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Retinal and choroidal thickness measurements in obstructive sleep apnea: impacts of continuous positive airway pressure treatment



To examine retinal and choroidal thicknesses in individuals with obstructive sleep apnea (OSA) and determine the impacts of continuous positive airway pressure (CPAP) treatment.


Prospective follow-up study conducted at a university hospital. 40 patients with OSA, 28 treated with CPAP, and 12 untreated, were enrolled immediately after diagnosis and graded according to the apnea hypopnea index (AHI) determined in an overnight polysomnography. Inclusion criteria were a new diagnosis of OSA and CPAP indicated. Participants underwent a full ophthalmologic examination including optical coherence tomography (OCT) at the peripapillary, macular, and choroidal levels and the same examination 3 months later. Outcome measures were peripapillary retinal nerve fiber layer (RNFL), total retinal (TRT), retinal ganglion cell layer (RGCL), inner plexiform layer (IPL), photoreceptor layer (PL), and choroidal thicknesses.


At 3 months, RGCL thickness was reduced at the inner nasal macula segment in the no-CPAP group (P = 0.016). In + CPAP, increases were produced in RNFL thickness (5/6 segments) and TRT (7/ 9 segments), while choroidal thinning was observed temporally (P = 0.003). At baseline, positive correlation was detected between choroidal thickness and AHI (r = 0.352, P = 0.005) and between IPL thickness (7/9 segments) and AHI (r = 0.414, P < 0.001).


Initial retinal and choroidal thickening was followed by RGCL thinning over 3 months. In patients receiving CPAP, we observed no thinning of any retinal layer and normalization of choroidal thickness.

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Fig. 1
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Fig. 4



Apnea hypopnea index


Automatic real time


Continuous positive airway pressure


Enhanced depth imaging






Intraclass correlation coefficient


Inferior inner macula




Inferior outer macula


Intraocular pressure


Inner plexiform layer






Nasal inner macula


Nasal outer macula


Obstructive sleep apnea


Photoreceptor layer


Retinal ganglion cell layer


Retinal nerve fiber layer


Superior inner macula




Superior outer macula

SpO2 :

Peripheral oxygen saturation

ST :


T :



Temporal inner macula


Temporal outer macula


Total retinal thickness


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Author information




All authors contributed to the study, conception, and design. Material preparation, data collection, and analysis were performed by Naranjo-Bonilla P., Muñoz-Villanueva María C., Giménez-Gómez R., and Jurado-Gámez B.. The first draft of the manuscript was written by Naranjo-Bonilla P., Muñoz-Villanueva María C., and Jurado-Gámez B., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Correspondence to P. Naranjo-Bonilla.

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Naranjo-Bonilla, P., Muñoz-Villanueva, M.C., Giménez-Gómez, R. et al. Retinal and choroidal thickness measurements in obstructive sleep apnea: impacts of continuous positive airway pressure treatment. Graefes Arch Clin Exp Ophthalmol (2021).

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  • Obstructive sleep apnea
  • CPAP
  • OCT
  • Retinal nerve fiber layer
  • Retinal ganglion cells
  • Inner plexiform layer
  • Choroid
  • Photoreceptor layer