Evaluation of Choroidal Thickness and Retinal Vessel Density with Serum HIF-1α and TNF-α Level in Patients with OSAS

Abstract

Purpose

To reveal changes in choroidal thickness, retinal vessel density, and serum HIF-1α and TNF-α levels in obstructive sleep apnea syndrome (OSAS) and their correlation.

Methods

This prospective case-control study included 118 patients divided into mild-to-moderate OSAS (n = 40), severe OSAS (n = 39), and a control group (n = 39). Choroidal thickness was evaluated with OCT, vessel density with OCTA, AHI index with polysomnography, and serum HIF-1α and TNF-α levels were analyzed using the enzyme-linked immunosorbent assay.

Results

The serum HIF-1α values of the participants in the mild-moderate OSAS and severe OSAS groups were [893.25(406.7–2068) and 1027(453–2527), respectively], and were both significantly higher than the control group [(521.5(231.6–2741))] (p < 0.001). Serum TNF-α levels did not differ significantly between the groups (p = 0.051).). Subfoveal choroidal thickness (SFCT) values of the severe OSAS groups were significantly lower than the control group (p < 0.05). The superficial and deep capillary plexus vascular density (SVD and DVD) values of the severe OSAS group were lower than the control group (p < 0.05). Serum HIF-1α and TNF-α levels of all participants were negatively correlated with both their SVD values (p < 0.05, r: –0.220 and p < 0.05, r: –0.252, respectively) and their DVD values (p < 0.001, r: –0.324 and p = 0.001, r: –0.299, respectively).

Conclusions

Increased serum levels of inflammatory mediators (HIF-1α ve TNF-α) in OSAS cause a decrease in SFCT, SVD, and DVD, which is an indication of systemic vascular damage. Further research on developing treatment strategies to modulate TNF-α ve HIF-1α may help recede vascular morbidity in OSAS patients.

Keywords:

• Choroidal thickness
• hypoxia inducible factor 1
• obstructive sleep apnea syndrome
• retinal vessel density
• tumor necrosis factor alpha

Authors’ contributions

BS and MO designed the study BS collected blood samples and data, ÜS performed the polysomnography, MA analyzed the serum HIF-1α and TNF-α levels with ELISA kits, BS, MO, ÜS, HF, FU, MK, MGA and MA interpreted the data and wrote original draft, all authors reviewed, edited and approved the final manuscript.

Consent to participate

Informed consent was obtained from all individual participants included in the study. Consent to publish: All the authors agreed to publish the article

Disclosure statement

The authors report no conflicts of interest and have no proprietary interest in any of the materials mentioned in this article.

Ethical approval

This study adhered to the tenets of the Declaration of Helsinki and was approved by the Recep Tayyip Erdogan University Ethics Committee (Approval ID: 2021/178).

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Additional information

Funding

This study was supported by the Recep Tayyip Erdoğan University Scientific Research Project (Project number TTU-2021-1309).