Original article
Nocturnal Intermittent Serious Hypoxia and Reoxygenation in Proliferative Diabetic Retinopathy Cases

https://doi.org/10.1016/j.ajo.2010.01.006Get rights and content

Purpose

To clarify the relationship between evaluation items of sleep-disordered breathing and diabetic retinopathy in detail.

Design

Cross-sectional comparative study.

Methods

Sixty-eight consecutive nonproliferative diabetic retinopathy and 151 proliferative diabetic retinopathy (PDR) cases who had undergone surgeries in our department were included in this study. Pulse oximetry was conducted overnight and mean oxygen saturation by pulse oximeter (SpO2; %), the sleeping 4% oxygen desaturation index (4% ODI times/hour), lowest SpO2 (%), and the cumulative percent time spent at SpO2 < 90% (CT 90%) were calculated. The results were evaluated and compared between the 2 groups. In addition, these results and preoperative patient background factors were analyzed using logistic regression analysis to clarify risk factor of PDR.

Results

4% ODI and CT 90% in the PDR group were significantly higher than in the nonproliferative diabetic retinopathy group (4% ODI, 7.8 vs. 4.9; P = .007; CT 90%, 2.2 vs 0.8; P = .0006). Lowest SpO2 was significantly lower in the PDR group than in the nonproliferative diabetic retinopathy groups (82.4 vs 87.0; P = .0006). Logistic regression analysis identified being younger, having a lower value for the lowest SpO2, and a high hemoglobin A1c value to be risk factors for PDR (age: odds ratio, 0.90; 95% confidence interval, −0.86 to −0.94; P < .0001; lowest SpO2: odds ratio, 0.93; 95% confidence interval, 0.88 to 0.99; P = .02; hemoglobin A1c: odds ratio, 1.00 to 1.69; P = .047).

Conclusions

This study indicated that PDR cases had episodes of nocturnal intermittent hypoxia and reoxygenation as a result of sleep-disordered breathing and that low-value lowest SpO2 were the risk factors for PDR development.

Section snippets

Methods

A total of 219 Japanese inpatients, who had type 2 diabetes, including 68 consecutive nonproliferative diabetic retinopathy (NPDR) cases and 151 consecutive PDR cases were included in this study. Patients with NPDR underwent vitreous surgery for macular edema or cataract surgery, and those with PDR underwent filtering surgery for neovascular glaucoma or vitreous surgery for macular edema, vitreous hemorrhage, and traction retinal detachment from April 1, 2006, through April 1, 2008, at the

Results

Preoperative patient background factors for the NPDR and PDR groups are shown in Table 1. There were significant differences between the 2 groups in age. The NPDR group was older than the PDR group (mean age ± standard deviation [SD], 65.9 ± 6.6 years [NPDR] vs 59.9 ± 9.9 years [PDR]; P > .0001). Preoperative HbA1c value and frequency of hypertension tended to be higher in the PDR than in the NPDR group (mean HbA1c value ± SD, 7.4 ± 1.5% [PDR] vs 7.1 ± 1.2% [NPDR]; P = .07; mean hypertension

Discussion

The mechanism by which SDB evokes arteriosclerotic diseases is speculated to be as follows. SDB can cause overnight repetitive hypoxemia and reoxygenation, resulting in autonomic hyperactivity that persists until daytime;10, 11 increased serum inflammatory cytokine levels, for example, vascular endothelial growth factor12; greater oxidant stress13; increased emergence of adhesion factors, such as intercellular adhesion molecule 1 and vascular cell adhesion molecule,14 and so on. A vascular

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