Utility of Ultra-Widefield Retinal Imaging for Sleep Apnea Screening

Introduction: Sleep apnea is an under recognized systemic condition with a variety of cardiovascular, ocular, and psychosocial complications. This records review was conducted to validate the clinical observation of an association between far peripheral retinal hemorrhages and sleep apnea. Methods: A retrospective record review was conducted at a primary care optometric clinic in Phoenix, Arizona, of all patients seen between January 2018 and April 2021 who opted to have an ultra-widefield retinal photo (OPTOS Daytona) at their comprehensive exam and had a subsequent diagnosis of retinal ischemia (H35.82) or retinal hemorrhage (H35.6-). The ultra-widefield retinal imaging was assessed for the location of the retinal hemorrhages and the medical record was reviewed for history of sleep apnea, primary care physician request for sleep study, and if so, sleep study results. Chi-square statistical analysis was used. Results: 3790 records were reviewed with 2251 having ultra-widefield retinal imaging (59.39%). 83 subjects had diagnosed retinal hemorrhages or ischemia of which 48 were far peripheral. Of those with only far peripheral retinal hemorrhage, 10 already had a diagnosis of sleep apnea and of the 38 with requested testing results 6 were positive, 2 were negative, 16 had no testing completed, and 14 were lost to follow up. Peripheral retinal hemorrhages were shown to have a significant association with sleep apnea. Faxed requests to primary care physicians for sleep study testing were shown to be an ineffective method of communication to get requested testing ordered. Discussion: There are currently no publications reporting the association between far peripheral retinal hemorrhages and sleep apnea. Patient education and primary care physician testing request communication were both shown to need improvement. Conclusion: Ultra-widefield retinal imaging at primary care examinations may have utility as a screening device for sleep apnea. There is need for a larger, prospective study of known sleep apnea patients and the incidence of far peripheral retinal hemorrhages seen on ultra-widefield retinal photos.