New Evidence Showing yet another Link between Sight-Threatening Diabetic Retinopathy and Obstructive Sleep Apnea: How Relevant is this to my General Practice?

Purpose: This work reports the association of obstructive sleep apnea (OSA) and cotton-wool spots (CWS) seen in patients with nonproliferative diabetic retinopathy (DR). Methods: A random sample of patients diagnosed with DR between January 1, 2015 and December 31, 2018, were selected from medical-billing codes. Dilated funduscopic examination findings and medical history were analyzed by reviewing medical records. Results: CWS were present in 12 of 118 patients without OSA, compared with 11 of 32 patients with OSA (10.2% vs 34.4%, respectively; P = .002). OSA was more common in men (68.8%, P = .03) and associated with a higher body mass index (30.0 ± 5.0 without OSA vs 33.6 ± 5.5 with OSA, P < .001). When comparing those with and without OSA, there was no association with age; glycated hemoglobin A1c; stage of DR; insulin dependence; presence of diabetic macular edema; smoking status; or a history of hypertension, hyperlipidemia, cardiovascular disease, or other breathing disorder. Conclusions: The presence of OSA is associated with CWS in patients with DR, as well as male sex and a higher body mass index. Further research is needed to determine the ophthalmologist’s role in the timely referral of patients with CWS for OSA evaluation.

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The Potential Association between Obstructive Sleep Apnea and Diabetic Retinopathy in Severe Obesity—The Role of Hypoxemia

PLoS ONE ◽

10.1371/journal.pone.0079521 ◽

2013 ◽

Vol 8 (11) ◽

pp. e79521 ◽

Cited By ~ 35

Author(s):

Dev Banerjee ◽

Wen Bun Leong ◽

Teresa Arora ◽

Melissa Nolen ◽

Vikas Punamiya ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Diabetic Retinopathy ◽

Sleep Apnea ◽

Severe Obesity ◽

Potential Association ◽

Obstructive Sleep

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Sleep Disordered Breathing in Patient with Type 2 Diabetes Mellitus and its Association with Diabetic Retinopathy: Single Center Study

Nepalese Medical Journal ◽

10.3126/nmj.v2i1.23546 ◽

2019 ◽

Vol 2 (1) ◽

pp. 160-163

Author(s):

Milesh Jung Sijapati ◽

Minalma Pandey ◽

Poojyashree Karki ◽

Nirupama Khadka

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Obstructive Sleep Apnea ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Obstructive Sleep ◽

Disordered Breathing

Introduction: Sleep-disordered breathing comprises of obstructive sleep apnea, central sleep apnea, and periodic breathing. There is a link between obesity diabetes and sleep apnea with its association with retinopathy. Therefore this study was done to find out the association of sleep-disordered breathing in uncontrolled diabetes mellitus and association with retinopathy.Materials and Methods: This study was done from 2015 September to 2018 September in Sleep center, Nepal. Patients diagnosed with Type 2 diabetes mellitus were included. Diabetes mellitus was diagnosed as blood sugar fasting ≥ 126mg/dl, or blood sugar postprandial ≥200mg/dl and glycosylated hemoglobin above 6.5%. Obstructive sleep apnea risk was determined using the STOP-BANG questionnaire. Relationships between the risk of Obstructive sleep apnea and clinical variables along with its association with diabetic retinopathy were evaluated using bivariate analyses and covariate-adjusted logistic regression models.Results: A total of 150 diabetic patients were analyzed. Among them 30 (20.0%) patients had mild Obstructive sleep apnea, 14 (9.3%) patients had moderate Obstructive sleep apnea and 15 (10.0%) patients had severe sleep apnea. Among patients with diabetes mellitus on multivariate regression analysis Obstructive sleep apnea was associated with diabetes mellitus OR 2.05, 95% CI (1.69- 8.83) and diabetic retinopathy OR 1.20 (0.67-5.89).Conclusions: This study concludes that those individuals having diabetes may be suffering from obstructive sleep apnea and association with retinopathy these individuals can be considered for the screening of sleep-disordered breathing by polysomnography.

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RELATIONSHIP BETWEEN OBSTRUCTIVE SLEEP APNEA AND THE PRESENCE AND SEVERITY OF DIABETIC RETINOPATHY

Retina ◽

10.1097/iae.0000000000001848 ◽

2018 ◽

Vol 38 (11) ◽

pp. 2197-2206 ◽

Cited By ~ 8

Author(s):

Aimee C. Chang ◽

Timothy P. Fox ◽

Shutao Wang ◽

Albert Y. Wu

Keyword(s):

Obstructive Sleep Apnea ◽

Diabetic Retinopathy ◽

Sleep Apnea ◽

Obstructive Sleep

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The role of choroidal thickness in diabetic retinopathy and obstructive sleep apnea syndrome

Sleep And Breathing ◽

10.1007/s11325-016-1343-y ◽

2016 ◽

Vol 20 (3) ◽

pp. 1009-1010 ◽

Cited By ~ 2

Author(s):

Miao He ◽

Wenyong Huang

Keyword(s):

Obstructive Sleep Apnea ◽

Diabetic Retinopathy ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Choroidal Thickness ◽

Sleep Apnea Syndrome ◽

Obstructive Sleep ◽

Apnea Syndrome

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Commentary: Obstructive sleep apnea: A silent associate of diabetic retinopathy

Indian Journal of Ophthalmology ◽

10.4103/ijo.ijo_864_21 ◽

2021 ◽

Vol 69 (11) ◽

pp. 3357

Author(s):

Kim Ramasamy ◽

Chitaranjan Mishra

Keyword(s):

Obstructive Sleep Apnea ◽

Diabetic Retinopathy ◽

Sleep Apnea ◽

Obstructive Sleep

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[Management of Adult Obstructive Sleep Apnea Syndrome in General Practice: a new model of risk prevention]

Clinical Management Issues ◽

10.7175/cmi.v11i1.1291 ◽

2017 ◽

Vol 11 (1) ◽

Author(s):

Carla Bruschelli ◽

Germano Bettoncelli ◽

Giorgio Carlo Monti

Keyword(s):

General Practice ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Treatment Protocol ◽

Upper Airways ◽

Obstructive Sleep ◽

Apnea Syndrome ◽

Management Of Care

Obstructive Sleep Apnea Syndrome is a condition characterized by paused breathing during sleep due to complete or partial obstruction of the upper airways. It is still underdiagnosed and underestimated, despite its respiratory, cardiovascular, and neurocognitive complications. Polysomnography is the gold standard for diagnosis. The treatment protocol, that has to be agreed with the patient, is behavioral, ventilator, and sometimes surgical.The role of general practitioners is essential for early identification of patients with high probability of OSAS. Physicians are supported by specific instruments of general practice, such as continuity of care, computerized medical records for oriented problems, medical history, and diagnostic-therapeutic methodology for an exclusive management model. Among their duties, there is also the management of care priorities for patients’ comorbidities.

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Governmental and Private Dentists’ Knowledge, Educational Background, Opinion, and Clinical Experience toward Obstructive Sleep Apnea and Oral Appliances

Journal of Contemporary Dentistry ◽

10.5005/jp-journals-10031-1202 ◽

2017 ◽

Vol 7 (3) ◽

pp. 139-143

Author(s):

Saeed M Banabilh ◽

Rasha Al-afaleg

Keyword(s):

General Practice ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Clinical Experience ◽

Statistical Significance ◽

Signs And Symptoms ◽

Educational Background ◽

Oral Appliances ◽

Cross Sectional ◽

Obstructive Sleep

ABSTRACT Aim The aims of this study were to determine the knowledge, educational background, opinion, and clinical experience of general practice dentists toward obstructive sleep apnea (OSA) and oral appliances (OAs). Materials and methods A cross-sectional study was carried out through a questionnaire which was distributed randomly to 200 general practice dentists both in public and private dental clinics at Qassim, Kingdom of Saudi Arabia. About 175 completed questionnaires were returned. The data were statistically analyzed using Statistical Package for the Social Sciences (SPSS). Results The results showed that only 48.6% of our governmental and private dentists were familiar with the term OSA with a statistical significance among governmental dentists (37.9%) who were more familiar with OSA signs and symptoms than private (21.1%) dentists (p < 0.016). In addition, the majority of the respondents (90.9%) reported a general lack of education in both OSA and OAs during their study in the dental school. A total of 142 (81.1%) dentists never prescribed OAs for OSA patients. However, 87.4% have never consulted or referred a suspected OSA patient to physicians. Conclusion General practice dentists surveyed possess poor knowledge and low clinical experience regarding OSA and OAs, which reflects the weak level of education in this field of dental sleep medicine. How to cite this article Banabilh SM, Al-afaleg R. Governmental and Private Dentists’ Knowledge, Educational Background, Opinion, and Clinical Experience toward Obstructive Sleep Apnea and Oral Appliances. J Contemp Dent 2017;7(3):139-143.

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Assessment, referral and management of obstructive sleep apnea by Australian general practitioners: a qualitative analysis

BMC Health Services Research ◽

10.1186/s12913-021-07274-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nicole Grivell ◽

Jenny Haycock ◽

Anne Redman ◽

Andrew Vakulin ◽

Nicholas Zwar ◽

...

Keyword(s):

General Practice ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

General Practitioners ◽

Models Of Care ◽

Structured Interviews ◽

Primary Responsibility ◽

Obstructive Sleep ◽

Depth Analysis ◽

Increasing Demand

Abstract Background The high and increasing demand for obstructive sleep apnea (OSA) care has exceeded the capacity of specialist sleep services prompting consideration of whether general practitioners could have an enhanced role in service delivery. However, little is known about the current involvement, experiences and attitudes of Australian general practitioners towards OSA. The purpose of this study was to provide an in-depth analysis of Australian general practitioners’ experiences and opinions regarding their care of patients with OSA to inform the design and implementation of new general practice models of care. Methods Purposive sampling was used to recruit participants with maximum variation in age, experience and location. Semi-structured interviews were conducted and were analysed using Thematic Analysis. Results Three major themes were identified: (1) General practitioners are important in recognising symptoms of OSA and facilitating a diagnosis by others; (2) Inequities in access to the assessment and management of OSA; and (3) General practitioners currently have a limited role in the management of OSA. Conclusions When consulting with patients with symptoms of OSA, general practitioners see their primary responsibility as providing a referral for diagnosis by others. General practitioners working with patients in areas of greater need, such as rural/remote areas and those of socio-economic disadvantage, demonstrated interest in being more involved in OSA management. Inequities in access to assessment and management are potential drivers for change in future models of care for OSA in general practice.

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