15.0)	14.0 (12.0~15.0)	13.0 (13.0~16.0)	15.0 (13.0~16.0)	0.545
Visual field
MD (dB)	−0.33 (−1.52~0.57)	−0.31 (−1.79~0.30)	−0.90 (−1.69~0.17)	−0.41 (−1.43~0.66)	0.727
PSD (dB)	1.78 (1.51~2.26)	1.62 (1.40~2.01)	1.56 (1.36~1.97)	1.55 (1.34~1.86)	0.213
RNFL thickness
Global (μm)	105 (98~109)	104 (97~111)	101 (96~107)	100 (91~106)	0.042
Superior (μm)	130 (116~144)	129 (115~144)	127 (115~139)	129 (114~136)	0.784
Inferior (μm)	133 (127~144)	131 (122~146)	130 (114~137)	127 (112~135)	0.006
Temporal (μm)	87 (76~114)	88 (76~100)	89 (77~101)	81 (73~92)	0.139
Nasal (μm)	64 (55~73)	64 (53~73)	60 (47~69)	63 (54~73)	0.816
Macular thickness
Average (μm)	293 (288~299)	293 (285~301)	293 (285~297)	293 (285~300)	0.929
Superior (μm)	296 (289~301)	295 (288~301)	294 (287~301)	294 (285~303)	0.936
Inferior (μm)	292 (284~296)	290 (280~302)	290 (284~296)	291 (282~297)	0.875
Peripapillary vascular density
Superficial layer (%)	46.19 (45.52~46.55)	46.09 (44.96~46.72)	45.44 (44.62~46.21)	45.14 (44.04~46.12)	0.002*
Deep layer (%)	43.91 (43.18~45.19)	44.15 (42.71~44.80)	43.67 (42.65~44.41)	43.02 (42.23~44.27)	0.030*
Choriocapillary layer (%)	44.60 (43.31~44.98)	44.56 (43.42~45.48)	44.43 (43.63~44.98)	44.99 (43.86~45.55)	0.213
Choroidal layer (%)	45.33 (44.15~46.13)	44.85 (43.90~45.79)	44.34 (42.19~45.56)	44.44 (42.56~45.19)	0.018*
Macular vascular density
Superficial layer (%)	44.80 (44.47~45.53)	44.94 (44.14~45.71)	44.69 (44.12~45.48)	44.21 (43.65~45.08)	0.019*
Deep layer (%)	45.98 (43.62~47.28)	46.01 (44.89~47.04)	45.78 (44.46~47.21)	45.10 (44.02~46.90)	0.490
Choriocapillary layer (%)	43.93 (42.88~44.94)	44.11 (42.78~44.96)	43.89 (42.38~44.78)	44.02 (42.26~45.18)	0.876
Choroidal layer (%)	46.28 (45.87~46.80)	46.82 (46.19~47.15)	46.13 (45.56~46.91)	46.17 (45.79~46.70)	0.007*

Notes: Continuous data were expressed as median (interquartile range) and compared using Kruskal–Wallis Test. *Statistically significant.

Abbreviations: OSA, obstructive sleep apnea/hypopnea syndrome; SE, spherical equivalence; IOP, intraocular pressure; RNFL, retinal nerve fiber layer; MD, mean deviation; PSD, pattern standard deviation.

Table 3 Comparison of Polysomnographic Data Between Normal/Mild OSA (AHI < 15; N = 75) and Moderate/Severe OSA Patients (AHI ≥ 15; N = 95)

	Control/Mild OSA	Moderate/Severe OSA	p value
Age (years)	37.0 (32.0~45.5)	39.0 (33.3~46.0)	0.371
Sex (Male/Female)	38/37	82/13	<0.0001*
BMI (kg/m^2)	23.9 (21.6~25.8)	27.1 (24.9~29.7)	<0.0001*
ESS	7 (5~10)	9 (6~13)	0.096
AHI (/hr)	6.7 (4.0~10.4)	32.9 (20.9~63.3)	<0.0001*
AHI in REM (/hr)	13.5 (4.7~20.0)	45.4 (32.5~59.5)	<0.0001*
Arousal index	9.3 (5.3~14.1)	29.7 (21.0~46.3)	<0.0001*
Longest Apnea (sec)	23.6 (17.2~35.4)	52.0 (37.3~69.4)	<0.0001*
mO2(%)	96.0 (95.1~96.5)	94.3 (92.6~95.3)	<0.0001*
LSaO2 (%)	89.0 (87.0~92.0)	78.0 (70.0~83.0)	<0.0001*
ODI (/hr)	3.7 (1.9~6.0)	28.0 (12.7~55.9)	<0.0001*

Notes: Continuous data were expressed as median (interquartile range) compared using Mann–Whitney Test and categorical data by chi-square test. *Statistically significant.

Abbreviations: OSA, obstructive sleep apnea/hypopnea syndrome; BMI, body mass index; ESS, Epworth Sleepiness Scale; AHI, apnea-hypopnea index; REM, rapid eye movement; mO₂, mean saturation of oxygen; LSaO₂, lowest saturation of oxygen; ODI, oxygen desaturation index.

Table 4 Comparison of Ophthalmologic Examinations Between Normal/Mild OSA (AHI < 15; N = 75) and Moderate/Severe OSA Patients (AHI ≥ 15; N = 95)

	Control/Mild OSA	Moderate/Severe OSA	p value
SE (diopters)	−2.88 (−5.25~-0.75)	−2.77 (−4.75~-0.75)	0.922
IOP (mmHg)	14 (12~15)	14 (13~16)	0.131
Visual field
MD (dB)	−0.31 (−1.79~0.34)	−0.64 (−1.66~0.61)	0.732
PSD (dB)	1.64 (1.44~2.11)	1.56 (1.36~1.90)	0.106
RNFL thickness
Global (μm)	104 (98~111)	101 (94~107)	0.010*
Superior (μm)	129 (115~144)	128 (115~137)	0.316
Inferior (μm)	132 (123~146)	128 (114~137)	0.002*
Temporal (μm)	88 (76~102)	85 (77~94)	0.181
Nasal (μm)	64 (53~73)	62 (49~73)	0.573
Macular thickness
Average (μm)	293 (285~299)	293 (285~299)	0.559
Superior (μm)	295 (288~301)	294 (286~303)	0.536
Inferior (μm)	291 (282~300)	290 (284~297)	0.517
Peripapillary vascular density
Superficial layer (%)	46.12 (45.05~46.70)	45.29 (44.38~46.15)	0.0003*
Deep layer (%)	44.15 (42.87~44.91)	43.14 (42.35~44.37)	0.004*
Choriocapillary layer (%)	44.60 (43.42~45.37)	44.68 (43.76~45.45)	0.495
Choroidal layer (%)	45.09 (43.95~45.87)	44.37 (42.22~45.33)	0.003*
Macular vascular density
Superficial layer (%)	44.82 (44.27~45.68)	44.45 (43.83~45.33)	0.012*
Deep layer (%)	46.01 (44.73~47.06)	45.41 (44.25~47.11)	0.313
Choriocapillary layer (%)	44.11 (42.84~44.96)	43.97 (42.34~44.99)	0.549
Choroidal layer (%)	46.63 (46.00~47.10)	46.13 (45.69~46.77)	0.004*

Notes: Continuous data were expressed as median (interquartile range) compared using Mann–Whitney Test. *Statistically significant.

Abbreviations: OSA, obstructive sleep apnea/hypopnea syndrome; SE, spherical equivalence; IOP, intraocular pressure; RNFL, retinal nerve fiber layer; MD, mean deviation; PSD, pattern standard deviation.

Figure 2 (A) peripapillary vascular densities, superficial layer. (B) peripapillary vascular densities, choroidal layer. (C) macular vascular densities, superficial layer. (D) macular vascular densities, choroidal layer.

Table 5 Rank Correlation (ρ) Between Polysomnographic Variables and Ophthalmologic Variables in All Participants

	Peripapillary VD Superficial Layer		Peripapillary VD Deep Layer		Peripapillary VD Choroid Layer		Macular VD Superficial Layer		Macular VD Choroid Layer		Global RNFL Thickness
	ρ	p	ρ	p	ρ	p	ρ	p	ρ	p	ρ	p
AHI	−0.257	0.0007*	−0.197	0.0102*	−0.220	0.0039*	−0.199	0.0094*	−0.186	0.0152*	−0.214	0.0054*
LSaO2	0.314	<0.0001*	0.230	0.0028*	0.133	0.0867	0.245	0.0014*	0.123	0.1141	0.132	0.0916
ODI	−0.264	0.0005*	−0.206	0.0074*	−0.218	0.0045*	−0.243	0.0015*	−0.170	0.0277*	−0.188	0.0158*

Notes: ρ: Spearman’s coefficient of rank correlation. *Statistically significant.

Abbreviations: OSA, obstructive sleep apnea/hypopnea syndrome; VD, vascular density; RNFL, retinal nerve fiber layer; AHI, apnea/hypopnea index; LSaO₂, lowest saturation of oxygen; ODI, oxygen desaturation index.

Figure 3 (A) Correlation between peripapillary vascular density in the superficial layer and AHI. (B) Correlation between macular vascular density in the superficial layer and AHI. (C) Correlation between peripapillary vascular density in the superficial layer and LSaO₂. (D) Correlation between macular vascular density in the superficial layer and LSaO₂.

Abbreviations: AHI, apnea/hypopnea index (/hr.); LSaO₂, lowest saturation of oxygen (%).