Impact of Obstructive Sleep Apnea on Diabetic Retinopathy Progression and Systemic Complications

•In this cohort study that included 9367 patients with diabetic retinopathy and obstructive sleep apnea, there was an increased rate of vision-threatening complications and need for ocular intervention through 5 years of follow-up when compared with a matched cohort of diabetic retinopathy patients without obstructive sleep apnea.•There was additionally an increased risk of experiencing systemic cardiovascular complications, including death, in the cohort of patients with diabetic retinopathy and obstructive sleep apnea during the 5-year period.•The results emphasize the need for improved screening measures of patients with diabetic retinopathy by eye care providers to potentially uncover underlying obstructive sleep apnea as a risk factor for the progression of ocular and systemic disease. To evaluate the risk of diabetic retinopathy progression and systemic vascular events, including death, in patients with nonproliferative diabetic retinopathy (NPDR) with obstructive sleep apnea (OSA). Retrospective cohort study. Electronic chart query using TriNetX, an electronic health records network comprising data from over 124 million patients. Patients with NPDR with and without OSA were identified. Patients were excluded if they had a history of proliferative disease (proliferative diabetic retinopathy), diabetic macular edema, or prior ocular intervention (intravitreal injection, laser, or pars plana vitrectomy). Propensity score matching was performed to control for baseline demographics and comorbidities. The rate of progression to vision-threatening complications, need for ocular intervention, and systemic events was measured at 1, 3, and 5 years. A total of 11 931 patients in each group were analyzed after propensity score matching. There was an elevated risk of proliferative diabetic retinopathy in the OSA cohort at 1 (risk ratio [RR]: 1.34, P < .001), 3 (RR: 1.31, P < .001), and 5 years (RR: 1.28, P < .001). There was an elevated risk of diabetic macular edema in the OSA group at all time points: 1 (RR: 1.31, P < .001), 3 (RR: 1.19, P