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Zhang JT, Cui S, Li Q, Li JR, Zhang YF, Zheng YH. Sleep-disordered breathing is related to retinal vein occlusion: A meta-analysis. Medicine (Baltimore) 2023; 102:e35411. [PMID: 37832067 PMCID: PMC10578690 DOI: 10.1097/md.0000000000035411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/05/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Previous studies suggest that sleep-disordered breathing (SDB) may be a potential risk factor of retinal vein occlusion (RVO). We conducted a meta-analysis to systematically explore the relationship between RVO and SDB. METHODS Observational studies assessing the relationship between SDB and RVO were retrieved by searches of electronic databases including the PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wan Fang databases from database inception to August 9, 2023. In consideration of intra-study heterogeneity, a random-effects model was adopted to combine the results. RESULTS Seven studies (1 retrospective cohort and 6 case-control studies) were included in this meta-analysis, and among 36,628 adults included in those studies, 6452 (17.6%) had SDB. The combined results indicated that SDB was associated with RVO [risk ratio (RR): 1.92, 95% confidence interval (CI): 1.60-2.30, P < .001] with no significant heterogeneity (I2 = 0%). Subgroup analyses showed consistent relationships between SDB and any RVO (RR: 1.73, 95% CI: 1.13-2.28, P < .001), central RVO (RR: 2.20, 95% CI: 1.57-3.08, P < .001), and branch RVO (RR: 1.85, 95% CI: 1.15-2.99, P = .01). Moreover, the relationship was consistent among patients with mild (RR: 1.82, 95% CI: 1.32-2.53, P < .001), moderate (RR: 2.17, 95% CI: 1.65-2.85, P < .001), and severe SDB (RR: 2.66, 95% CI: 1.96-3.62, P < .001). The association was consistent in studies that adjusted for age and sex (RR: 2.17, 95% CI: 1.50-3.13, P < .001), and in studies with additional adjustment for comorbidities (RR: 1.78, 95% CI: 1.42-2.25, P < .001). CONCLUSION SDB is associated with RVO in adults.
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Affiliation(s)
- Jun-Tao Zhang
- Department Ophthalmology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Sha Cui
- Department Ophthalmology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Qin Li
- Department Ophthalmology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Jin-Rong Li
- Department Ophthalmology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Yan-Fang Zhang
- Department Ophthalmology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Yan-Huang Zheng
- Department Ophthalmology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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Al‐Sebaei MO, Bamashmous MS, Mirdad MH, Sindi MA. Prevalence of patients at risk for developing obstructive sleep apnea based on the STOP-BANG questionnaire at King Abdulaziz University Faculty of Dentistry. Clin Exp Dent Res 2023; 9:198-203. [PMID: 36349988 PMCID: PMC9932230 DOI: 10.1002/cre2.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a common sleep disorder. Its susceptibility can easily be detected when it is at an early stage as can patients who are at risk of OSA. A simple questionnaire such as STOP-BANG (SB) can facilitate early detection. Our study aims to assess the risk of OSA and evaluate its correlating risk factors in patients attending King Abdulaziz University Faculty of Dentistry (KAUFD), Jeddah, Saudi Arabia, using the SB questionnaire. METHODS Ethical approval was obtained. A random sample of patients ages 18-80 years, who visited KAUFD between November 2016 and April 2017 were recruited. Three highly trained and calibrated dental interns obtained the following measurements (weight, height, blood pressure, and neck circumference) and administered the questionnaire in a face-to-face interview. RESULTS A total of 55 patients (62% females) participated in the study with a mean age of 34.6 years and hypertension reported as 16.4%. According to the SB, 31% of patients were found at high risk of OSA. Large neck circumference (40.22[±4.7] cm) and gender (66% males) were found to be significantly correlated with high-risk patients; p < .001. CONCLUSION Approximately one third of the patients were at high risk of OSA, with men and patients having large neck circumference being significantly more affected. Systolic blood pressure, hypertension, and smoking were found to be high in high-risk patients. However, they were not statistically and significantly different from those patients who were not in high risk. The role of a dentist should be to utilize the questionnaire to detect any patient at risk of OSA and refer them accordingly.
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Affiliation(s)
- Maisa O. Al‐Sebaei
- Department of Oral and Maxillofacial Surgery, Faculty of DentistryKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Mohamed S. Bamashmous
- Department of Dental Public Health, Faculty of DentistryKing Abdulaziz UniversityJeddahSaudi Arabia
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Qin Z, Li X, Ren H, Song W, Su L, Gao X. The Correlation between Obstructive Sleep Apnea and Retinal Vein Obstruction: A Meta-Analysis and Systematic Review. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8065629. [PMID: 35935317 PMCID: PMC9296346 DOI: 10.1155/2022/8065629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
Abstract
Despite of inadequate evidence, previous studies have demonstrated a potential correlation between obstructive sleep apnea (OSA) and retinal vein occlusion (RVO). In this study, a meta-analysis is conducted to investigate the correlation between OSA and RVO. Databases are searched for relevant literatures up to July 14, 2021, including PubMed, Embase, Cochrane, Web of Science, CNKI, WanFang, VIP, and Chinese Biomedical Literature Database (CBM). The odds ratio (OR) and 95% confidence interval (CI) are estimated to evaluate the correlation between OSA and RVO. Six articles were finally enrolled, including 36,086 subjects from 5 case-controlled studies and 1 cohort study. It is clearly evident that the RVO risk is higher among OSA patients than non-OSA patients (OR = 3.24, 95% CI = 3.24). The results of sensitivity analysis indicate that the present meta-analysis is robust and reliable. Furthermore, Egger's test for publication bias is performed with P = 0.195, and the results reveal no significant publication bias. The findings demonstrate that OSA is significantly correlated with RVO, and OSA is a risk factor for RVO.
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Affiliation(s)
- Ziwen Qin
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Xiang Li
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Hanyu Ren
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Wei Song
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Longlong Su
- Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
| | - Xiaoling Gao
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
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Al Saeed AA, AlShabib NS, Al Taisan AA, Kreary YA. Association of Retinal Vascular Manifestation and Obstructive Sleep Apnea (OSA): A Narrative Review. Clin Ophthalmol 2021; 15:3315-3320. [PMID: 34393479 PMCID: PMC8360361 DOI: 10.2147/opth.s305968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/20/2021] [Indexed: 12/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by frequent episodes of partial or complete obstruction of the airway during sleep causing repeated episodes of apnea. OSA is more prevalent in middle-aged and older adults. OSA is associated with numerous ocular manifestations, including retinal manifestations. Literature highlighted the clear association between OSA and numerous ocular conditions including glaucoma and papilledema. This comprehensive and narrative review aims to summarize up-to-date clinical research concerning the association of OSA and vascular conditions that affect the retina. OSA is associated with the central serous chorioretinopathy (CSC), retinal vein occlusion (RVO), hypertensive retinopathy (HTRP) and development of diabetic retinopathy (DR). Sympathetic activation, hypoxia, and hormonal dysregulation all lead to serious retinal vascular conditions that will worsen OSA patients’ quality of life. It is important to refer patients with newly diagnosed OSA to an ophthalmology clinic for the appropriate test.
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Affiliation(s)
- Ali A Al Saeed
- College of Medicine, King Faisal University, Al-Ahasa, Saudi Arabia
| | | | - Abdulaziz A Al Taisan
- Department of Ophthalmology, College of Medicine, King Faisal University, Al-Ahasa, Saudi Arabia
| | - Yahya A Kreary
- Department of Vitreoretinal Surgery, Dhahran Eye Specialist Hospital, Dhahran, Eastern Province, Saudi Arabia
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Liu PK, Chiu TY, Wang NK, Levi SR, Tsai MJ. Ocular Complications of Obstructive Sleep Apnea. J Clin Med 2021; 10:jcm10153422. [PMID: 34362205 PMCID: PMC8348497 DOI: 10.3390/jcm10153422] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is characterized by repetitive episodes of paused breathing during sleep, which in turn induces transient nocturnal hypoxia and hypercapnia. The high prevalence of OSA and its associated health consequences place a heavy burden on the healthcare system. In particular, the consequent episodic oxygenic desaturation/reoxygenation series and arousals from sleep in patients with OSA have the potential to trigger oxidative stress, elevated systemic inflammatory responses, and autonomic dysfunction with sympathetic activation. Given these adverse side-effects, OSA is highly correlated to many eye diseases that are common in everyday ophthalmic practices. Some of these ocular consequences are reversible, but they may permanently threaten a patient’s vision if not treated appropriately. Here, this article seeks to review the ocular consequences and potential pathophysiologic associations in patients with OSA. Understanding these OSA-related eye diseases may help clinicians provide comprehensive care to their patients.
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Affiliation(s)
- Pei-Kang Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-K.L.); (T.-Y.C.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Tzu-Yu Chiu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-K.L.); (T.-Y.C.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Sarah R. Levi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 5601)
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Hwang M, Zhang K, Nagappa M, Saripella A, Englesakis M, Chung F. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnoea in patients with cardiovascular risk factors: a systematic review and meta-analysis. BMJ Open Respir Res 2021; 8:8/1/e000848. [PMID: 33664122 PMCID: PMC7934717 DOI: 10.1136/bmjresp-2020-000848] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Obstructive sleep apnoea (OSA) is highly prevalent in patients with cardiovascular risk factors and is associated with increased morbidity and mortality. This review presents the predictive parameters of the STOP-Bang questionnaire as a screening tool for OSA in this population. Methods A search of databases was performed. The inclusion criteria were: (1) use of the STOP-Bang questionnaire to screen for OSA in adults (>18 years) with cardiovascular risk factors; (2) polysomnography or home sleep apnoea testing performed as a reference standard; (3) OSA defined by either Apnoea–Hypopnoea Index (AHI) or Respiratory Disturbance Index; and (4) data on predictive parameters of the STOP-Bang questionnaire. A random-effects model was used to obtain pooled predictive parameters of the STOP-Bang questionnaire. Results The literature search resulted in 3888 articles, of which 9 papers met the inclusion criteria, involving 1894 patients. The average age of the included patients was 58±13 years with body mass index (BMI) of 30±6 kg/m2, and 64% were male. The STOP-Bang questionnaire has a sensitivity of 89.1%, 90.7% and 93.9% to screen for all (AHI ≥5), moderate-to-severe (AHI ≥15) and severe (AHI≥30) OSA, respectively. The specificity was 32.3%, 22.5% and 18.3% and the area under the curve (AUC) was 0.86, 0.65 and 0.52 for all, moderate-to-severe and severe OSA, respectively. Conclusion The STOP-Bang questionnaire is an effective tool to screen for OSA (AHI≥5) with AUC of 0.86 in patients with cardiovascular risk factors.
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Affiliation(s)
- Mark Hwang
- Faculty of Medicine, Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Zhang
- Faculty of Medicine, Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mahesh Nagappa
- Department of Anaesthesia & Perioperative Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Aparna Saripella
- Department of Anaesthesia and Pain Medicine, University Health Network, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Frances Chung
- Department of Anaesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
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Abstract
PURPOSE OF REVIEW The aim of this article is to summarize up-to-date research on the effects of obstructive sleep apnea (OSA) on retinal vascular conditions. RECENT FINDINGS OSA is associated with the development of diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy. The severity of OSA and biomarkers such as the apnea-hypopnea index (AHI) correlate with the severity of retinal disease. Dysregulation of circadian locomotor output cycles kaput (CLOCK) genes that govern circadian rhythm is associated with development of proliferative retinal disease. SUMMARY OSA and retinal vascular disease have a high cost burden on the healthcare system. OSA creates systemic changes and hypoxic conditions that may incite or exacerbate retinal vascular diseases. Retinal changes may be the first clinical manifestation of otherwise undiagnosed OSA, so it is important to refer patients with new-onset retinal vascular disease for appropriate sleep testing.
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Affiliation(s)
| | - Kapil G Kapoor
- Eastern Virginia Medical School, Norfolk
- Wagner and Kapoor Research Institute, Virginia Beach, Virginia, USA
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