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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Apnea hypopnea index
Automatic real time
Continuous positive airway pressure
Enhanced depth imaging
Intraclass correlation coefficient
Inferior inner macula
Inferior outer macula
Inner plexiform layer
Nasal inner macula
Nasal outer macula
Obstructive sleep apnea
Retinal ganglion cell layer
Retinal nerve fiber layer
Superior inner macula
Superior outer macula
- SpO2 :
Peripheral oxygen saturation
- ST :
- T :
- TIM :
Temporal inner macula
- TOM :
Temporal outer macula
- TRT :
Total retinal thickness
Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239
Jurado-Gamez B, Fernandez-Marin MC, Gomez-Chaparro JL, Munoz-Cabrera L, Lopez-Barea J, Perez-Jimenez F, Lopez-Miranda J (2011) Relationship of oxidative stress and endothelial dysfunction in sleep apnoea. Eur Respir J 37:873–879
Kur J, Newman EA, Chan-Ling T (2012) Cellular and physiological mechanisms underlying blood flow regulation in the retina and choroid in health and disease. Prog Retin Eye Res 31:377–406
Papst N, Demant E, Niemeyer G (1982) Changes in pO2 induce retinal autoregulation in vitro. Graefes Arch Clin Exp Ophthalmol 219:6–10
Nickla DL, Wallman J (2010) The multifunctional choroid. Prog Retin Eye Res 29:144–168
Wu CY, Riangwiwat T, Rattanawong P, Nesmith BLW, Deobhakta A (2018) Association of obstructive sleep apnea with central serous chorioretinopathy and choroidal thickness: a systematic review and meta-analysis. Retina 38:1642–1651
He M, Han X, Wu H, Huang W (2016) Choroidal thickness changes in obstructive sleep apnea syndrome: a systematic review and meta-analysis. Sleep Breath 20:369–378
Shiba T, Takahashi M, Sato Y, Onoda Y, Hori Y, Sugiyama T, Bujo H, Maeno T (2014) Relationship between severity of obstructive sleep apnea syndrome and retinal nerve fiber layer thickness. Am J Ophthalmol 157:1202–1208
Moyal L, Blumen-Ohana E, Blumen M, Blatrix C, Chabolle F, Nordmann JP (2018) Parafoveal and optic disc vessel density in patients with obstructive sleep apnea syndrome: an optical coherence tomography angiography study. Graefes Arch Clin Exp Ophthalmol 256:1235–1243
Zengin MO, Tuncer I, Karahan E (2014) Retinal nerve fiber layer thickness changes in obstructive sleep apnea syndrome: one year follow-up results. Int J Ophthalmol 7:704–708
Hashim SP, Al Mansouri FA, Farouk M, Al Hashemi AA, Singh R (2014) Prevalence of glaucoma in patients with moderate to severe obstructive sleep apnea: ocular morbidity and outcomes in a 3 year follow-up study. Eye 28:1304–1309
Abdullayev A, Tekeli O, Yanik O, Acican T, Gulbay B (2019) Investigation of the presence of glaucoma in patients with obstructive sleep apnea syndrome using and not using continuous positive airway pressure treatment. Turk J Ophthalmol 49:134–141
Ferrandez B, Ferreras A, Calvo P, Abadia B, Fogagnolo P, Wang Y, Marin JM, Iester M (2014) Retinal sensitivity is reduced in patients with obstructive sleep apnea. Invest Ophthalmol Vis 55:7119–7125
Lloberes P, Duran-Cantolla J, Martinez-Garcia MA, Marin JM, Ferrer A, Corral J, Masa JF, Parra O, Alonso-Alvarez ML, Teran-Santos J (2011) Diagnosis and treatment of sleep apnea-hypopnea syndrome. Spanish Society of Pulmonology and Thoracic Surgery. Arch Bronconeumol 47:143–156
Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, Academy A, of Sleep M, (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the sleep apnea definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8:597–619
Jurado-Gamez B, Bardwell WA, Cordova-Pacheco LJ, Garcia-Amores M, Feu-Collado N, Buela-Casal G (2015) A basic intervention improves CPAP adherence in sleep apnoea patients: a controlled trial. Sleep Breath 19:509–514
Lin PW, Friedman M, Lin HC, Chang HW, Pulver TM, Chin CH (2011) Decreased retinal nerve fiber layer thickness in patients with obstructive sleep apnea/hypopnea syndrome. Graefes Arch Clin Exp Ophthalmol 249:585–593
Wang JS, Xie HT, Jia Y, Zhang MC (2016) Retinal nerve fiber layer thickness changes in obstructive sleep apnea syndrome: a systematic review and meta-analysis. Int J Ophthalmol 9:1651–1656
Casas P, Ascaso FJ, Vicente E, Tejero-Garces G, Adiego MI, Cristobal JA (2013) Retinal and optic nerve evaluation by optical coherence tomography in adults with obstructive sleep apnea-hypopnea syndrome (OSAHS). Graefes Arch Clin Exp Ophthalmol 251:1625–1634
Hayreh SS, Zimmerman MB, Podhajsky P, Alward WL (1994) Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol 117:603–624
Bekkers A, Borren N, Ederveen V, Fokkinga E, Andrade De Jesus D, Sanchez Brea L, Klein S, van Walsum T, Barbosa-Breda J, Stalmans I (2020) Microvascular damage assessed by optical coherence tomography angiography for glaucoma diagnosis: a systematic review of the most discriminative regions. Acta Ophthalmol
Lin PW, Lin HC, Friedman M, Chang HW, Salapatas AM, Lin MC, Chen YC (2020) Effects of CPAP for patients with OSA on visual sensitivity and retinal thickness. Sleep Med 67:156–163
Lattimore JD, Celermajer DS, Wilcox I (2003) Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol 41:1429–1437
Yu J, Gu R, Zong Y, Xu H, X W, (2016) Relationship between retinal perfusion and retinal thickness in healthy subjects: an optical coherence tomography angiography study. Invest Ophthalmol Vis Sci 57(9):204–210
Ucak T, Unver E (2020) Alterations in parafoveal and optic disc vessel densities in patients with obstructive sleep apnea syndrome. J Ophthalmol 2020:4034382
Yu J, Xiao K, Huang J, Sun X, Jiang C (2017) Reduced retinal vessel density in obstructive sleep apnea syndrome patients: an optical coherence tomography angiography study. Invest Ophthalmol Vis Sci 58:3506–3512
Jurado-Gamez B, Bujalance Cabrera C, Caballero Ballesteros L, Marin Hinojosa C, Munoz Cabrera L, Perez-Jimenez F, Lopez-Miranda J (2012) Association of cellular adhesion molecules and oxidative stress with endothelial function in obstructive sleep apnea. Intern Med 51:363–368
Kergoat H, Herard ME, Lemay M (2006) RGC sensitivity to mild systemic hypoxia. Invest Ophthalmol Vis Sci 47:5423–5427
Provencio I, Rodriguez IR, Jiang G, Hayes WP, Moreira EF, Rollag MD (2000) A novel human opsin in the inner retina. J Neurosci 20:600–605
Butler MP, Smales C, Wu H, Hussain MV, Mohamed YA, Morimoto M, Shea SA (2015) The circadian system contributes to apnea lengthening across the night in obstructive sleep apnea. Sleep 38:1793–1801
van de Kreeke JA, Darma S, Chan Pin Yin J, Tan HS, Abramoff MD, Twisk JWR, Verbraak FD (2020) The spatial relation of diabetic retinal neurodegeneration with diabetic retinopathy. PloS one 15:e0231552
Sivaprasad S, Arden G (2016) Spare the rods and spoil the retina: revisited. Eye 30:189–192
Duque-Chica GL, Gracitelli CPB, Moura ALA, Nagy BV, Vidal KS, de Melo G, Paranhos A Jr, Cahali MB, Ventura DF (2019) Contributions of the melanopsin-expressing ganglion cells, cones, and rods to the pupillary light response in obstructive sleep apnea. Invest Ophthalmol Vis Sci 60:3002–3012
Schaal S, Sherman MP, Nesmith B, Barak Y (2016) Untreated obstructive sleep apnea hinders response to bevacizumab in age-related macular degeneration. Retina 36:791–797
Lee AG, Golnik K, Kardon R, Wall M, Eggenberger E, Yedavally S (2002) Sleep apnea and intracranial hypertension in men. Ophthalmology 109:482–485
Erdem CZ, Altin R, Erdem LO, Kargi S, Kart L, Cinar F, Ayoglu F (2003) Doppler measurement of blood flow velocities in extraocular orbital vessels in patients with obstructive sleep apnea syndrome. J Clin Ultrasound 31:250–257
Fuchsjager-Mayrl G, Luksch A, Malec M, Polska E, Wolzt M, Schmetterer L (2003) Role of endothelin-1 in choroidal blood flow regulation during isometric exercise in healthy humans. Invest Ophthalmol Vis Sci 44:728–733
Wildsoet C, Wallman J (1995) Choroidal and scleral mechanisms of compensation for spectacle lenses in chicks. Vision Res 35:1175–1194
Conflict of interest
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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). https://doi.org/10.1007/s00417-021-05322-w
- Obstructive sleep apnea
- Retinal nerve fiber layer
- Retinal ganglion cells
- Inner plexiform layer
- Photoreceptor layer