Effect of Continuous Positive Airway Pressure Treatment on the Arteriole-to-Venule Ratio in Patients With Nonproliferative Diabetic Retinopathy and Obstructive Sleep Apnea: A Randomized Trial

Abstract

Background and Objective: This study aimed to assess the effect of continuous positive airway pressure (CPAP) on the arteriolar-to-venular ratio (AVR) in patients with diabetic retinopathy (DR) and obstructive sleep apnea (OSA). Patients and Methods: A prospective, randomized, unblinded, and controlled clinical trial with parallel groups was performed. From a base of 138 patients, 83 were randomized to either CPAP or control. Nonstereoscopic 35º photographs were processed with Sirius software. Results: The intention-to-treat analysis showed no differences in AVR, although the arteriolar diameter increased from baseline in the CPAP group. Per-protocol analysis showed a 12-month increase in AVR ( P = 0.035) and arteriolar diameter ( P = 0.033) in CPAP versus control group. The venular diameter showed a nonstatistically significant reduction. Conclusions: CPAP is a potentially novel treatment for individuals with DR and concomitant OSA, improving the retinopathy status, reversing the arteriolar narrowing, and therefore increasing the AVR, tending to reduce the venular diameter. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:XX–XX.]