Obesity and Obstructive Sleep Apnea in Patients With Keratoconus in a Turkish Population

*Department of Ophthalmology, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
Cornea (Impact Factor: 2.04). 12/2013; 33(2). DOI: 10.1097/ICO.0000000000000024
Source: PubMed


The aim of this study was to compare the frequency of occurrence of obesity and high risk of developing obstructive sleep apnea (OSA) in a keratoconus population with that of a control group.
This prospective, case-controlled multicenter study was performed on patients with keratoconus and age- and gender-matched control subjects. One hundred forty-six patients were included in each group, and the Berlin Questionnaire was used for classifying patients as having a high risk or low risk of developing OSA. The patients' demographic and clinical characteristics were compared with the Mann-Whitney U test for continuous variables and with the χ test for categorical variables.
The keratoconus (85 male/61 female) and control (79 male/67 female) groups' median ages were 25 (8-65) and 24 (9-60) years, respectively. Of the 146 patients in each group, 11 (7.5%) patients were determined to be at a high risk of developing OSA in the keratoconus group, and 8 (5.5%) patients were determined to be at a high risk of developing OSA in the control group. There was no significant difference between the groups (P = 0.477). The keratoconus and control groups' median body mass index values were found to be within normal ranges of 23.2 and 23.4, respectively.
In this study, the mean body mass index value of the keratoconus group was determined to be within normal limits. In a Turkish population, the ratio of a high risk of developing OSA was not found to be significantly different between the keratoconus and control groups.

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Available from: Engin B Ozgurhan, May 06, 2015
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    ABSTRACT: Obstructive sleep apnea (OSA) is a serious disorder characterized with repeated episodes of upper airway obstruction during sleep, resulting in nocturnal hypoxemia and hypercapnia which leads to many systemic and also ocular complications. Various eye disorders reported to be associated with OSA. Floppy eyelid syndrome (FES), cornea disorders, glaucoma, non-arteritic anterior ischemic optic neuropathy, papilledema, central serous chorioretinopathy, and retinal vein occlusion are some of these disorders. (RVO). This review aims to take the attention of the ophthalmologists on the possibility of ocular disorders that can be accompanied by sleeping disorders. Floppy eyelid syndrome Mostly seen in overweight, middle aged males with the complaint of foreign body sensation, burning, tearing, and redness; FES is characterized with the clinical findings of flaccid and easily everted upper lids, occurring spontaneously or with minimal traction, and chronic papillary conjunctivitis of the upper palpebral conjunctiva. Tarsal plaque biopsies of the patients with FES revealed the histopathological features as an increase in the elastolytic metalloproteinase enzymes and a subsequent decrease in the elastin fibers of the tissue [6,7]. In the literature the prevalence of FES in the OSA population has been reported to vary from 2% to 32% [8,9]. OSA is known to be seen mostly in overweight patients, so there is not a clear distinction regarding the etiology concerning whether FES and OSA is related directly or FES is mainly related to obesity. The prevalence of obesity in OSA has ranged from 60% to 70% [10,11], while the prevalence of obesity in FES patients has ranged from 43% to 92% [12,13]. In their review of patients with lax eyelid syndrome, Fowler and Dutton [14] stated that there was not a significant difference regarding the prevalence of OSA between patients who had obesity and FES and who had obesity but did not have FES. They also found that patients with OSA tended to have the prevalence of obesity significantly higher than those without OSA (76% vs. 20%). So they concluded that increased OSA prevalence among patients with FES was possibly associated with the concomitant obesity. On the contrary of the findings of this study, Ezra et al. [10] found a strong relationship between OSA and FES independent of weight. They explained that the possible mechanism might have been the changes in central nervous system arousability in OSA. Another possible explanation for the underlying mechanism of the association between OSA and FES is believed to be the increased venous pressure caused by right heart failure and apnea in patients with OSA [15]. Regarding the ocular surface findings along with FES, Acar et al. revealed low levels of Schirmer I values and tear break up times, and an increase in corneal staining and ocular surface disease index scores
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    ABSTRACT: Purpose: The purpose of this study was to determine whether an association exists between common systemic diseases, sociodemographic factors, and keratoconus (KCN) among a large, diverse group of insured individuals in the United States. Design: Retrospective longitudinal cohort study. Participants: Sixteen thousand fifty-three patients with KCN were matched 1:1 with persons without KCN. Methods: Persons with KCN were identified using billing codes and matched by age, gender, and overall health with a control group with no record of KCN. Multivariable logistic regression assessed whether sociodemographic factors and certain systemic diseases affected the odds of KCN. Main outcome measures: Odds ratios (ORs) with 95% confidence intervals (CIs) of receiving a KCN diagnosis. Results: After adjustment for confounders, black persons had 57% higher odds (adjusted OR, 1.57; 95% CI, 1.38-1.79; P < 0.001) and Latino persons had 43% higher odds (adjusted OR, 1.43; 95% CI, 1.26-1.62; P < 0.001) of being diagnosed with KCN compared with whites. Asians had 39% reduced odds (adjusted OR, 0.61; 95% CI, 0.50-0.75; P < 0.001) of being diagnosed with KCN compared with whites. Patients with uncomplicated diabetes mellitus (DM) had 20% lower odds of KCN (adjusted OR, 0.80; 95% CI, 0.71-0.90; P = 0.002), and patients with DM complicated by end-organ damage had 52% lower odds of having KCN (adjusted OR, 0.48; 95% CI, 0.40-0.58; P < 0.001) compared with those without DM. Persons with collagen vascular disease had 35% lower odds of KCN (adjusted OR, 0.65; 95% CI, 0.47-0.91; P = 0.01). Other conditions found to have increased odds of KCN included sleep apnea (adjusted OR, 1.13; 95% CI, 1.00-1.27; P = 0.05), asthma (adjusted OR, 1.31; 95% CI, 1.17-1.47; P < 0.001), and Down syndrome (adjusted OR, 6.22; 95% CI, 2.08-18.66; P < 0.001). There was no association between KCN and allergic rhinitis, mitral valve disorder, aortic aneurysm, or depression (P > 0.1 for all comparisons). Conclusions: Clinicians caring for persons with KCN should inquire about breathing or sleeping and, when appropriate, refer patients for evaluation for sleep apnea or asthma. Patients with DM have lower risk of KCN, potentially because of corneal glycosylation.
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