Evaluation of the relationship between background factors and sleep-disordered breathing in patients with proliferative diabetic retinopathy.
ABSTRACT To clarify the relationship between sleep-disordered breathing (SDB) and background factors in patients with proliferative diabetic retinopathy (PDR).
One hundred fifty-one consecutive PDR patients were included in this study. These patients' SDB parameters, including the mean and lowest SpO(2), sleeping 4% oxygen desaturation index (ODI), and cumulative percentage of time spent at SpO(2) < 90% (CT90%), were measured. Simple linear regression analyses were conducted to investigate whether the SDB parameters correlated with systemic factors for PDR, including age, duration of diabetes, HbA1c value, incidence of hypertension, estimated glomerular filtration rate (eGFR), body mass index (BMI), and insulin therapy. Logistic regression analysis was also conducted to investigate whether the SDB evaluation items were factors independently associated with the incidence of hypertension.
Hypertension and BMI were statistically correlated with all of the parameters. The eGFR was statistically correlated with 4% ODI and insulin therapy with the lowest SpO(2). Logistic regression analysis revealed 4% ODI and eGFR as factors independently contributing to the incidence of hypertension.
The results of our study confirmed the relationship between SDB and background factors reported to be risk factors for diabetic retinopathy progression in patients with PDR.
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ABSTRACT: There is increasing evidence that obstructive sleep apnea (OSA) is an independent risk factor for arterial hypertension. Because there are no controlled studies showing a substantial effect of nasal continuous positive airway pressure (nCPAP) therapy on hypertension in OSA, the impact of treatment on cardiovascular sequelae has been questioned altogether. Therefore, we studied the effect of nCPAP on arterial hypertension in patients with OSA. Sixty consecutive patients with moderate to severe OSA were randomly assigned to either effective or subtherapeutic nCPAP for 9 weeks on average. Nocturnal polysomnography and continuous noninvasive blood pressure recording for 19 hours was performed before and with treatment. Thirty two patients, 16 in each group, completed the study. Apneas and hypopneas were reduced by approximately 95% and 50% in the therapeutic and subtherapeutic groups, respectively. Mean arterial blood pressure decreased by 9.9+/-11.4 mm Hg with effective nCPAP treatment, whereas no relevant change occurred with subtherapeutic nCPAP (P=0.01). Mean, diastolic, and systolic blood pressures all decreased significantly by approximately 10 mm Hg, both at night and during the day. Effective nCPAP treatment in patients with moderate to severe OSA leads to a substantial reduction in both day and night arterial blood pressure. The fact that a 50% reduction in the apnea-hypopnea index did not result in a decrease in blood pressure emphasizes the importance of highly effective treatment. The drop in mean blood pressure by 10 mm Hg would be predicted to reduce coronary heart disease event risk by 37% and stroke risk by 56%.Circulation 02/2003; 107(1):68-73. · 15.20 Impact Factor
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ABSTRACT: To report on the prevalence of retinopathy in patients with newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM) and to evaluate the relationship of retinopathy to clinical and biochemical variables. A multicenter, randomized, controlled clinical study of therapy in patients with NIDDM. Patients were part of the United Kingdom Prospective Diabetes Study, a 23-center study of 2964 white patients who had both eyes photographed and assessed. The presence and severity of diabetic retinopathy were evaluated by sex, and the relationship of retinopathy to medical and biochemical parameters was assessed. Retinopathy, defined as microaneurysms or worse lesions in at least 1 eye, was present in 39% of men and 35% of women. Marked retinopathy with cotton wool spots or intraretinal microvascular abnormalities was present in 8% of men and 4% of women. The severity of retinopathy was related in both sexes to higher fasting plasma glucose levels, higher systolic and diastolic blood pressure, lower serum insulin levels, and reduced beta-cell function. In addition, in men, increased alcohol consumption was related to increased severity of retinopathy, while leaner women had more severe eye lesions. Visual acuity was normal in most patients, but in men there was a trend for those with more severe retinal lesions to have worse visual acuity. Diabetic retinopathy is common in patients with newly diagnosed NIDDM. Careful ophthalmic assessment at diagnosis is important.Archives of Ophthalmology 03/1998; 116(3):297-303. · 3.83 Impact Factor
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ABSTRACT: The four-year incidence and progression of retinopathy were investigated in a population-based sample of people with diabetes diagnosed at 30 years of age or older. For insulin users, 73 (47%) of the 154 who did not have any retinopathy at the first visit developed it in the four-year interval, and 31 (7%) of the 418 free of proliferative retinopathy developed it. Worsening of retinopathy occurred in a total of 34% (142/418). For nonusers of insulin, corresponding rates were 34% (110/320) for incidence of any retinopathy, 2% (11/486) for developing proliferative retinopathy, and 25% (121/486) for worsening. These population-based data clearly indicate the risk of retinopathy worsening in a short interval (four years) in a large proportion of people with older-onset diabetes, a group previously thought to be relatively protected from retinopathy. Such patients who make up the largest proportion of diabetic patients in the United States need examination when diabetes is first diagnosed and regular follow-up.Archives of Ophthalmology 03/1989; 107(2):244-9. · 3.83 Impact Factor