Sleep-disordered breathing is not associated with the presence of retinal microvascular abnormalities

The Sleep Heart Health Study

Lori L. Boland, Eyal Shahar, Tien Y. Wong, Ronald Klein, Naresh M Punjabi, John A. Robbins, Anne B. Newman

Research output: Contribution to journalArticle

Abstract

Study Objective: Sleep apnea and milder forms of sleep-disordered breathing (SDB) have been associated with overt clinical cardiovascular disease, but it is unknown whether SDB is associated with arterial microvascular pathology. We examined the relation between SDB and retinal microvascular abnormalities. Design: Cross-sectional study. Participants: Subjects were 2,927 men and women, aged 51 to 97 years, who participated in the Sleep Heart Health Study and had retinal photographs taken within approximately 3 years of overnight, unattended, at-home polysomnography. Measurements and Results: A respiratory disturbance index (RDI), calculated as the average number of apneas and hypopneas per hour of sleep, was used as an indicator of SDB in analysis. The overall prevalence of retinopathy was slightly higher in people with higher RDI values (5.4%, 4.9%, 8.6%, and 7.6%, respectively, in increasing quartiles of RDI), but after adjustment for age, body-mass index, hypertension, diabetes, and other factors, the presence of retinopathy was not associated with SDB. With the possible exceptions of microaneurysms and generalized arteriolar narrowing, as measured by lower arteriole-to-venule ratio, specific retinal abnormalities were not associated consistently with the RDI. Relative to the first quartile of RDI, the adjusted odds ratios (95% confidence interval) for the presence of microaneurysm in the second, third, and fourth quartiles of RDI were 1.05 (0.44-2.55), 1.97 (0.89-4.37), and 1.79 (0.78-4.10), respectively. An increase of RDI from 0 to 10 was associated with a predicted decrease in arteriole-to-venule ratio of 0.01. Results were similar when analyses were conducted in normotensive and nondiabetic persons separately. Conclusions: These data do not demonstrate a notable relation between SDB and retinal abnormalities. However, since this is the first investigation of a link between retinopathy and SDB, similar studies should be conducted in other population samples to demonstrate either consistency or inconsistency of our findings across studies.

Original languageEnglish (US)
Pages (from-to)467-473
Number of pages7
JournalSleep
Volume27
Issue number3
StatePublished - 2004

Fingerprint

Sleep Apnea Syndromes
Sleep
Health
Venules
Arterioles
Polysomnography
Apnea
Body Mass Index
Cardiovascular Diseases
Cross-Sectional Studies
Odds Ratio
Confidence Intervals
Pathology
Hypertension
Population

Keywords

  • Hypoxemia
  • Microvascular disease
  • Retinopathy
  • Sleep-disordered breathing

ASJC Scopus subject areas

  • Physiology

Cite this

Boland, L. L., Shahar, E., Wong, T. Y., Klein, R., Punjabi, N. M., Robbins, J. A., & Newman, A. B. (2004). Sleep-disordered breathing is not associated with the presence of retinal microvascular abnormalities: The Sleep Heart Health Study. Sleep, 27(3), 467-473.

Sleep-disordered breathing is not associated with the presence of retinal microvascular abnormalities : The Sleep Heart Health Study. / Boland, Lori L.; Shahar, Eyal; Wong, Tien Y.; Klein, Ronald; Punjabi, Naresh M; Robbins, John A.; Newman, Anne B.

In: Sleep, Vol. 27, No. 3, 2004, p. 467-473.

Research output: Contribution to journalArticle

Boland, LL, Shahar, E, Wong, TY, Klein, R, Punjabi, NM, Robbins, JA & Newman, AB 2004, 'Sleep-disordered breathing is not associated with the presence of retinal microvascular abnormalities: The Sleep Heart Health Study', Sleep, vol. 27, no. 3, pp. 467-473.
Boland, Lori L. ; Shahar, Eyal ; Wong, Tien Y. ; Klein, Ronald ; Punjabi, Naresh M ; Robbins, John A. ; Newman, Anne B. / Sleep-disordered breathing is not associated with the presence of retinal microvascular abnormalities : The Sleep Heart Health Study. In: Sleep. 2004 ; Vol. 27, No. 3. pp. 467-473.
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abstract = "Study Objective: Sleep apnea and milder forms of sleep-disordered breathing (SDB) have been associated with overt clinical cardiovascular disease, but it is unknown whether SDB is associated with arterial microvascular pathology. We examined the relation between SDB and retinal microvascular abnormalities. Design: Cross-sectional study. Participants: Subjects were 2,927 men and women, aged 51 to 97 years, who participated in the Sleep Heart Health Study and had retinal photographs taken within approximately 3 years of overnight, unattended, at-home polysomnography. Measurements and Results: A respiratory disturbance index (RDI), calculated as the average number of apneas and hypopneas per hour of sleep, was used as an indicator of SDB in analysis. The overall prevalence of retinopathy was slightly higher in people with higher RDI values (5.4{\%}, 4.9{\%}, 8.6{\%}, and 7.6{\%}, respectively, in increasing quartiles of RDI), but after adjustment for age, body-mass index, hypertension, diabetes, and other factors, the presence of retinopathy was not associated with SDB. With the possible exceptions of microaneurysms and generalized arteriolar narrowing, as measured by lower arteriole-to-venule ratio, specific retinal abnormalities were not associated consistently with the RDI. Relative to the first quartile of RDI, the adjusted odds ratios (95{\%} confidence interval) for the presence of microaneurysm in the second, third, and fourth quartiles of RDI were 1.05 (0.44-2.55), 1.97 (0.89-4.37), and 1.79 (0.78-4.10), respectively. An increase of RDI from 0 to 10 was associated with a predicted decrease in arteriole-to-venule ratio of 0.01. Results were similar when analyses were conducted in normotensive and nondiabetic persons separately. Conclusions: These data do not demonstrate a notable relation between SDB and retinal abnormalities. However, since this is the first investigation of a link between retinopathy and SDB, similar studies should be conducted in other population samples to demonstrate either consistency or inconsistency of our findings across studies.",
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T1 - Sleep-disordered breathing is not associated with the presence of retinal microvascular abnormalities

T2 - The Sleep Heart Health Study

AU - Boland, Lori L.

AU - Shahar, Eyal

AU - Wong, Tien Y.

AU - Klein, Ronald

AU - Punjabi, Naresh M

AU - Robbins, John A.

AU - Newman, Anne B.

PY - 2004

Y1 - 2004

N2 - Study Objective: Sleep apnea and milder forms of sleep-disordered breathing (SDB) have been associated with overt clinical cardiovascular disease, but it is unknown whether SDB is associated with arterial microvascular pathology. We examined the relation between SDB and retinal microvascular abnormalities. Design: Cross-sectional study. Participants: Subjects were 2,927 men and women, aged 51 to 97 years, who participated in the Sleep Heart Health Study and had retinal photographs taken within approximately 3 years of overnight, unattended, at-home polysomnography. Measurements and Results: A respiratory disturbance index (RDI), calculated as the average number of apneas and hypopneas per hour of sleep, was used as an indicator of SDB in analysis. The overall prevalence of retinopathy was slightly higher in people with higher RDI values (5.4%, 4.9%, 8.6%, and 7.6%, respectively, in increasing quartiles of RDI), but after adjustment for age, body-mass index, hypertension, diabetes, and other factors, the presence of retinopathy was not associated with SDB. With the possible exceptions of microaneurysms and generalized arteriolar narrowing, as measured by lower arteriole-to-venule ratio, specific retinal abnormalities were not associated consistently with the RDI. Relative to the first quartile of RDI, the adjusted odds ratios (95% confidence interval) for the presence of microaneurysm in the second, third, and fourth quartiles of RDI were 1.05 (0.44-2.55), 1.97 (0.89-4.37), and 1.79 (0.78-4.10), respectively. An increase of RDI from 0 to 10 was associated with a predicted decrease in arteriole-to-venule ratio of 0.01. Results were similar when analyses were conducted in normotensive and nondiabetic persons separately. Conclusions: These data do not demonstrate a notable relation between SDB and retinal abnormalities. However, since this is the first investigation of a link between retinopathy and SDB, similar studies should be conducted in other population samples to demonstrate either consistency or inconsistency of our findings across studies.

AB - Study Objective: Sleep apnea and milder forms of sleep-disordered breathing (SDB) have been associated with overt clinical cardiovascular disease, but it is unknown whether SDB is associated with arterial microvascular pathology. We examined the relation between SDB and retinal microvascular abnormalities. Design: Cross-sectional study. Participants: Subjects were 2,927 men and women, aged 51 to 97 years, who participated in the Sleep Heart Health Study and had retinal photographs taken within approximately 3 years of overnight, unattended, at-home polysomnography. Measurements and Results: A respiratory disturbance index (RDI), calculated as the average number of apneas and hypopneas per hour of sleep, was used as an indicator of SDB in analysis. The overall prevalence of retinopathy was slightly higher in people with higher RDI values (5.4%, 4.9%, 8.6%, and 7.6%, respectively, in increasing quartiles of RDI), but after adjustment for age, body-mass index, hypertension, diabetes, and other factors, the presence of retinopathy was not associated with SDB. With the possible exceptions of microaneurysms and generalized arteriolar narrowing, as measured by lower arteriole-to-venule ratio, specific retinal abnormalities were not associated consistently with the RDI. Relative to the first quartile of RDI, the adjusted odds ratios (95% confidence interval) for the presence of microaneurysm in the second, third, and fourth quartiles of RDI were 1.05 (0.44-2.55), 1.97 (0.89-4.37), and 1.79 (0.78-4.10), respectively. An increase of RDI from 0 to 10 was associated with a predicted decrease in arteriole-to-venule ratio of 0.01. Results were similar when analyses were conducted in normotensive and nondiabetic persons separately. Conclusions: These data do not demonstrate a notable relation between SDB and retinal abnormalities. However, since this is the first investigation of a link between retinopathy and SDB, similar studies should be conducted in other population samples to demonstrate either consistency or inconsistency of our findings across studies.

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