Relationship between sleep-disordered breathing and iris and/or angle neovascularization in proliferative diabetic retinopathy cases

Am J Ophthalmol. 2011 Apr;151(4):604-9. doi: 10.1016/j.ajo.2010.10.002. Epub 2011 Jan 22.


Purpose: To investigate whether sleep-disordered breathing is a risk factor for iris and/or angle neovascularization in patients with proliferative diabetic retinopathy (PDR).

Design: Cross-sectional comparative case series.

Subjects and methods: One hundred fifty-one consecutive patients with PDR who underwent surgery in our hospital were divided based on the presence of iris and/or angle neovascularization (NV group, 37 patients) or absence of NV (non-NV group, 114 patients). Pulse oximetry was conducted during the night and the mean SpO(2), 4% oxygen desaturation index (4% ODI times/hour), the lowest SpO(2)% during sleep (lowest SpO(2)), and the cumulative percentage of time at SpO(2) <90% in analysis times (CT90%) were calculated. When the 4% ODI exceeded 5 times/hour, sleep-disordered breathing was diagnosed. The results were compared between the 2 groups. Preoperative systemic parameters also were analyzed by logistic regression to clarify risk factors for the NV group.

Results: A mean total of 50% (62% of the NV group and 46% of the non-NV group) was diagnosed with sleep-disordered breathing. The mean SpO(2) and lowest SpO(2) did not differ significantly between the 2 groups; the 4% ODI (12.3 vs 6.6) and CT90% (3.8 vs 1.7) were significantly higher in the NV group (P=.02, for both comparisons). Logistic regression analysis identified insulin therapy (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.26∼7.20; P=.01); and 4% ODI (OR, 1.09; CI, 1.01∼1.16; P=.02) as risk factors for the NV group.

Conclusions: In patients with PDR, nocturnal intermittent hypoxia/reoxygenation resulting from sleep-disordered breathing may be a risk factor for iris and/or angle neovascularization.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Anterior Chamber / blood supply*
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetic Retinopathy / complications*
  • Female
  • Filtering Surgery
  • Glaucoma, Neovascular / diagnosis
  • Glaucoma, Neovascular / etiology*
  • Glaucoma, Neovascular / surgery
  • Humans
  • Hypoxia / etiology
  • Insulin / therapeutic use
  • Iris / blood supply*
  • Male
  • Middle Aged
  • Neovascularization, Pathologic / diagnosis
  • Neovascularization, Pathologic / etiology*
  • Oximetry
  • Oxygen / blood
  • Risk Factors
  • Sleep Apnea Syndromes / complications*
  • Sleep Apnea Syndromes / diagnosis


  • Insulin
  • Oxygen