Sleep-disordered breathing and effects on ocular health

University of Waterloo, School of Optometry, Waterloo, Ont., Canada.
Canadian Journal of Ophthalmology (Impact Factor: 1.3). 05/2007; 42(2):238-43. DOI: 10.1139/I07-029
Source: PubMed

ABSTRACT Sleep-disordered breathing may make the eye vulnerable due to the direct effect of hypoxia or it can involve pathways that lead to impaired autoregulation of optic nerve perfusion. In this review, we discuss our present understanding of the interactions that occur between sleep-disordered breathing and the eye, with particular attention to discussing possible links with glaucoma, nonarteritic anterior ischemic optic neuropathy, visual field defects, papilledema, and floppy eyelid syndrome. The importance of understanding these relationships is the positive benefits to ocular health that can derive when sleep-disordered breathing is diagnosed and treated.

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    • "OSAS-related hypoxia, hypercapnia, and decreased oxygen saturation have been shown to increase the risk of systemic blood and pulmonary hypertension, arrhythmia, myocardial infarction, congestive heart failure and stroke [5] [6] [7] [8] [9]. There have been reports that OSAS is also associated with ophthalmic disorders, including glaucoma (and normal tension glaucoma ), visual field changes, optic disk swelling, non-arteritic anterior ischemic optic neuropathy, central serous choroidoretinopathy , and retinal vein occlusions [10] [11] [12] [13] [14] [15] [16] [17]. Previous studies of glaucoma and OSAS use various study designs, patient populations, methods, and AHI cut-offs in their analyses. "
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    ABSTRACT: OBJECTIVE: To investigate the prevalence of glaucoma, visual field abnormalities, as well as changes in retinal nerve fiber layer in patients with obstructive sleep apnea syndrome (OSAS). METHODS: In this cross-sectional study, 51 patients with OSAS were included. Based on apnea hypopnea index (AHI), there were 26, 6 and 19 cases of severe (AHI⩾30), moderate (15⩽AHI<30), and mild (5⩽AHI<15) OSAS, respectively. The control group was matched for age, sex and body mass index. Prevalence of glaucoma and ocular hypertension as well as the following values were assessed and compared between two groups: best-corrected visual acuity, intraocular pressure, central corneal thickness (CCT), cup:disk ratio, mean deviation (MD), pattern standard deviation, and retinal nerve fiber layer (RNFL) parameters using glaucoma diagnosis measurement (GDx). RESULTS: Seven eyes (6.7%) had intraocular pressure (IOP)>21mmHg; of these, four eyes (3.9%) had glaucoma. No significant difference was detected in CCT between the two groups. IOP was significantly higher in the OSAS group before (p<0.001) and after (p<0.001) correcting for CCT. There was a significant difference between groups in MD and most GDx parameters including DISK (temporal-superior-nasal-inferior-temporal) average (p=0.002), superior average (p=0.05) and nerve fiber indicator (NFI) (p=0.03), where those in the patient group showed lower values. There was a significant positive correlation between AHI and both IOP and NFI. CONCLUSIONS: OSAS patients had a higher prevalence of glaucoma and ocular hypertension. OSAS patients also had higher IOP, worse visual field indices, and lower RNFL parameters compared with the control group.
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    ABSTRACT: To evaluate the prevalence of nocturnal oxygen desaturation and sleep-disordered breathing symptoms within a glaucoma population. One hundred and twelve subjects (glaucoma=52, control=60) aged between 45 and 80 years were recruited for the study. Clinical assessment included overnight ambulatory pulse oximetry monitoring and administration of a self-reported sleep-disordered breathing questionnaire. There were no differences in age, sex, body mass index, or prevalence of systemic hypertension between the groups. The mean oxygen desaturation index of the glaucoma group (8.6) did not differ significantly from that of the control group (9.6) (P=0.715). The prevalence of moderate to severe respiratory dysfunction (oxygen desaturation index >20) in the glaucoma group (17%) was similar to that in the control group (12%) (P=0.463). The severity of sleep-disordered breathing symptoms was similar between the groups (P=0.157). No statistically significant association was found between glaucoma and either nocturnal oxygen desaturation or sleep-disordered breathing. Although this study cannot exclude the possibility of either impaired optic nerve head autoregulation or hypoxic damage occurring secondary to sleep apnea syndrome, the findings do not support the routine use of pulse oximetry in the workup of individuals with glaucoma.
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