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Obstructive Sleep Apnea in Patients With and Without Diabetic Retinopathy: An Observational Study and Comparative
Kavita R Bhatnagar1, Kiran Yadav1, Kirti Jaisingh1
1Ophthalmology, All India Institute of Medical Sciences, Jodhpur, IND.
Cureus
|March 23, 2026
Summary
Obstructive sleep apnea (OSA) may worsen diabetic retinopathy (DR) in type 2 diabetes patients. While not statistically conclusive, this study suggests OSA screening could identify additional risk factors for DR and proliferative DR (PDR).
Area of Science:
- Ophthalmology
- Endocrinology
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) causes intermittent hypoxia, potentially exacerbating retinal ischemia and accelerating diabetic retinopathy (DR) progression.
- Diabetic retinopathy (DR), especially proliferative diabetic retinopathy (PDR), is a leading cause of vision loss in diabetic patients.
- Understanding the link between OSA and DR is crucial for comprehensive diabetes management.
Purpose of the Study:
- To investigate the association between obstructive sleep apnea (OSA) and diabetic retinopathy (DR), including PDR, in Indian type 2 diabetes mellitus (T2DM) patients.
- To identify clinical factors associated with high OSA risk in T2DM patients with DR.
- To explore the potential role of OSA as a modifiable risk factor for DR progression.
Main Methods:
- Prospective observational study involving 85 T2DM patients (45 with DR, 40 without DR) from October 2022 to December 2023.
- OSA screening using the Epworth Sleepiness Scale (ESS); high-risk patients (ESS ≥10) underwent polysomnography (PSG).
- Apnea-Hypopnea Index (AHI) and Oxygen Desaturation Index (ODI) were used to grade OSA severity.
Main Results:
- High OSA risk correlated significantly with longer diabetes duration, elevated HbA1c, dyslipidemia, hypertension, neck circumference, and BMI.
- DR prevalence was slightly higher in high-risk OSA patients (58.33% vs. 52.05%), with a trend toward PDR (57.14% vs. 42%).
- Preliminary PSG data showed a trend of higher ODI and AHI in the DR group, but results were not statistically significant (p>0.05).
Conclusions:
- The association between OSA and DR/PDR requires further investigation as current findings are statistically inconclusive.
- Screening for OSA in DR clinics can help identify patients with additional cardiovascular and metabolic risk factors.
- Further research is warranted to validate OSA as a modifiable risk factor for preventing or managing diabetic retinopathy.
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