Retinal and Choroidal Changes in Obstructive Sleep Apnea Syndrome Assessed by Ultra- Widefield Swept-Source Optical Coherence Tomography Angiography

Retinal and Choroidal Changes in Obstructive Sleep Apnea Syndrome Assessed by Ultra- Widefield Swept-Source Optical Coherence Tomography Angiography | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Retinal and Choroidal Changes in Obstructive Sleep Apnea Syndrome Assessed by Ultra- Widefield Swept-Source Optical Coherence Tomography Angiography Xinyi Chen, Ningning Tang, Chaomin Chen, Lixia Qin, Daizai Lei, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7839987/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract PURPOSE To investigate central and peripheral retinal and choroidal alterations using ultra-widefield swept-source optical coherence tomography angiography (UWF-SS-OCTA) in patients with obstructive sleep apnea syndrome (OSAS) stratified by disease severity. METHODS The study included patients with mild-moderate OSAS (n = 23 eyes), severe OSAS (n = 22 eyes), and healthy controls (n = 26 eyes). UWF- SS-OCTA scans centered on the fovea were used to divide the macula 8 concentric rings spanning from the central macula to the peripheral retina (0–21 mm). Vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), and choroidal thickness (CT) were analyzed across all rings. Correlations with apnea-hypopnea index (AHI) and lowest oxygen saturation (LSaO₂) were also assessed. RESULTS SCP vessel density was significantly reduced only in the far periphery (ring 8) across all OSAS groups. DCP impairment was more extensive, with severe OSAS patients showing significantly decreased vessel density in peripheral rings 5–8 versus controls (all p < 0.05), particularly in the superior and inferior quadrants (all p < 0.05). Choroidal thinning in severe OSAS followed a similar pattern, being significantly reduced in rings 4–8 (all p < 0.05), particularly in the superior, inferior, and nasal quadrants (all p < 0.05). DCP vessel density and choroidal thickness in peripheral regions correlated negatively with AHI and positively with LSaO₂. CONCLUSIONS For patients with OSAS, damage to the deep capillary plexus and choroid predominantly affects the peripheral retina and is significantly associated with the severity of hypoxia. Obstructive sleep apnea syndrome ultra-widefield swept-source optical coherence tomography angiography retina choroid Figures Figure 1 INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a common breathing disorder [ 1 ], characterized by a sleep-related collapse of the upper airway, leading to partial or complete obstruction, recurrent apneas and hypopneas, intermittent hypoxemia, and hypercapnia [ 2 ]. Typical clinical manifestations include habitual loud snoring, witnessed apneas, and excessive daytime sleepiness [ 3 ]. Major risk factors comprise obesity, alcohol consumption, male sex, and anatomical abnormalities of the upper airway [ 4 , 5 ]. Notably, the global prevalence of OSAS has risen markedly and has emerged as a significant public-health concern. Beyond impairing sleep quality and causing daytime fatigue, OSAS is strongly associated with severe cardiometabolic disorders, such as hypertension, coronary artery disease, stroke, diabetes mellitus, and metabolic syndrome [ 6 – 8 ]. These comorbidities not only markedly undermine the quality of life but also pose substantial threats to long-term health outcomes. The ocular blood supply primarily originates from the branches of the ophthalmic artery: the central retinal artery and the ciliary arteries. Among these, the choroidal circulation is predominantly regulated by sympathetic nerves, which lacks the ability of autonomic innervation. While in contrast, the retinal circulation not controlled by the autonomic nerve, but relies on intrinsic autoregulatory mechanisms to maintain stable perfusion [ 9 ]. Given that the retina is one of the most metabolically active tissues in the human body, recurrent intermittent hypoxia in OSAS may induce hemodynamic disturbances in the retinal microcirculation [ 10 ]. Numerous studies have demonstrated associations between OSAS and various ocular pathologies, including glaucoma, diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy [ 11 – 14 ]. Consequently, the retinal vasculature not only serves a key target of hypoxic injury but also provides a critical window for monitoring systemic vascular status. Optical coherence tomography angiography (OCTA) is an emerging non-invasive imaging technique that allows for quantitative assessment of vascular density and thickness within retinal and choroidal layers, as well as detailed visualization of microstructural features [ 15 ]. With advantages such as non-invasive nature, rapid acquisition, layer-specific quantification, and high reproducibility, OCTA has been widely adopted in the evaluation of various retinal diseases [ 16 – 18 ]. Compared to fluorescein angiography, OCTA offers superior safety, greater efficiency, and enhanced operational convenience [ 19 ]. In recent years, OCTA has been increasingly employed to evaluate retinal microvascular alterations in patients with OSAS. However, previous investigations have been limited by conventional scanning protocols, which typically restrict the fields of view to ≤ 6 x 6 mm², thereby restricting comprehensive evaluation of the peripheral retina. To address this limitation, the present study utilizes ultra-widefield swept-source OCTA (UWF-SS-OCTA) with a scanning area of 26 x 21 mm² to compare retinal and choroidal parameters across both central and peripheral regions in OSAS patients of varying severity and of healthy controls. We anticipate that this approach will demonstrate the potential of UWF-SS-OCTA in the early detection of OSAS-related ocular changes, particularly peripheral alterations, thereby providing a novel analytical tool for future investigations. MATERIALS AND METHODS Study population This study was approved by the Ethics Committee of the People's Hospital of Guangxi Zhuang Autonomous Region (Approval Number:KY-IIT-2023-112) and adhered to the tenets of the Declaration of Helsinki. All participants provided written informed consent. Consecutive patients presenting with sleep-related snoring were recruited from our Sleep Medicine Center between June 2024 and December 2024. Participants underwent standardized assessments including collection of baseline characteristics, medical history documentation, and overnight polysomnography (PSG). A total of 45 patients meeting inclusion criteria were assigned to the OSAS cohort and further stratified into mild-to-moderate (n = 23 patients, 23 eyes) and severe (n = 22 patients, 22 eyes) groups based on the apnea-hypopnea index (AHI). Twenty-six age-matched healthy subjects, who were screened using the STOP-Bang questionnaire to exclude OSAS, served as controls (n = 26 eyes). Inclusion criteria were as follows: (1) age between 25 and 65 years; (2) no history of ocular surgery, trauma or primary glaucoma; (3) no significant ametropia (myopia < − 6.00 D, astigmatism < ± 2.00 D) and normal intraocular pressure (IOP ≤ 21 mmHg); (4) absence of ocular conditions affecting OCTA imaging (e.g., pathologic myopia, macular degeneration, optic neuropathy, retinal detachment, uveitis) and no opacity of refractive media; (5) ability to complete OCTA imaging with stable fixation. Exclusion criteria included: (1) prior treatment for OSAS; (2) presence of systemic diseases (e.g., coronary heart disease, diabetes mellitus, stroke, uncontrolled hypertension) or use of vasoactive medications; (3) history of psychiatric disorders. Routine examinations For all participants, basic demographic and medical history data were collected. A comprehensive ophthalmic examination was conducted, covering the anterior segment to the posterior pole, including: uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy, color fundus photography, and UWF-SS-OCTA. All examinations were conducted by experienced ophthalmologists. UWF-SS-OCTA image acquisition UWF-SS-OCTA was performed using the VG200N device (SVision Imaging, Ltd., Luoyang, China). All scans were centered on the fovea and covered a 26 x 21 mm² field. The system operated at a 1,050 nm central wavelength with an A-scan rate of 400,000 scans per second. Following the Early Treatment Diabetic Retinopathy Study (ETDRS) sectors, the area from 0–21 mm was divided into eight concentric rings centered on the fovea: ring 1 (0–1 mm), ring 2 (1–3 mm), ring 3 (3–6 mm), ring 4 (6–9 mm), ring 5 (9–12 mm), ring 6 (12–15 mm), ring 7 (15–18 mm), and ring 8 (18–21 mm) (Fig. 1 ). The central zone was defined as 0–6 mm and the peripheral zone as 6–21 mm. Vessel density of the SCP and DCP, and choroidal thickness were automatically segmented and quantified using the proprietary software (Van Gogh, v3.0.254). When a ring-level comparison reached statistical significance, the corresponding ring was further divided into superior (S), temporal (T), inferior (I), and nasal (N) sectors for subregional analysis. All OCTA scans were performed by a single experienced ophthalmologist ensure consistency. Polysomnography The overnight PSG was conducted for all enrolled participants using an E-series EEG/PSG system (Compumedics, Australia) by the certified sleep technicians from our Sleep Medicine Center. Recordings were obtained between 22:00 and 06:00, with a minimum duration of eight hours. All polysomnographic data were manually scored by board-certified physicians according to the Chinese Guidelines for the Diagnosis and Treatment of Obstructive Sleep Apnea–Hypopnea Syndrome. The following parameters were extracted: apnea–hypopnea index (AHI, events/h), lowest oxygen saturation (LSaO₂, %), and longest apnea duration (LAD, s). Based on the AHI values, patients with OSAS were categorized into a mild-to-moderate group (AHI 5–30 events/h) and a severe group (AHI > 30 events/h) [ 20 ]. STOP-Bang questionnaire assessment The STOP-Bang questionnaire was administered to all participants to to screen for the likelihood of OSAS [ 21 ]. This validated tool includes eight yes/no questions: (1) loud snoring (loud enough to be heard through closed doors); (2) frequent daytime fatigue or sleepiness; (3) witnessed apneas or choking episodes during sleep; (4) hypertension or ongoing antihypertensive treatment; (5) body mass index (BMI) > 35 kg/m²; (6) age > 50 years; (7) neck circumference > 40 cm; and (8) male sex. According to established clinical criteria [ 22 ], participants scoring ≥ 3 were considered at high risk for OSAS and were further evaluated by PSG; controls were selected from individuals with a score < 3, indicating a low risk for OSAS and were unlikely to require further diagnostic testing. Statistical Analyses All statistical analyses were performed with SPSS 27.0 (IBM Corporation, Armonk, NY, USA). Normality was assessed using the Shapiro-Wilk test. Categorical variables were presented as frequencies (percentages) and were compared with the chi-square test. Continuous variables were expressed as median (interquartile range, IQR). Comparisons among three groups were performed using the Kruskal-Wallis test, followed by pairwise comparisons with Dunn-Bonferroni corrections when significant differences were detected. Two-group comparisons were performed using the Mann-Whitney U test. Spearman rank correlation coefficient was used to evaluate the correlation between polysomnography indicators and retinal microcirculation parameters. A P-value < 0.05 was considered statistically significant. RESULTS Basic data analysis A total of 26 healthy controls (26 eyes) and 45 patients diagnosed with OSAS were included in this study. The OSAS cohort was stratified into mild-to-moderate (23 patients,23 eyes) and severe (22 patients,22 eyes) groups based on AHI scores. No significant differences were observed in age ( p = 0.252), sex distribution ( p = 0.366), eye side ( p = 0.893), or intraocular pressure ( p = 0.552) among groups. However, BMI differed significantly ( p < 0.001), with severe OSAS group exhibiting higher BMI (median 26.75 kg/m², IQR 24.95–28.15) versus controls (median 23.40 kg/m², IQR 20.78–26.55) (Table 1 ). Table 1 Baseline Characteristics and Polysomnographic Parameters Control group (n = 26) Mild-to-moderate group(n = 23) Severe group (n = 22) P Age (y) 47.50(38.75,54.00) 52.00(45.00,56.00) 42.00(34.25,56.00) 0.252 Sex (n,%) 0.366 Male 14(53.8) 13(56.5) 16(72.7) Female 12(46.2) 10(43.5) 6(27.3) Eye(n,%) 0.893 OD 22(84.6) 20(87.0) 18(81.8) OS 4(15.4) 3(13.0) 4(18.2) IOP (mmHg) 14.00(13.00,15.15) 13.00(12.00,15.50) 14.00(12.00,16.00) 0.552 BMI (kg/m 2 ) 23.40(20.78,26.55) 23.40(22.00,24.40) 26.75(24.95,28.15) < 0.001* AHI (events/h) N/A 13.60(7.70,18.60) 65.95(45.83,71.20) N/A LSaO 2 (%) N/A 87.00(81.00,89.00) 71.50(63.25,80.00) N/A LAD (s) N/A 46.00(35.00,64.00) 72.00(63.75,92.00) N/A Notes: Continuous data are expressed as median (interquartile range, IQR) compared using Kruskal-Wallis Test and categorical data are analyzed using chi-square test; * indicates statistically significant differences (p < 0.05). Abbreviations: PSG: polysomnography; IOP: intraocular pressure; BMI: body mass index; AHI: apnea-hypopnea index; LSaO 2 : lowest blood oxygen saturation; LAD: longest apnea duration; N/A: not applicable. Retinal vascular density parameters SCP vessel density was significantly reduced only in the outermost ring 8 in both OSAS groups compared to controls (severe vs controls: p = 0.002; mild-to-moderate vs controls: p = 0.027). In contrast, the DCP exhibited more extensive reductions in the severe group. Vessel densities in rings 5–8 were significantly lower in the severe group compared to controls (ring 5: p = 0.003; ring 6: p < 0.001; ring 7: p < 0.001; ring 8: p = 0.002) (Table 2 ). Subregional analysis further revealed that the DCP vessel density reduction in the severe group was most pronounced in the superior and inferior quadrants (all p < 0.05) (Table 3 ). Table 2 Comparison of Superficial and Deep Capillary Plexus Vascular Density Among Control and OSAS Groups Regions Variables Control group (n = 26) Mild-to-moderate group(n = 23) Severe group (n = 22) P P 1 P 2 Ring 1 SCP(%) 27.97(22.31,38.40) 26.23(22.32,35.62) 26.47(20.63,32.77) 0.472 0.697 0.228 DCP(%) 4.23(1.09,7.99) 3.42(0.98,5.45) 3.58(0.70,5.04) 0.398 0.389 0.179 Ring 2 SCP(%) 70.36(65.96,72.86) 67.84(65.43,74.21) 68.20(66.66,70.75) 0.420 0.273 0.250 DCP(%) 5.53(2.81,7.66) 3.60(2.02,5.36) 2.88(1.01,4.85) 0.058 0.149 0.023 Ring 3 SCP(%) 65.38(61.61,66.39) 63.10(60.14,66.33) 61.86(59.59,64.55) 0.192 0.533 0.073 DCP(%) 8.42(5.50,11.24) 7.09(4.65,8.43) 7.09(4.86,9.03) 0.231 0.133 0.159 Ring 4 SCP(%) 36.98(32.51,41.75) 36.41(33.33,37.70) 35.19(32.63,38.50) 0.285 0.402 0.116 DCP(%) 14.12(12.14,16.17) 12.94(11.59,15.74) 11.74(9.25,15.28) 0.115 0.288 0.052 Ring 5 SCP(%) 28.88(26.40,33.43) 27.17(24.34,35.49) 27.33(24.58,31.34) 0.296 0.433 0.120 DCP(%) 16.52(13.14,19.57) 15.27(12.91,17.12) 12.49(10.18,15.57) 0.011* 0.193 0.003* Ring 6 SCP(%) 30.09(25.36,32.73) 29.93(25.01,32.99) 29.21(24.10,33.53) 0.857 0.667 0.612 DCP(%) 19.03(16.28,21.54) 18.00(13.92,20.97) 14.41(11.29,17.73) 0.001* 0.235 < 0.001* Ring 7 SCP(%) 25.52(22.32,28.05) 25.06(21.48,27.91) 24.05(20.10,27.91) 0.694 0.666 0.395 DCP(%) 16.64(14.36,19.95) 17.34(13.44,21.45) 11.78(10.02,14.27) < 0.001* 0.987 < 0.001* Ring 8 SCP(%) 19.65(16.08,21.48) 15.82(12.80,17.75) 15.23(13.26,16.24) 0.002* 0.027* 0.002* DCP(%) 14.17(11.18,16.90) 13.83(10.78,17.22) 9.87(7.87,11.67) 0.001* 0.869 0.002* Notes: Continuous data are expressed as median (interquartile range, IQR) and compared using Kruskal-Wallis Test; P indicates the p-value across all three groups; P 1 indicates the p-value between the control group and the mild-to-moderate group; P 2 indicates the p-value between the control group and the severe group; * indicates statistically significant differences (p < 0.05). Abbreviations: OSAS: Obstructive Sleep Apnea Syndrome; SCP: Superficial Capillary Layer; DCP: Deep Capillary Layer. Table 3 Comparison of Deep Capillary Plexus Vascular Density by Subregion Between Severe OSAS and Control Groups Regions Quadrants Control group (n = 26) Severe group (n = 22) Z P Ring 5 S 16.05(13.11,19.99) 10.42(7.77,14.09) -3.124 0.002* T 26.85(19.35,31.77) 20.79(15.38,30.21) -1.179 0.238 I 18.10(11.96,21.96) 12.71(9.09,18.37) -1.924 0.054 N 5.85(4.55,7.30) 4.99(1.85,6.10) -1.904 0.057 Ring 6 S 27.23(22.13,29.26) 18.35(14.71,20.53) -4.097 < 0.001* T 16.46(10.49,23.94) 13.32(6.92,19.78) -1.345 0.179 I 25.58(19.04,32.44) 21.74(16.66,25.27) -1.883 0.060 N 7.16(4.11,8.78) 4.23(2.59,7.11) -1.842 0.066 Ring 7 S 24.48(21.55,30.49) 18.07(14.55,22.68) -3.311 < 0.001* T 8.55(5.13,13.38) 5.17(2.98,10.90) -1.469 0.142 I 25.45(18.76,30.97) 16.51(7.62,20.27) -3.497 < 0.001* N 10.55(4.61,12.58) 5.41(2.22,9.21) -1.842 0.066 Ring 8 S 23.04(18.27,30.07) 18.71(12.81,24.43) -2.276 0.023* T 3.91(2.21,5.28) 4.53(1.19,5.55) -0.021 0.983 I 19.70(15.24,22.69) 11.36(6.80,19.19) -3.083 0.002* N 6.02(4.02,11.39) 4.14(1.27,9.40) -1.717 0.086 Notes: Continuous data are expressed as median (interquartile range, IQR) compared using Mann-Whitney Test; * indicates statistically significant differences (p < 0.05). Abbreviations: S: Superior; T: Temporal; I: Inferior; N: Nasal. Choroidal thickness parameters Choroidal thickness in the severe group was significantly thinner in peripheral rings 4–8 compared to controls (ring 4: p = 0.018; ring 5: p = 0.012; ring 6: p = 0.009; ring 7: p = 0.011; ring 8: p = 0.001) (Table 4 ). Subregional analysis further revealed that thinning was most prominent in the superior, inferior, and nasal quadrants (all p < 0.05) (Table 5 ). Table 4 Comparison of Choroidal Thickness Among Control and OSAS Groups Regions Control group (n = 26) Mild-to-moderate group(n = 23) Severe group (n = 22) P P 1 P 2 Ring 1 369.18(289.05,452.00) 314.76(246.72,359.33) 317.18(230.92,387.90) 0.139 0.095 0.083 Ring 2 353.14(289.58,447.39) 315.15(293.14,351.24) 307.88(224.03,387.21) 0.156 0.118 0.085 Ring 3 351.19(285.81,405.76) 304.95(236.78,337.32) 288.24(206.41,359.34) 0.105 0.123 0.045 Ring 4 330.05(254.91,384.93) 275.99(237.15,321.35) 259.89(209.97,319.13) 0.047* 0.078 0.018* Ring 5 298.00(237.87,348.88) 255.20(230.95,304.25) 250.63(198.94,289.49) 0.035* 0.089 0.012* Ring 6 276.23(234.25,326.65) 253.86(228.20,285.85) 240.21(192.73,276.13) 0.031* 0.131 0.009* Ring 7 252.24(224.40,291.02) 237.90(204.72,260.41) 224.68(185.50,251.23) 0.037* 0.203 0.011* Ring 8 234.93(203.93,259.21) 213.15(183.55,230.20) 185.70(152.88,216.05) 0.005* 0.095 0.001* Notes: Continuous data are expressed as median (interquartile range, IQR) and compared using Kruskal–Wallis Test; P indicates the p-value across all three groups; P 1 indicates the p-value between the control group and the mild-to-moderate group; P 2 indicates the p-value between the control group and the severe group;* indicates statistically significant differences (p < 0.05). Table 5 Comparison of Choroidal Thickness by Subregion Between Severe OSAS and Control Groups Regions Quadrants Control group (n = 26) Severe group (n = 22) Z P Ring 4 S 388.61(288.94,449.56) 324.66(242.46,382.36) -2.297 0.022* T 324.12(286.52,425.34) 267.06(238.58,351.86) -1.614 0.107 I 323.53(261.39,385.59) 273.79(204.21,321.99) -1.945 0.052 N 226.17(163.87,289.89) 176.46(133.40,225.87) -2.214 0.027* Ring 5 S 394.49(285.65,431.51) 312.94(236.28,358.25) -2.607 0.009* T 292.91(261.01,374.83) 260.11(224.04,322.22) -1.635 0.102 I 295.25(222.52,340.56) 249.45(184.97,279.36) -2.173 0.030* N 210.11(146.54,273.39) 173.04(156.55,202.12) -1.655 0.098 Ring 6 S 340.23(269.12,387.85) 271.44(226.65,309.74) -2.690 0.007* T 272.94(239.60,334.50) 260.32(224.30,303.97) -1.469 0.142 I 245.49(195.37,275.33) 205.57(157.46,247.30) -2.069 0.039* N 267.32(195.44,304.70) 211.67(188.87,246.88) -2.193 0.028* Ring 7 S 264.17(235.90,336.55) 232.63(207.29,257.71) -2.690 0.007* T 264.17(227.62,302.54) 249.00(203.59,275.16) -1.614 0.107 I 209.97(172.11,227.00) 179.58(158.68,225.36) -1.324 0.185 N 285.31(205.05,310.23) 222.79(187.75,248.56) -2.545 0.011* Ring 8 S 232.01(205.91,272.59) 208.35(159.28,319.65) -2.938 0.003* T 233.20(206.07,262.50) 197.29(163.83,243.61) -1.945 0.052 I 181.62(152.81,203.97) 156.24(126.92,177.57) -2.007 0.045* N 269.75(219.33,309.55) 218.64(165.18,245.80) -2.711 0.007* Notes: Continuous data are expressed as median (interquartile range, IQR) compared using Mann-Whitney Test;* indicates statistically significant differences (p < 0.05). Abbreviations: S:Superior; T: Temporal; I: Inferior; N: Nasal. Correlations between polysomnographic indices and ocular microcirculation Spearman correlation analyses revealed that DCP vessel density in peripheral rings 6–8 was inversely correlated with the AHI (ring 6: ρ = −0.352, p = 0.018; ring 7: ρ = −0.467, p = 0.001; ring 8: ρ = −0.427, p = 0.003) and positively associated with the LSaO₂ (ring 6: ρ = 0.382, p = 0.010; ring 7: ρ = 0.512, p < 0.001; ring 8: ρ = 0.417, p = 0.004) (Table 6 ). Similarly, choroidal thickness in peripheral rings 3–8 showed significant inverse correlations with AHI (ring 3: ρ = −0.302, p = 0.044; ring 4: ρ = −0.333, p = 0.025; ring 5: ρ = −0.361, p = 0.015; ring 6: ρ = −0.405, p = 0.006; ring 7: ρ = −0.427, p = 0.003; ring 8: ρ = −0.414, p = 0.005) and positive correlations with LSaO₂ (ring 3: ρ = 0.308, p = 0.039; ring 4: ρ = 0.351, p = 0.018; ring 5: ρ = 0.376, p = 0.011; ring 6: ρ = 0.388, p = 0.009; ring 7: ρ = 0.384, p = 0.009; ring 8: ρ = 0.351, p = 0.018) (Table 7 ). Table 6 Rank Correlations Between Polysomnography Parameters and Deep Capillary Plexus Density Ring 1 Ring 2 Ring 3 Ring 4 Ring 5 Ring 6 Ring 7 Ring 8 AHI ρ −0.168 −0.184 0.093 −0.003 −0.145 −0.352 −0.467 −0.427 P 0.270 0.227 0.544 0.983 0.342 0.018* 0.001* 0.003* LSaO 2 ρ −0.046 0.030 -0.059 −0.060 0.214 0.382 0.512 0.417 P 0.762 0.844 0.700 0.696 0.158 0.010* < 0.001* 0.004* Notes : ρ : Spearman’s coefficient of rank correlation; * indicates statistically significant differences (p < 0.05). Abbreviations : AHI: apnea-hypopnea index; LSaO 2 : lowest blood oxygen saturation Table 7 Rank Correlations Between Polysomnography Parameters and Choroidal Thickness Ring 1 Ring 2 Ring 3 Ring 4 Ring 5 Ring 6 Ring 7 Ring 8 AHI ρ −0.236 −0.253 −0.302 −0.333 −0.361 −0.405 −0.427 −0.414 P 0.119 0.094 0.044* 0.025* 0.015* 0.006* 0.003* 0.005* LSaO 2 ρ 0.206 0.237 0.308 0.351 0.376 0.388 0.384 0.351 P 0.174 0.116 0.039* 0.018* 0.011* 0.009* 0.009* 0.018* Notes : ρ : Spearman’s coefficient of rank correlation; * indicates statistically significant differences (p < 0.05). Abbreviations : AHI: apnea-hypopnea index; LSaO 2 : lowest blood oxygen saturation DISCUSSION This study identifies the characteristic patterns of retinal blood vessels and choroidal structural changes in OSAS patients. First, we observed a clear layer-specific pattern of vascular density reduction, with DCP being significantly affected, while the changes in SCP were relatively mild. Second, significant regional differences were evident within the affected DCP; the decrease in vascular density in the peripheral regions were more pronounced than that in the central region, and these difference were significantly correlated with the severity of hypoxia. Notably, the changes of choroidal thickness mirrored those observed in DCP; the choroidal thinning in OSAS patients also preferentially involved the peripheral region, with no significant change in the central region. This regional thinning was significantly correlated with the severity of hypoxia. Our findings indicate that vascular density alterations in patients with OSAS are most pronounced within the DCP, whereas changes in the SCP are confined to the extreme retinal periphery. We hypothesize that the DCP may be affected earlier than the SCP in the pathogenesis of OSAS-related retinal microangiopathy. This preferential vulnerability likely reflects the distinct anatomical and physiological characteristics of the two plexuses: the SCP is directly supplied by retinal arterioles, conferring higher perfusion pressure and oxygen availability, whereas the DCP receives blood via vertical anastomotic branches from the SCP, resulting in lower blood flow and less efficient oxygen diffusion. Moreover, the DCP is located adjacent to the metabolically active outer retina, which is exquisitely sensitive to hypoxia [ 23 ]. This “DCP-priority injury” paradigm has been corroborated across a spectrum of vascular disorders. Coscas et al. reported that retinal vein occlusion was associated with a greater reduction in DCP vessel density compared to SCP [ 24 ]. Çiloğlu et al. found in an experiment studying the effects of chronic smoking on microvasculature that smoking selectively impaired the macular retinal microcirculation, leading to decreased DCP vessel density without concomitant changes in the SCP [ 25 ]. Similarly, investigations of early diabetic retinopathy have revealed that microvascular alterations initially occur in the DCP [ 26 ]. Çolak et al. further confirmed that in OSAS patients, the vascular density of the DCP in the parafoveal and peripheral regions was significantly reduced, while the vascular density of the superficial capillary plexus was not affected [ 27 ]. As a systemic vascular disorder, OSAS is characterized by recurrent nocturnal airway collapse, resulting in intermittent hypoxemia and hypercapnia. These conditions trigger oxidative stress and inflammatory pathways, suppress vasodilatory function, and promote atherosclerosis [ 28 ]. The synergistic effects of endothelial dysfunction and vascular sclerosis collectively compromise retinal microcirculatory perfusion [ 29 ]. Therefore, the DCP, with its relatively limited oxygen supply, is more susceptible to chronic hypoxia and hypercapnia-induced damage. After confirming that the DCP was the primary microvascular target in OSAS, we also found that the reduction in DCP vessel density was significantly more pronounced in the peripheral retina and strongly correlated with the severity of nocturnal hypoxia. This regional selectivity can be attributed to anatomical disparities between the central and peripheral retinal vascular systems. In the central macular area, vessels originate exclusively from the central retinal artery (CRA) and form a dense anastomotic network, with high perfusion pressure and extensive collateralization. Conversely, the peripheral retina is supplied by terminal anastomoses between CRA branches and the short posterior ciliary arteries (SPCAs), and these vessels have smaller diameters and limited collateral reserves [ 30 ]. Consequently, we propose that the peripheral retina may serve as a more sensitive indicator of early microvascular compromise. Consistent with this hypothesis, Yang et al. reported that, in preclinical diabetic retinopathy, the degree of capillary dilation and tortuosity in the periphery of the retina was more severe than that in the central macula [ 31 ]. Similarly, Battaglia Parodi et al. demonstrated that patients with central retinal vein occlusion (CRVO) had significantly lower DCP vessel density in the peripheral retina than the healthy control group [ 32 ]. It should be noted that the fragility of the peripheral vasculature is not only manifested in structure but also in function. Experimental data suggest that the ciliary vascular system is more susceptible to hypercapnia-induced injury than the retinal vascular system [ 33 ]. During the pathophysiologic cascade of OSAS, recurrent carbon dioxide (CO2) accumulation at night directly affects endothelial function of the SPCAs, leading to vasospasm or occlusion in the peripheral retina. This mechanism preferentially compromises the peripheral DCP microvessels, where both anatomical fragility and reduced perfusion render it particularly vulnerable. The distribution of choroidal thinning and DCP vascular attenuation in OSAS is strikingly concordant, preferentially affecting the peripheral fundus while the central macula is relatively intact. This topographic pattern is closely linked to the severity of intermittent hypoxia. The choroid—a thin, highly vascular membrane-delivers oxygen and nutrients to the outer retina and contains abundant non-vascular smooth muscle controlled by the sympathetic and parasympathetic nerves [ 34 ]. Recurrent hypoxic episodes in OSAS activate the sympathetic nervous system, precipitating structural remodeling of choroidal vessels. Concomitantly, the stability of hypoxia-inducible factors and the upregulation of vascular endothelial growth factor compromise endothelial integrity and vascular permeability, ultimately resulting in choroidal thinning [ 35 , 36 ]. Although Bruch’s membrane anatomically separates the retina and choroid, these two layers are physiologically interdependent. Most previous investigations have mainly examined retinal and choroidal alterations separately, with less attention paid to their mutual influence. Oh et al. demonstrated a correlation between choriocapillaris density and flow indices in both the superficial and deep capillary plexuses [ 37 ], and Wang et al. reported a particularly robust association between choriocapillaris density and DCP perfusion [ 38 ]. Collectively, these findings suggest that, in addition to systemic inflammatory and immune mechanisms, DCP microvascular injury may be directly modulated by choroidal hemodynamic changes. Longitudinal studies with larger cohorts are required to elucidate the temporal interplay between retinal and choroidal microcirculation during OSAS progression, with particular emphasis on the dynamic characteristics of peripheral damage. This study has several limitations. First, the sample size was relatively small, and no stratified analysis by sex or age was conducted, which may limit the application scope of our findings. Future studies need to target larger cohorts and be verified in multiple center. Second, the definition of the control group was based solely on the STOP-Bang questionnaire without confirmation via PSG, potentially introducing selection bias. Third, since this is a cross-sectional study, we could only identify associations between OSAS severity and retinal or choroidal parameters, but we could not determine the causal relationship. Longitudinal studies are needed to evaluate the dynamic changes in ocular parameters after OSAS treatment and to clarify time sequence of these changes. Fourth, our analysis focused exclusively on vascular densities of the SCP and DCP, as well as choroidal parameters, but did not incorporate other critical fundus metrics such as foveal avascular zone (FAZ) parameters, retinal nerve fiber layer (RNFL) thickness, choriocapillaris density. These parameters may be closely linked to ocular manifestations in OSAS patients, and exclusion of these parameters may not allow a full assessment of the changes in the retina and choroid. Future research should integrate more types of quantitative and qualitative OCTA parameters for a comprehensive evaluation. Finally, although UWF-SS-OCTA offers a broader view, signal interference and motion artifacts may affect the image quality of the far peripheral retina, potentially resulting in data loss or reduced measurement accuracy in these regions. Despite rigorous quality control and data screening, this technical limitation merits further in-depth research. Overall, patients with obstructive sleep apnea syndrome (OSAS) demonstrated significantly reduced deep capillary plexus (DCP) vascular density and thinner choroidal thickness in the peripheral retina compared with controls. These alterations were correlated with severity of hypoxia. Ultra-widefield swept-source optical coherence tomography angiography (UWF-SS-OCTA) enabled non-invasive, high-resolution visualization of peripheral fundus regions that are poorly imaged by conventional techniques, establishing a quantitative platform for early detection of microvascular lesions related to OSAS. Abbreviations OSAS:Obstructive Sleep Apnea Syndrome UWF-SS-OCTA:Ultra-Widefield Swept-Source Optical Coherence Tomography Angiography UCVA:Uncorrected Visual Acuity BCVA:Best-Corrected Visual Acuity IOP:Intraocular Pressure AHI:Apnea-Hypopnea Index LSaO₂:Lowest Oxygen Saturation longest apnea duration (LAD SCP:Superficial Capillary Plexus DCP:Deep Capillary Plexus CT:Choroidal Thickness VD:Vessel Density PSG:Polysomnography ETDRS:Early Treatment Diabetic Retinopathy Study FAZ:Foveal Avascular Zone RNFL:Retinal Nerve Fiber Layer CRA:Central Retinal Artery SPCAs:Short Posterior Ciliary Arteries CRVO:Central Retinal Vein Occlusion Declarations Funding This work was supported by [the Guangxi Key Research and Development] (Grant number [GuikeAB24010171]). Competing Interests The authors have no relevant financial or non-financial interests to disclose. Author Contributions Xinyi Chen (First Author): Conceptualization, Methodology, Software, Investigation, Formal Analysis, Writing - Original Draft; Ningning Tang: Data Curation; Chaomin Chen: Visualization, Investigation; Ling Cui (Corresponding Author): Conceptualization, Funding Acquisition, Resources, Supervision, Writing - Review & Editing. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the People's Hospital of Guangxi Zhuang Autonomous Region (Date. September 22, 2023/No. KY-IIT-2023-112).” Consent to participate All participants provided written informed consent. Consent to publish Not applicable. Data Availability Statements The datasets analysed during the current study are available from the corresponding author on reasonable request. References Veasey SC, Rosen IM (2019) Obstructive Sleep Apnea in Adults. 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Eur J Ophthalmol 30:48–57. https://doi.org/10.1177/1120672118816225 Wang Q, Chan S, Yang JY, You B, Wang YX, Jonas JB, Wei WB (2016) Vascular Density in Retina and Choriocapillaris as Measured by Optical Coherence Tomography Angiography. Am J Ophthalmol 168:95–109. https://doi.org/10.1016/j.ajo.2016.05.005 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":1995077,"visible":true,"origin":"","legend":"\u003cp\u003eThis image represents the superficial capillary plexus of the left eye in a healthy controls, covering a total area of 26 × 21 mm². According to the ETDRS zoning protocol , the region extending from 0 to 21 mm from the foveal center was subdivided into eight concentric rings: ring 1 (0–1 mm), ring 2 (1–3 mm), ring 3 (3–6 mm), ring 4 (6–9 mm), ring 5 (9–12 mm), ring 6 (12–15 mm), ring 7 (15–18 mm), and ring 8 (18–21 mm)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7839987/v1/9daf77bd28dfd0f9b12b1966.png"},{"id":104400937,"identity":"2dcdb8ef-0d63-4418-b163-822e9fad17ad","added_by":"auto","created_at":"2026-03-11 12:11:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3405185,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7839987/v1/e5206d43-2e7c-416e-bcb1-ee2ed8b8e2ca.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Retinal and Choroidal Changes in Obstructive Sleep Apnea Syndrome Assessed by Ultra- Widefield Swept-Source Optical Coherence Tomography Angiography","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eObstructive sleep apnea syndrome (OSAS) is a common breathing disorder [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], characterized by a sleep-related collapse of the upper airway, leading to partial or complete obstruction, recurrent apneas and hypopneas, intermittent hypoxemia, and hypercapnia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Typical clinical manifestations include habitual loud snoring, witnessed apneas, and excessive daytime sleepiness [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Major risk factors comprise obesity, alcohol consumption, male sex, and anatomical abnormalities of the upper airway [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Notably, the global prevalence of OSAS has risen markedly and has emerged as a significant public-health concern. Beyond impairing sleep quality and causing daytime fatigue, OSAS is strongly associated with severe cardiometabolic disorders, such as hypertension, coronary artery disease, stroke, diabetes mellitus, and metabolic syndrome [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These comorbidities not only markedly undermine the quality of life but also pose substantial threats to long-term health outcomes.\u003c/p\u003e\u003cp\u003eThe ocular blood supply primarily originates from the branches of the ophthalmic artery: the central retinal artery and the ciliary arteries. Among these, the choroidal circulation is predominantly regulated by sympathetic nerves, which lacks the ability of autonomic innervation. While in contrast, the retinal circulation not controlled by the autonomic nerve, but relies on intrinsic autoregulatory mechanisms to maintain stable perfusion [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Given that the retina is one of the most metabolically active tissues in the human body, recurrent intermittent hypoxia in OSAS may induce hemodynamic disturbances in the retinal microcirculation [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Numerous studies have demonstrated associations between OSAS and various ocular pathologies, including glaucoma, diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Consequently, the retinal vasculature not only serves a key target of hypoxic injury but also provides a critical window for monitoring systemic vascular status.\u003c/p\u003e\u003cp\u003eOptical coherence tomography angiography (OCTA) is an emerging non-invasive imaging technique that allows for quantitative assessment of vascular density and thickness within retinal and choroidal layers, as well as detailed visualization of microstructural features [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. With advantages such as non-invasive nature, rapid acquisition, layer-specific quantification, and high reproducibility, OCTA has been widely adopted in the evaluation of various retinal diseases [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Compared to fluorescein angiography, OCTA offers superior safety, greater efficiency, and enhanced operational convenience [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In recent years, OCTA has been increasingly employed to evaluate retinal microvascular alterations in patients with OSAS. However, previous investigations have been limited by conventional scanning protocols, which typically restrict the fields of view to \u0026le;\u0026thinsp;6 x 6 mm\u0026sup2;, thereby restricting comprehensive evaluation of the peripheral retina. To address this limitation, the present study utilizes ultra-widefield swept-source OCTA (UWF-SS-OCTA) with a scanning area of 26 x 21 mm\u0026sup2; to compare retinal and choroidal parameters across both central and peripheral regions in OSAS patients of varying severity and of healthy controls. We anticipate that this approach will demonstrate the potential of UWF-SS-OCTA in the early detection of OSAS-related ocular changes, particularly peripheral alterations, thereby providing a novel analytical tool for future investigations.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population\u003c/h2\u003e\u003cp\u003e This study was approved by the Ethics Committee of the People's Hospital of Guangxi Zhuang Autonomous Region (Approval Number:KY-IIT-2023-112) and adhered to the tenets of the Declaration of Helsinki. All participants provided written informed consent. Consecutive patients presenting with sleep-related snoring were recruited from our Sleep Medicine Center between June 2024 and December 2024. Participants underwent standardized assessments including collection of baseline characteristics, medical history documentation, and overnight polysomnography (PSG). A total of 45 patients meeting inclusion criteria were assigned to the OSAS cohort and further stratified into mild-to-moderate (n\u0026thinsp;=\u0026thinsp;23 patients, 23 eyes) and severe (n\u0026thinsp;=\u0026thinsp;22 patients, 22 eyes) groups based on the apnea-hypopnea index (AHI). Twenty-six age-matched healthy subjects, who were screened using the STOP-Bang questionnaire to exclude OSAS, served as controls (n\u0026thinsp;=\u0026thinsp;26 eyes). Inclusion criteria were as follows: (1) age between 25 and 65 years; (2) no history of ocular surgery, trauma or primary glaucoma; (3) no significant ametropia (myopia\u0026thinsp;\u0026lt;\u0026thinsp;\u0026minus;\u0026thinsp;6.00 D, astigmatism\u0026thinsp;\u0026lt;\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00 D) and normal intraocular pressure (IOP\u0026thinsp;\u0026le;\u0026thinsp;21 mmHg); (4) absence of ocular conditions affecting OCTA imaging (e.g., pathologic myopia, macular degeneration, optic neuropathy, retinal detachment, uveitis) and no opacity of refractive media; (5) ability to complete OCTA imaging with stable fixation. Exclusion criteria included: (1) prior treatment for OSAS; (2) presence of systemic diseases (e.g., coronary heart disease, diabetes mellitus, stroke, uncontrolled hypertension) or use of vasoactive medications; (3) history of psychiatric disorders.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eRoutine examinations\u003c/h3\u003e\n\u003cp\u003eFor all participants, basic demographic and medical history data were collected. A comprehensive ophthalmic examination was conducted, covering the anterior segment to the posterior pole, including: uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy, color fundus photography, and UWF-SS-OCTA. All examinations were conducted by experienced ophthalmologists.\u003c/p\u003e\n\u003ch3\u003eUWF-SS-OCTA image acquisition\u003c/h3\u003e\n\u003cp\u003eUWF-SS-OCTA was performed using the VG200N device (SVision Imaging, Ltd., Luoyang, China). All scans were centered on the fovea and covered a 26 x 21 mm\u0026sup2; field. The system operated at a 1,050 nm central wavelength with an A-scan rate of 400,000 scans per second. Following the Early Treatment Diabetic Retinopathy Study (ETDRS) sectors, the area from 0\u0026ndash;21 mm was divided into eight concentric rings centered on the fovea: ring 1 (0\u0026ndash;1 mm), ring 2 (1\u0026ndash;3 mm), ring 3 (3\u0026ndash;6 mm), ring 4 (6\u0026ndash;9 mm), ring 5 (9\u0026ndash;12 mm), ring 6 (12\u0026ndash;15 mm), ring 7 (15\u0026ndash;18 mm), and ring 8 (18\u0026ndash;21 mm) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The central zone was defined as 0\u0026ndash;6 mm and the peripheral zone as 6\u0026ndash;21 mm. Vessel density of the SCP and DCP, and choroidal thickness were automatically segmented and quantified using the proprietary software (Van Gogh, v3.0.254). When a ring-level comparison reached statistical significance, the corresponding ring was further divided into superior (S), temporal (T), inferior (I), and nasal (N) sectors for subregional analysis. All OCTA scans were performed by a single experienced ophthalmologist ensure consistency.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003ePolysomnography\u003c/h3\u003e\n\u003cp\u003eThe overnight PSG was conducted for all enrolled participants using an E-series EEG/PSG system (Compumedics, Australia) by the certified sleep technicians from our Sleep Medicine Center. Recordings were obtained between 22:00 and 06:00, with a minimum duration of eight hours. All polysomnographic data were manually scored by board-certified physicians according to the Chinese Guidelines for the Diagnosis and Treatment of Obstructive Sleep Apnea\u0026ndash;Hypopnea Syndrome. The following parameters were extracted: apnea\u0026ndash;hypopnea index (AHI, events/h), lowest oxygen saturation (LSaO₂, %), and longest apnea duration (LAD, s). Based on the AHI values, patients with OSAS were categorized into a mild-to-moderate group (AHI 5\u0026ndash;30 events/h) and a severe group (AHI\u0026thinsp;\u0026gt;\u0026thinsp;30 events/h) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSTOP-Bang questionnaire assessment\u003c/h3\u003e\n\u003cp\u003eThe STOP-Bang questionnaire was administered to all participants to to screen for the likelihood of OSAS [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This validated tool includes eight yes/no questions: (1) loud snoring (loud enough to be heard through closed doors); (2) frequent daytime fatigue or sleepiness; (3) witnessed apneas or choking episodes during sleep; (4) hypertension or ongoing antihypertensive treatment; (5) body mass index (BMI)\u0026thinsp;\u0026gt;\u0026thinsp;35 kg/m\u0026sup2;; (6) age\u0026thinsp;\u0026gt;\u0026thinsp;50 years; (7) neck circumference\u0026thinsp;\u0026gt;\u0026thinsp;40 cm; and (8) male sex. According to established clinical criteria [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], participants scoring\u0026thinsp;\u0026ge;\u0026thinsp;3 were considered at high risk for OSAS and were further evaluated by PSG; controls were selected from individuals with a score\u0026thinsp;\u0026lt;\u0026thinsp;3, indicating a low risk for OSAS and were unlikely to require further diagnostic testing.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analyses\u003c/h2\u003e\u003cp\u003eAll statistical analyses were performed with SPSS 27.0 (IBM Corporation, Armonk, NY, USA). Normality was assessed using the Shapiro-Wilk test. Categorical variables were presented as frequencies (percentages) and were compared with the chi-square test. Continuous variables were expressed as median (interquartile range, IQR). Comparisons among three groups were performed using the Kruskal-Wallis test, followed by pairwise comparisons with Dunn-Bonferroni corrections when significant differences were detected. Two-group comparisons were performed using the Mann-Whitney U test. Spearman rank correlation coefficient was used to evaluate the correlation between polysomnography indicators and retinal microcirculation parameters. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eBasic data analysis\u003c/h2\u003e\n \u003cp\u003eA total of 26 healthy controls (26 eyes) and 45 patients diagnosed with OSAS were included in this study. The OSAS cohort was stratified into mild-to-moderate (23 patients,23 eyes) and severe (22 patients,22 eyes) groups based on AHI scores. No significant differences were observed in age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.252), sex distribution (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.366), eye side (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.893), or intraocular pressure (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.552) among groups. However, BMI differed significantly (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with severe OSAS group exhibiting higher BMI (median 26.75 kg/m\u0026sup2;, IQR 24.95\u0026ndash;28.15) versus controls (median 23.40 kg/m\u0026sup2;, IQR 20.78\u0026ndash;26.55) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline Characteristics and Polysomnographic Parameters\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMild-to-moderate\u003c/p\u003e\n \u003cp\u003egroup(n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSevere group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.50(38.75,54.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.00(45.00,56.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.00(34.25,56.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex (n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13(56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16(72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10(43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEye(n,%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20(87.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18(81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIOP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.00(13.00,15.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.00(12.00,15.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.00(12.00,16.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.552\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.40(20.78,26.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.40(22.00,24.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.75(24.95,28.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAHI (events/h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.60(7.70,18.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65.95(45.83,71.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLSaO\u003csub\u003e2\u003c/sub\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87.00(81.00,89.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71.50(63.25,80.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLAD (s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.00(35.00,64.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72.00(63.75,92.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eNotes:\u0026nbsp;\u003c/strong\u003eContinuous data are expressed as median (interquartile range, IQR) compared using Kruskal-Wallis Test and categorical data are analyzed using chi-square test; * indicates statistically significant differences (p \u0026lt; 0.05).\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations:\u0026nbsp;\u003c/strong\u003ePSG: polysomnography; IOP: intraocular pressure; BMI: body mass index; AHI: apnea-hypopnea index;\u003c/p\u003e\n \u003cp\u003eLSaO\u003csub\u003e2\u003c/sub\u003e: lowest blood oxygen saturation; LAD: longest apnea duration; N/A: not applicable.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eRetinal vascular density parameters\u003c/h2\u003e\n \u003cp\u003eSCP vessel density was significantly reduced only in the outermost ring 8 in both OSAS groups compared to controls (severe vs controls: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002; mild-to-moderate vs controls: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027). In contrast, the DCP exhibited more extensive reductions in the severe group. Vessel densities in rings 5\u0026ndash;8 were significantly lower in the severe group compared to controls (ring 5: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003; ring 6: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; ring 7: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; ring 8: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Subregional analysis further revealed that the DCP vessel density reduction in the severe group was most pronounced in the superior and inferior quadrants (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Superficial and Deep Capillary Plexus Vascular Density Among Control and OSAS Groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRegions\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMild-to-moderate\u003c/p\u003e\n \u003cp\u003egroup(n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSevere group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.97(22.31,38.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.23(22.32,35.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.47(20.63,32.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.23(1.09,7.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.42(0.98,5.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.58(0.70,5.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e70.36(65.96,72.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67.84(65.43,74.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68.20(66.66,70.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.53(2.81,7.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.60(2.02,5.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.88(1.01,4.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65.38(61.61,66.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63.10(60.14,66.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.86(59.59,64.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.42(5.50,11.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.09(4.65,8.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.09(4.86,9.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.98(32.51,41.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.41(33.33,37.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.19(32.63,38.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.12(12.14,16.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.94(11.59,15.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.74(9.25,15.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.88(26.40,33.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.17(24.34,35.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.33(24.58,31.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.52(13.14,19.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.27(12.91,17.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.49(10.18,15.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.09(25.36,32.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.93(25.01,32.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.21(24.10,33.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.03(16.28,21.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.00(13.92,20.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.41(11.29,17.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.52(22.32,28.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.06(21.48,27.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.05(20.10,27.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.64(14.36,19.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.34(13.44,21.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.78(10.02,14.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.987\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.65(16.08,21.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.82(12.80,17.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.23(13.26,16.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.027*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.17(11.18,16.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.83(10.78,17.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.87(7.87,11.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eNotes:\u0026nbsp;\u003c/strong\u003eContinuous data are expressed as median (interquartile range, IQR) and compared using Kruskal-Wallis Test; \u003cem\u003eP\u003c/em\u003e indicates the p-value across all three groups;\u003cem\u003e\u0026nbsp;P\u003c/em\u003e1 indicates the p-value between the control group and the mild-to-moderate group;\u003cem\u003eP\u003c/em\u003e2 indicates the p-value between the control group and the severe group; * indicates statistically significant differences (p \u0026lt; 0.05).\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations:\u0026nbsp;\u003c/strong\u003eOSAS: Obstructive Sleep Apnea Syndrome; SCP: Superficial Capillary Layer; DCP: Deep Capillary Layer.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Deep Capillary Plexus Vascular Density by Subregion Between Severe OSAS and Control Groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRegions\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eQuadrants\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSevere group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.05(13.11,19.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.42(7.77,14.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.85(19.35,31.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.79(15.38,30.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.10(11.96,21.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.71(9.09,18.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.85(4.55,7.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.99(1.85,6.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.23(22.13,29.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.35(14.71,20.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-4.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.46(10.49,23.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.32(6.92,19.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.58(19.04,32.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.74(16.66,25.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.16(4.11,8.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.23(2.59,7.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.48(21.55,30.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.07(14.55,22.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.55(5.13,13.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.17(2.98,10.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.45(18.76,30.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.51(7.62,20.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.55(4.61,12.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.41(2.22,9.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.04(18.27,30.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.71(12.81,24.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.023*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.91(2.21,5.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.53(1.19,5.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.70(15.24,22.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.36(6.80,19.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.02(4.02,11.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.14(1.27,9.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eNotes:\u0026nbsp;\u003c/strong\u003eContinuous data are expressed as median (interquartile range, IQR) compared using Mann-Whitney Test; * indicates statistically significant differences (p \u0026lt; 0.05). \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations:\u0026nbsp;\u003c/strong\u003eS: Superior; T: Temporal; I: Inferior; N: Nasal.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eChoroidal thickness parameters\u003c/h2\u003e\n \u003cp\u003eChoroidal thickness in the severe group was significantly thinner in peripheral rings 4\u0026ndash;8 compared to controls (ring 4: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018; ring 5: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012; ring 6: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009; ring 7: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011; ring 8: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). Subregional analysis further revealed that thinning was most prominent in the superior, inferior, and nasal quadrants (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Choroidal Thickness Among Control and OSAS Groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRegions\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMild-to-moderate\u003c/p\u003e\n \u003cp\u003egroup(n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSevere group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e369.18(289.05,452.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e314.76(246.72,359.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e317.18(230.92,387.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e353.14(289.58,447.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e315.15(293.14,351.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e307.88(224.03,387.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e351.19(285.81,405.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e304.95(236.78,337.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e288.24(206.41,359.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e330.05(254.91,384.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e275.99(237.15,321.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e259.89(209.97,319.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.047*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.018*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e298.00(237.87,348.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e255.20(230.95,304.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e250.63(198.94,289.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.035*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.012*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e276.23(234.25,326.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e253.86(228.20,285.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e240.21(192.73,276.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.031*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.009*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e252.24(224.40,291.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e237.90(204.72,260.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e224.68(185.50,251.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.037*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e234.93(203.93,259.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e213.15(183.55,230.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e185.70(152.88,216.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNotes:\u0026nbsp;\u003c/strong\u003eContinuous data are expressed as median (interquartile range, IQR) and compared using Kruskal\u0026ndash;Wallis Test; \u003cem\u003eP\u003c/em\u003e indicates the p-value across all three groups;\u003cem\u003e\u0026nbsp;P\u003c/em\u003e1 indicates the p-value between the control group and the mild-to-moderate group; \u003cem\u003eP\u003c/em\u003e2 indicates the p-value between the control group and the severe group;* indicates statistically significant differences (p \u0026lt; 0.05).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Choroidal Thickness by Subregion Between Severe OSAS and Control Groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRegions\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eQuadrants\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSevere group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e388.61(288.94,449.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e324.66(242.46,382.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.022*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e324.12(286.52,425.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e267.06(238.58,351.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e323.53(261.39,385.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e273.79(204.21,321.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.945\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e226.17(163.87,289.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e176.46(133.40,225.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.027*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e394.49(285.65,431.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e312.94(236.28,358.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.009*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e292.91(261.01,374.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e260.11(224.04,322.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e295.25(222.52,340.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e249.45(184.97,279.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.030*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e210.11(146.54,273.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e173.04(156.55,202.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e340.23(269.12,387.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e271.44(226.65,309.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e272.94(239.60,334.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e260.32(224.30,303.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e245.49(195.37,275.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e205.57(157.46,247.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.039*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e267.32(195.44,304.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e211.67(188.87,246.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.028*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e264.17(235.90,336.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e232.63(207.29,257.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e264.17(227.62,302.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e249.00(203.59,275.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e209.97(172.11,227.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e179.58(158.68,225.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e285.31(205.05,310.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e222.79(187.75,248.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.545\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRing 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e232.01(205.91,272.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e208.35(159.28,319.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e233.20(206.07,262.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e197.29(163.83,243.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.945\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e181.62(152.81,203.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e156.24(126.92,177.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.045*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e269.75(219.33,309.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e218.64(165.18,245.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eNotes:\u0026nbsp;\u003c/strong\u003eContinuous data are expressed as median (interquartile range, IQR) compared using Mann-Whitney Test;* indicates statistically significant differences (p \u0026lt; 0.05).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations:\u0026nbsp;\u003c/strong\u003eS:Superior; T: Temporal; I: Inferior; N: Nasal.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eCorrelations between polysomnographic indices and ocular microcirculation\u003c/h2\u003e\n \u003cp\u003eSpearman correlation analyses revealed that DCP vessel density in peripheral rings 6\u0026ndash;8 was inversely correlated with the AHI (ring 6: \u003cem\u003e\u0026rho;\u003c/em\u003e = \u0026minus;0.352, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018; ring 7: \u003cem\u003e\u0026rho;\u003c/em\u003e = \u0026minus;0.467, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001; ring 8: \u003cem\u003e\u0026rho;\u003c/em\u003e = \u0026minus;0.427, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) and positively associated with the LSaO₂ (ring 6: \u003cem\u003e\u0026rho;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.382, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010; ring 7: \u003cem\u003e\u0026rho;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.512, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; ring 8: \u003cem\u003e\u0026rho;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.417, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) (Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e). Similarly, choroidal thickness in peripheral rings 3\u0026ndash;8 showed significant inverse correlations with AHI (ring 3: \u003cem\u003e\u0026rho;\u003c/em\u003e = \u0026minus;0.302, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044; ring 4: \u003cem\u003e\u0026rho;\u003c/em\u003e = \u0026minus;0.333, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025; ring 5: \u003cem\u003e\u0026rho;\u003c/em\u003e = \u0026minus;0.361, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015; ring 6: \u003cem\u003e\u0026rho;\u003c/em\u003e = \u0026minus;0.405, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006; ring 7: \u003cem\u003e\u0026rho;\u003c/em\u003e = \u0026minus;0.427, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003; ring 8: \u003cem\u003e\u0026rho;\u003c/em\u003e = \u0026minus;0.414, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005) and positive correlations with LSaO₂ (ring 3: \u003cem\u003e\u0026rho;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.308, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039; ring 4: \u003cem\u003e\u0026rho;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.351, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018; ring 5: \u003cem\u003e\u0026rho;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.376, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011; ring 6: \u003cem\u003e\u0026rho;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.388, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009; ring 7: \u003cem\u003e\u0026rho;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.384, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009; ring 8: \u003cem\u003e\u0026rho;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.351, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018) (Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRank Correlations Between Polysomnography Parameters and Deep Capillary Plexus Density\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 6\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 7\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 8\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAHI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026rho;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.427\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.018*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLSaO\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026rho;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.762\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.010*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e\u003cstrong\u003eNotes\u003c/strong\u003e: \u003cem\u003e\u0026rho;\u003c/em\u003e: Spearman\u0026rsquo;s coefficient of rank correlation; * indicates statistically significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: AHI: apnea-hypopnea index; LSaO\u003csub\u003e2\u003c/sub\u003e: lowest blood oxygen saturation\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRank Correlations Between Polysomnography Parameters and Choroidal Thickness\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 6\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 7\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRing 8\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAHI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026rho;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.427\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.414\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.044*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.025*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.015*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLSaO\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026rho;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.039*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.018*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.009*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.009*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.018*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e\u003cstrong\u003eNotes\u003c/strong\u003e: \u003cem\u003e\u0026rho;\u003c/em\u003e: Spearman\u0026rsquo;s coefficient of rank correlation; * indicates statistically significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: AHI: apnea-hypopnea index; LSaO\u003csub\u003e2\u003c/sub\u003e: lowest blood oxygen saturation\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study identifies the characteristic patterns of retinal blood vessels and choroidal structural changes in OSAS patients. First, we observed a clear layer-specific pattern of vascular density reduction, with DCP being significantly affected, while the changes in SCP were relatively mild. Second, significant regional differences were evident within the affected DCP; the decrease in vascular density in the peripheral regions were more pronounced than that in the central region, and these difference were significantly correlated with the severity of hypoxia. Notably, the changes of choroidal thickness mirrored those observed in DCP; the choroidal thinning in OSAS patients also preferentially involved the peripheral region, with no significant change in the central region. This regional thinning was significantly correlated with the severity of hypoxia.\u003c/p\u003e\u003cp\u003eOur findings indicate that vascular density alterations in patients with OSAS are most pronounced within the DCP, whereas changes in the SCP are confined to the extreme retinal periphery. We hypothesize that the DCP may be affected earlier than the SCP in the pathogenesis of OSAS-related retinal microangiopathy. This preferential vulnerability likely reflects the distinct anatomical and physiological characteristics of the two plexuses: the SCP is directly supplied by retinal arterioles, conferring higher perfusion pressure and oxygen availability, whereas the DCP receives blood via vertical anastomotic branches from the SCP, resulting in lower blood flow and less efficient oxygen diffusion. Moreover, the DCP is located adjacent to the metabolically active outer retina, which is exquisitely sensitive to hypoxia [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This \u0026ldquo;DCP-priority injury\u0026rdquo; paradigm has been corroborated across a spectrum of vascular disorders. Coscas et al. reported that retinal vein occlusion was associated with a greater reduction in DCP vessel density compared to SCP [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. \u0026Ccedil;iloğlu et al. found in an experiment studying the effects of chronic smoking on microvasculature that smoking selectively impaired the macular retinal microcirculation, leading to decreased DCP vessel density without concomitant changes in the SCP [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Similarly, investigations of early diabetic retinopathy have revealed that microvascular alterations initially occur in the DCP [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. \u0026Ccedil;olak et al. further confirmed that in OSAS patients, the vascular density of the DCP in the parafoveal and peripheral regions was significantly reduced, while the vascular density of the superficial capillary plexus was not affected [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. As a systemic vascular disorder, OSAS is characterized by recurrent nocturnal airway collapse, resulting in intermittent hypoxemia and hypercapnia. These conditions trigger oxidative stress and inflammatory pathways, suppress vasodilatory function, and promote atherosclerosis [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The synergistic effects of endothelial dysfunction and vascular sclerosis collectively compromise retinal microcirculatory perfusion [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Therefore, the DCP, with its relatively limited oxygen supply, is more susceptible to chronic hypoxia and hypercapnia-induced damage.\u003c/p\u003e\u003cp\u003eAfter confirming that the DCP was the primary microvascular target in OSAS, we also found that the reduction in DCP vessel density was significantly more pronounced in the peripheral retina and strongly correlated with the severity of nocturnal hypoxia. This regional selectivity can be attributed to anatomical disparities between the central and peripheral retinal vascular systems. In the central macular area, vessels originate exclusively from the central retinal artery (CRA) and form a dense anastomotic network, with high perfusion pressure and extensive collateralization. Conversely, the peripheral retina is supplied by terminal anastomoses between CRA branches and the short posterior ciliary arteries (SPCAs), and these vessels have smaller diameters and limited collateral reserves [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Consequently, we propose that the peripheral retina may serve as a more sensitive indicator of early microvascular compromise. Consistent with this hypothesis, Yang et al. reported that, in preclinical diabetic retinopathy, the degree of capillary dilation and tortuosity in the periphery of the retina was more severe than that in the central macula [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Similarly, Battaglia Parodi et al. demonstrated that patients with central retinal vein occlusion (CRVO) had significantly lower DCP vessel density in the peripheral retina than the healthy control group [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. It should be noted that the fragility of the peripheral vasculature is not only manifested in structure but also in function. Experimental data suggest that the ciliary vascular system is more susceptible to hypercapnia-induced injury than the retinal vascular system [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. During the pathophysiologic cascade of OSAS, recurrent carbon dioxide (CO2) accumulation at night directly affects endothelial function of the SPCAs, leading to vasospasm or occlusion in the peripheral retina. This mechanism preferentially compromises the peripheral DCP microvessels, where both anatomical fragility and reduced perfusion render it particularly vulnerable.\u003c/p\u003e\u003cp\u003eThe distribution of choroidal thinning and DCP vascular attenuation in OSAS is strikingly concordant, preferentially affecting the peripheral fundus while the central macula is relatively intact. This topographic pattern is closely linked to the severity of intermittent hypoxia. The choroid\u0026mdash;a thin, highly vascular membrane-delivers oxygen and nutrients to the outer retina and contains abundant non-vascular smooth muscle controlled by the sympathetic and parasympathetic nerves [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Recurrent hypoxic episodes in OSAS activate the sympathetic nervous system, precipitating structural remodeling of choroidal vessels. Concomitantly, the stability of hypoxia-inducible factors and the upregulation of vascular endothelial growth factor compromise endothelial integrity and vascular permeability, ultimately resulting in choroidal thinning [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Although Bruch\u0026rsquo;s membrane anatomically separates the retina and choroid, these two layers are physiologically interdependent. Most previous investigations have mainly examined retinal and choroidal alterations separately, with less attention paid to their mutual influence. Oh et al. demonstrated a correlation between choriocapillaris density and flow indices in both the superficial and deep capillary plexuses [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], and Wang et al. reported a particularly robust association between choriocapillaris density and DCP perfusion [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Collectively, these findings suggest that, in addition to systemic inflammatory and immune mechanisms, DCP microvascular injury may be directly modulated by choroidal hemodynamic changes. Longitudinal studies with larger cohorts are required to elucidate the temporal interplay between retinal and choroidal microcirculation during OSAS progression, with particular emphasis on the dynamic characteristics of peripheral damage.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, the sample size was relatively small, and no stratified analysis by sex or age was conducted, which may limit the application scope of our findings. Future studies need to target larger cohorts and be verified in multiple center. Second, the definition of the control group was based solely on the STOP-Bang questionnaire without confirmation via PSG, potentially introducing selection bias. Third, since this is a cross-sectional study, we could only identify associations between OSAS severity and retinal or choroidal parameters, but we could not determine the causal relationship. Longitudinal studies are needed to evaluate the dynamic changes in ocular parameters after OSAS treatment and to clarify time sequence of these changes. Fourth, our analysis focused exclusively on vascular densities of the SCP and DCP, as well as choroidal parameters, but did not incorporate other critical fundus metrics such as foveal avascular zone (FAZ) parameters, retinal nerve fiber layer (RNFL) thickness, choriocapillaris density. These parameters may be closely linked to ocular manifestations in OSAS patients, and exclusion of these parameters may not allow a full assessment of the changes in the retina and choroid. Future research should integrate more types of quantitative and qualitative OCTA parameters for a comprehensive evaluation. Finally, although UWF-SS-OCTA offers a broader view, signal interference and motion artifacts may affect the image quality of the far peripheral retina, potentially resulting in data loss or reduced measurement accuracy in these regions. Despite rigorous quality control and data screening, this technical limitation merits further in-depth research.\u003c/p\u003e\u003cp\u003eOverall, patients with obstructive sleep apnea syndrome (OSAS) demonstrated significantly reduced deep capillary plexus (DCP) vascular density and thinner choroidal thickness in the peripheral retina compared with controls. These alterations were correlated with severity of hypoxia. Ultra-widefield swept-source optical coherence tomography angiography (UWF-SS-OCTA) enabled non-invasive, high-resolution visualization of peripheral fundus regions that are poorly imaged by conventional techniques, establishing a quantitative platform for early detection of microvascular lesions related to OSAS.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOSAS:Obstructive Sleep Apnea Syndrome\u003c/p\u003e\n\u003cp\u003eUWF-SS-OCTA:Ultra-Widefield Swept-Source Optical Coherence Tomography Angiography\u003c/p\u003e\n\u003cp\u003eUCVA:Uncorrected Visual Acuity\u003c/p\u003e\n\u003cp\u003eBCVA:Best-Corrected Visual Acuity\u003c/p\u003e\n\u003cp\u003eIOP:Intraocular Pressure\u003c/p\u003e\n\u003cp\u003eAHI:Apnea-Hypopnea Index\u003c/p\u003e\n\u003cp\u003eLSaO₂:Lowest Oxygen Saturation\u003c/p\u003e\n\u003cp\u003elongest apnea duration (LAD\u003c/p\u003e\n\u003cp\u003eSCP:Superficial Capillary Plexus\u003c/p\u003e\n\u003cp\u003eDCP:Deep Capillary Plexus\u003c/p\u003e\n\u003cp\u003eCT:Choroidal Thickness\u003c/p\u003e\n\u003cp\u003eVD:Vessel Density\u003c/p\u003e\n\u003cp\u003ePSG:Polysomnography\u003c/p\u003e\n\u003cp\u003eETDRS:Early Treatment Diabetic Retinopathy Study\u003c/p\u003e\n\u003cp\u003eFAZ:Foveal Avascular Zone\u003c/p\u003e\n\u003cp\u003eRNFL:Retinal Nerve Fiber Layer\u003c/p\u003e\n\u003cp\u003eCRA:Central Retinal Artery\u003c/p\u003e\n\u003cp\u003eSPCAs:Short Posterior Ciliary Arteries\u003c/p\u003e\n\u003cp\u003eCRVO:Central Retinal Vein Occlusion\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by [the Guangxi Key Research and Development] (Grant number [GuikeAB24010171]).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXinyi Chen (First Author): Conceptualization, Methodology, Software, Investigation, Formal Analysis, Writing - Original Draft;\u003c/p\u003e\n\u003cp\u003eNingning Tang: Data Curation;\u003c/p\u003e\n\u003cp\u003eChaomin Chen: Visualization, Investigation;\u003c/p\u003e\n\u003cp\u003eLing Cui (Corresponding Author): Conceptualization, Funding Acquisition, Resources, Supervision, Writing - Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was\u0026nbsp;performed\u0026nbsp;in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the People's Hospital of Guangxi Zhuang Autonomous Region (Date.\u0026nbsp;September 22, 2023/No. KY-IIT-2023-112).”\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statements\u003c/strong\u003e\u003cstrong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVeasey SC, Rosen IM (2019) Obstructive Sleep Apnea in Adults. N Engl J Med 380:1442\u0026ndash;1449. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMcp1816152\u003c/span\u003e\u003cspan address=\"10.1056/NEJMcp1816152\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJa D, Sc V, Bj M, Cp O (2010) Pathophysiology of Sleep Apnea. Physiol Rev 90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1152/physrev.00043.2008\u003c/span\u003e\u003cspan address=\"10.1152/physrev.00043.2008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRowley JA, Lareau S, Fahy BF, Garvey C, Sockrider M (2017) What Is Obstructive Sleep Apnea in Adults? 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Am J Ophthalmol 168:95\u0026ndash;109. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ajo.2016.05.005\u003c/span\u003e\u003cspan address=\"10.1016/j.ajo.2016.05.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Obstructive sleep apnea syndrome, ultra-widefield, swept-source optical coherence tomography angiography, retina, choroid","lastPublishedDoi":"10.21203/rs.3.rs-7839987/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7839987/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePURPOSE\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo investigate central and peripheral retinal and choroidal alterations using ultra-widefield swept-source optical coherence tomography angiography (UWF-SS-OCTA) in patients with obstructive sleep apnea syndrome (OSAS) stratified by disease severity.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMETHODS\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study included patients with mild-moderate OSAS (n\u0026thinsp;=\u0026thinsp;23 eyes), severe OSAS (n\u0026thinsp;=\u0026thinsp;22 eyes), and healthy controls (n\u0026thinsp;=\u0026thinsp;26 eyes). UWF- SS-OCTA scans centered on the fovea were used to divide the macula 8 concentric rings spanning from the central macula to the peripheral retina (0\u0026ndash;21 mm). Vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), and choroidal thickness (CT) were analyzed across all rings. Correlations with apnea-hypopnea index (AHI) and lowest oxygen saturation (LSaO₂) were also assessed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRESULTS\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSCP vessel density was significantly reduced only in the far periphery (ring 8) across all OSAS groups. DCP impairment was more extensive, with severe OSAS patients showing significantly decreased vessel density in peripheral rings 5\u0026ndash;8 versus controls (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), particularly in the superior and inferior quadrants (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Choroidal thinning in severe OSAS followed a similar pattern, being significantly reduced in rings 4\u0026ndash;8 (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), particularly in the superior, inferior, and nasal quadrants (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). DCP vessel density and choroidal thickness in peripheral regions correlated negatively with AHI and positively with LSaO₂.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCONCLUSIONS\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFor patients with OSAS, damage to the deep capillary plexus and choroid predominantly affects the peripheral retina and is significantly associated with the severity of hypoxia.\u003c/p\u003e","manuscriptTitle":"Retinal and Choroidal Changes in Obstructive Sleep Apnea Syndrome Assessed by Ultra- Widefield Swept-Source Optical Coherence Tomography Angiography","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 12:17:31","doi":"10.21203/rs.3.rs-7839987/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"042ca237-37cd-4e15-bad5-d0f017f929fc","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T21:08:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-29 12:17:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7839987","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7839987","identity":"rs-7839987","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}