Apnea hypopnea index during rapid eye movement sleep with diabetic retinopathy in patients with type 2 diabetes

Abstract

Context: Recent studies based on home sleep apnea testing (HSAT) reported the potential association of sleep disordered breathing, such as obstructive sleep apnea (OSA), with diabetic retinopathy (DR). A few studies showed that the apnea-hypopnea index (AHI) during rapid eye movement (REM) sleep (REM-AHI) is associated with glycated hemoglobin and hypertension, two known risk factors for DR. However, there are no studies that have evaluated the association of REM-AHI with DR because previous studies were based on HSAT. Objective: To determine the association of REM-AHI with DR. Design, Setting, and Patients: The study subjects were 131 patients with type 2 diabetes mellitus who underwent all-night polysomnography with 30 minutes of REM sleep and were free of heart failure or active lung disease and had not yet been treated for OSA. Logistic regression analysis was performed to determine the effect of REM-AHI on the prevalence of DR adjusted by several known risk factors for DR. Results: Quartile of REM-AHI was independently associated with DR (P = 0.024) (Q2: OR, 3.887; 95% CI, 0.737 to 20.495; Q3: OR, 9.467; 95% CI, 1.883 to 47.588; Q4: OR, 12.898; 95% CI, 2.008 to 82.823 relative to Q1), whereas quartile of non-REM (NREM)-AHI was not (P = 0.119). Similarly, continuous REM-AHI (OR, 2.875; 95% CI, 1.224 to 6.752; P = 0.015) was independently associated with DR, whereas NREM-AHI was not (P = 0.107). In addition, AHI was independently associated with DR when controlling for several known risk factors for DR (P = 0.043). Conclusion: REM-AHI was independently associated with DR. REM-AHI could be a potential risk factor for DR.