Association Between Sleep Apnea Risk Score and Retinal Microvasculature Using Optical Coherence Tomography Angiography

Published:August 31, 2020DOI:


      • In obstructive sleep apnea syndrome, the retinal vasculature gets affected.
      • There is a marked change in the superficial and deep capillary plexus vessel densities as seen on optical coherence tomography angiography in patients with varying scores for obstructive sleep apnea syndrome risk as identified by the STOP-BANG questionnaire.


      To investigate the retinal vessel changes at peripapillary and parafoveal regions using optical coherence tomography angiography in patients with varying obstructive sleep apnea syndrome (OSAS) risk, identified by the STOP-BANG questionnaire.


      Prospective, hospital-based cross-sectional study.


      Participants were divided into 3 groups based on the OSAS risk score. Flow areas and vessel densities were calculated at peripapillary and parafoveal regions using optical coherence tomography angiography. Microvasculature changes between the 3 groups and correlation between OSAS risk score and vascular changes were calculated.


      Six hundred and six eyes of 303 patients were included in groups 1 (n = 96), 2 (n = 135), and 3 (n = 72). In patients with high OSAS risk, an increase in flow areas (P = .011) and vessel densities (P = .002) in superficial capillary plexus was noted. In contrast, flow areas (P = .003) and vessel densities (P < .000) in deep capillary plexus were reduced. Positive correlation was noted between sleep scores and vessel densities in superficial capillary plexus (P = .04). Negative correlation was noted between sleep scores and flow areas (P = .003) and vessel densities (P ≤ .001) in deep capillary plexus.


      The sleep apnea questionnaire is an easy method of identifying the disease severity stage, but polysomnography still remains the definitive gold standard. Optical coherence tomography angiography shows some associations with disease severity, but it cannot be used unambiguously to distinguish the severity of sleep apnea.
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