Objective: To investigate vascular networks of the retina and choroid using Optical coherence tomography angiography (OCTA) to identify early biomarkers of obstructive sleep apnea syndrome (OSAS) severity in children.

Methods: Children with OSAS referred to sleep center were recruited. OSAS patients were diagnosed based on video-polysomnography (PSG) and sixty-two eyes of 31 children with OSAS were evaluated and compared with 20 eyes of 10 healthy age-matched children. Comprehensive ophthalmological examination and OCTA imaging were carried out to evaluate the choroidal and retinal vascular network density indices.

Results: Choriocapillaris flow area decreased (p= 0.006) and superficial capillary plexus vessel density increased (p=0.01) with increasing severity of OSAS. In calculating the correlations between PSG and OCTA variables there was a negative correlation between choriocapillaris flow area and apnea hypopnea index (AHI) (p= 0.02, r² -0.5).

Conclusions: The severity of OSAS influences the choroidal and retinal capillary vascular networks. The correlation of the choriocapillaris flow area with AHI indicate the connection of the choroidal microvasculature with the number of obstructive apneas and hypopneas events.