OSA increases risk for central serous chorioretinopathy
Obstructive sleep apnea increases the risk for central serous chorioretinopathy in both men and women, according to a study published in American Journal of Ophthalmology.
“Central serous chorioretinopathy (CSC) is a disorder characterized by the formation of a localized neurosensory retinal detachment caused by leakage of uid at the level of the retinal pigment epithelium,” Carolyn K. Pan, MD, of the Byers Eye Institute, and colleagues wrote. “The pathophysiology of CSC remains poorly understood despite advances in imaging techniques and numerous studies of the disease. ... OSA has been identied as a possible risk factor for the development of CSC, but the extent of this association is not fully understood.”
In a retrospective cohort study, investigators selected 59,016,145 patients via database search to determine the incidence of CSC stratified by age, sex and OSA diagnosis. Cox proportional hazard models further determined risk for CSC development, and positive predictive values estimated what a new CSC diagnosis would have in predicting subsequent OSA diagnosis.
Study results showed CSC risk increased with both age (HR = 1.03; P < .001) and OSA diagnosis (HR = 1.081; P < .033), with lower risk found in women (HR = 0.284;P < .001). Researchers estimated annual incidence was 9.6 per 100,000 women vs. 23.4 per 100,000 men, with higher incidence indicated in those with OSA (17.2 per 100,000 women with OSA vs. 40.8 per 100,000 men with OSA). Positive predicted value of a CSC diagnosis as a predictor of a subsequent OSA diagnosis was highest in the fifth decade of life.
“We estimate that the incidence of CSC in the United States is higher than previously reported. Men are at higher risk of CSC than women, and OSA increases risk of CSC for both men and women,” Pan and colleagues concluded. “Some patients, particularly men in their fth and sixth decade, with a new CSC diagnosis may be good candidates for OSA evaluation.”
Perspective
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Many of us encounter CSC in our practices and are aware of the previously studied risk factors including psychological stress, male sex, Type A personality, corticosteroid medication use, endocrine disorders resulting in increased endogenous steroids, hypertension and pregnancy. This article provides further insight into a less understood risk factor: OSA.
Undiagnosed OSA can negatively impact on our patient’s morbidity, mortality and quality of life. This study showed an increased incidence of CSC in patients with OSA, suggesting it is another important risk factor to consider.
Additionally, this study provided insight that for male patients aged 40 to 59 years presenting with CSC, we should maintain high clinical suspicion for undiagnosed OSA. We should investigate if additional risk factors for OSA are present, including high BMI. If present, a referral for further evaluation should be considered, as diagnosing OSA can greatly benefit our patients.
Overall, this study identifies an important opportunity to help diagnose OSA as well as recognize it as a potential risk factor for CSC development. That being said, one limitation of this study is the lack of imaging to confirm CSC diagnosis, and the study did not incorporate additional risk factors for OSA in the models. It is important to consider evaluating other risk factors of OSA in determining appropriate referrals to avoid large numbers of unnecessary and expensive evaluations.
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