Rationale: The impact of obstructive sleep apnea (OSA) on microvascular system suggests that spectral domain optical coherence tomography (SD-OCT) evaluation of the choroidal vasculature could provide clinically relevant insights into disease presence and severity.
Objective: To investigate the value of choroidal vascular imaging with SD-OCT in diagnosing the presence and predicting the severity of OSA.
Methods: SD-OCT images of 120 patients with OSA were analyzed to extract choroidal biomarkers. Patients were categorized into 4 levels of OSA severity according to their apnea-hypopnea index. ImageJ/FIJI (National Institutes of Health, Bethesda, Maryland, USA) was used to measure choroidal thickness and vascular indices in Haller's and non-Haller's layers across regions on the nasal and temporal sides of the fovea. Thickness ratios of choroidal layers, total choroidal area, choroidal vascularity index, and luminal-to-stromal ratios were compared between individuals without OSA and with different severities of OSA. Analysis of variance, receiver operating characteristic analysis, and logistic regression were employed to evaluate inter-group differences and the predictive value of choroidal parameters.
Results: OSA's presence and increasing severity significantly impacted the non-Haller's layer thickness and Haller's/non-Haller's layer thickness ratios, particularly in the nasal region (1000-2500 µm). The nasal 2500 µm region showed the highest discriminative power for severe OSA (AUC = 0.733, P < .001). Logistic regression analysis identified the Haller's/non-Haller's layer thickness ratio at nasal 2500 µm as the most significant predictor of severe OSA (odds ratio = 2.147, P = .002), adjusted for age, gender, and comorbidities.
Conclusions: OSA is associated with choroidal microvascular remodeling, especially nasal to the fovea. This remodeling increases the ratio of Haller's/non-Haller's layer thickness ratio, which may be a potential biomarker for OSA severity. These findings highlight the utility of SD-OCT in non-invasively detecting systemic vascular alterations linked to OSA, supporting its role in early diagnosis and monitoring of disease progression.
Keywords: Haller’s layer; apnea-hypopnea index; choroidal thickness; obstructive sleep apnea; oculomics; optical coherence tomography.
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