Diabetics With Sleep Apnea at Higher Risk for Eye Disease

Obstructive sleep apnea (OSA) is known to be associated with many health problems, but most people do not realize that it can lead to some serious vision issues.

Poorly managed diabetes also can cause eye problems that can lead to blindness. People who have both type 2 diabetes and OSA are at an increased risk of developing diabetic retinopathy — the most common form of diabetic eye disease.

United Kindgom researchers followed adults with type 2 diabetes over a four-year period and found that those with OSA have more than double the risk of worsening retina disease, compared to diabetics without the sleep-breathing disorder. And the worse the sleep apnea, the faster the progression of diabetic eye disease.

Diabetic retinopathy occurs when the tiny blood vessels in the back of the eye become blocked and deprive the retina of oxygen. In diabetics, chronic high glucose levels associated with diabetes damage these blood vessels. In people with obstructive sleep apnea, episodes of airway obstruction lead to intermittent drops in blood oxygen, contributing to retinal damage.

In people with both diabetes and sleep apnea, which experts estimate is about 50 percent of diabetics, the risk of sight-threatening eye disease is, therefore, compounded.

“Unfortunately, many people with obstructive sleep apnea are not aware that they have the condition. It is highly underdiagnosed,” said Jeremy Tabak, M.D., medical director of Baptist Sleep Center at Galloway and Sleep Diagnostic Center at Baptist Hospital.

Obstructive sleep apnea occurs when the airway narrows and obstructs during sleep, interrupting breathing and resulting in gasping and snoring. Left untreated, sleep apnea can lead to other serious health issues, such as high blood pressure, heart disease, stroke and depression.

Some common symptoms of sleep apnea include:

• Snoring
• Restless sleep
• Pauses in breathing, observed by family members
• Daytime sleepiness
• Cognition problems
• Morning headaches

Dr. Tabak recommends that people with diabetes talk to their doctor if they are experiencing any of these symptoms. Simple screening tools, such as the STOP BANG questionnaire and Epworth Sleepiness Scale, can help determine if patients are at risk for sleep apnea. The results of these surveys may prompt a sleep laboratory evaluation to properly diagnose sleep apnea. Dr. Tabak also advises diabetics to see their eye doctor for a yearly eye exam with dilation — even if their vision seems fine.

Diabetic retinopathy usually affects both eyes. As the condition progresses, symptoms include:

• Spots or dark strings floating in the vision
• Blurred vision
• Fluctuating vision
• Impaired color vision
• Dark or empty areas in the vision
• Vision loss

“Sight complications and blindness are potentially treatable,” Dr. Tabak said. “Careful management of type 2 diabetes and obstructive sleep apnea is the best way to prevent vision loss.”

Lifestyle changes, such as losing weight, exercising more, quitting smoking and avoiding alcohol, can help people manage diabetes and reduce OSA. Continuous positive airway pressure (CPAP), which keeps the airways open, is the most common treatment for obstructive sleep apnea.

“Preventive treatment strategies can slow the progression of complications associated with OSA,” Dr. Tabak said. “Diabetics with OSA who use CPAP treatment for the sleep breathing disorder will see improvement in their OSA-related symptoms as well as their glucose levels and overall quality of life.”