Retinal Vascular Density Deterioration Observed in Obstructive Sleep Apnea

Retinal vascular density deterioration may accompany obstructive sleep apnea (OSA), according to a study published in Microvascular Research. Optical coherence tomography-angiography (OCT-A) can be used to assess coronary artery involvement in these individuals, the report suggests. 

Researchers included 123 participants with mild (n=72; median age, 58 years; 69% men) and moderate to severe OSA (n=51; median age, 56 years; 78% men) along with 62 age- and sex-matched control group participants (n=62; median age, 55 years; 74% men) in the cross-sectional study between 2020 and 2022. All participants underwent OCT-A assessment and the researchers examined associations between coronary vascular status and retinal vascular density deterioration. Obstructive coronary artery disease was defined as 50% stenosis, myocardial ischemia as a diameter reduction less than 50% or fractional flow reserve greater than 0.80, and microvascular coronary artery disease as myocardial ischemia without obstructive coronary artery disease.

Participants with OSA had significantly lower superficial capillary plexus (49.9% vs 52.5%; P <.0001), deep capillary plexus (50.5% vs 55.2%; P <.0001), and radial peripapillary capillary (49.6% vs 50.9%; P=.007) densities and larger foveal avascular zone (FAZ) area (P =.012) compared with control group individuals.

Among individuals with OSA, a smaller superficial capillary plexus density and FAZ, along with a larger deep capillary plexus and radial peripapillary capillary density, were observed in moderate and severe OSA compared with mild disease. However, these differences did not reach statistical significance.

Women with microvascular coronary artery disease (n=23) had significantly higher vessel densities in the deep capillary plexus and peripapillary region of the optic disc compared with individuals with obstructive coronary artery disease (P <.05), according to the report.

“Microvascular retinal impairment detected by optical coherence tomography angiography can be used to determine the coronary artery involvement in patients with OSA [syndrome],” according to the researchers. “In addition, optical coherence tomography angiography findings (especially impairment of [deep capillary plexus] layer measurements) may be a warning sign for the presence of obstructive coronary artery disease in females with OSA [syndrome].”

Study limitations include the exclusion of patients with acute coronary syndrome.