The research, led by Dr. Maide Gözde İnam from the Department of Ophthalmology, Edward S. Harkness Eye Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, highlights the potential of eye-based imaging as a diagnostic tool for this common
OSA, characterized by repeated interruptions in breathing during sleep, has long been known to affect the body’s microvascular system. Given this association, the researchers explored whether changes in the choroidal vasculature—the network of blood vessels beneath the retina—could reflect the presence and severity of OSA. Spectral domain optical coherence tomography (SD-OCT) was employed to capture detailed cross-sectional images of the choroid, enabling a deeper look into these vascular changes.
The study analyzed SD-OCT images from 120 individuals diagnosed with OSA. Participants were divided into four groups based on the severity of their condition, as defined by the apnea–hypopnea index. Using ImageJ/FIJI software developed by the National Institutes of Health, the team measured various choroidal biomarkers, including choroidal thickness, vascular indices, total choroidal area, and the luminal-to-stromal ratio. These parameters were compared among participants with varying degrees of OSA and those without the condition.
The key findings include the following:
- The presence and severity of obstructive sleep apnea were significantly associated with changes in the choroidal structure, particularly within the non-Haller’s layer.
- The thickness ratio between Haller’s and non-Haller’s layers showed a strong correlation with OSA severity, especially in the nasal region located 1000–2500 µm from the fovea.
- The nasal 2500 µm region exhibited the highest discriminative ability for identifying severe OSA, with an area under the curve (AUC) value of 0.733.
- Logistic regression analysis identified the Haller’s/non-Haller’s layer thickness ratio at the nasal 2500 µm region as the most significant predictor of severe OSA.
- This association remained significant after adjusting for age, sex, and comorbidities, with an odds ratio of 2.147.
According to the authors, these results indicate that OSA is associated with microvascular remodeling in the choroid, particularly on the nasal side of the fovea. This remodeling alters the balance between the vascular layers, increasing the thickness ratio of Haller’s to non-Haller’s layers—a potential imaging biomarker for disease severity.
"The study highlights the promise of SD-OCT as a non-invasive, accessible tool for identifying systemic vascular changes associated with OSA. By detecting subtle microvascular alterations, OCT imaging could support early diagnosis, assist in risk stratification, and help monitor disease progression in patients with obstructive sleep apnea," the authors concluded.
Reference:
İnam MG, İnam O, Lin JM, Park J, Gucer D, Tezel TH. Predicting the Presence and Severity of Obstructive Sleep Apnea with Optical Coherence Tomography. Ann Am Thorac Soc. 2025 Sep 30. doi: 10.1513/AnnalsATS.202506-579OC. Epub ahead of print. PMID: 41025935.
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