Predicting the presence and severity of obstructive sleep apnea with optical coherence tomography

The impact of obstructive sleep apnea (OSA) on microvascular system suggests that spectral domain optical coherence tomography (SD-OCT) evaluation of the choroidal vasculature could provide clinically relevant insights into disease presence and severity.

To investigate the value of choroidal vascular imaging with SD-OCT in diagnosing the presence and predicting the severity of OSA.

SD-OCT images of 120 patients with OSA were analyzed to extract choroidal biomarkers. Patients were categorized into 4 levels of OSA severity according to their apnea-hypopnea index. ImageJ/FIJI (National Institutes of Health, Bethesda, Maryland, USA) was used to measure choroidal thickness and vascular indices in Haller's and non-Haller's layers across regions on the nasal and temporal sides of the fovea. Thickness ratios of choroidal layers, total choroidal area, choroidal vascularity index, and luminal-to-stromal ratios were compared between individuals without OSA and with different severities of OSA. Analysis of variance, receiver operating characteristic analysis, and logistic regression were employed to evaluate inter-group differences and the predictive value of choroidal parameters.

OSA's presence and increasing severity significantly impacted the non-Haller's layer thickness and Haller's/non-Haller's layer thickness ratios, particularly in the nasal region (1000-2500 µm). The nasal 2500 µm region showed the highest discriminative power for severe OSA (AUC = 0.733, P < .001). Logistic regression analysis identified the Haller's/non-Haller's layer thickness ratio at nasal 2500 µm as the most significant predictor of severe OSA (odds ratio = 2.147, P = .002), adjusted for age, gender, and comorbidities.

OSA is associated with choroidal microvascular remodeling, especially nasal to the fovea. This remodeling increases the ratio of Haller's/non-Haller's layer thickness ratio, which may be a potential biomarker for OSA severity. These findings highlight the utility of SD-OCT in non-invasively detecting systemic vascular alterations linked to OSA, supporting its role in early diagnosis and monitoring of disease progression.