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Taskiran-Sag A, Yazgi H, Ozulken K, Eroglu E. Optical coherence tomography findings in primary headache disorders: is pain duration a clinical correlate? Int J Neurosci 2024:1-7. [PMID: 38768056 DOI: 10.1080/00207454.2024.2358367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Ganglion cell layer thickness (GCLT) may be used as a potential marker for central neural changes. We compared GCLT by using spectral domain optical coherence tomography (SD-OCT) in patients with primary headache disorders and healthy controls. We seek whether there was any difference between the headache groups and whether any clinical parameters correlated to GCLT. METHODS Fifty-three primary headache patients, 11 age and sex-matched healthy subjects were included in this cross-sectional study after power analysis. All subjects underwent SD-OCT. The duration of disorder, headache frequency, severity, duration of pain, presence of ocular pain, and accompanying symptoms have been collected. RESULTS Mean GCLT of the headache group was 15.7 ± 3.8 µm (mean ± standard deviation), and the control group was 17.5 ± 2.4. The difference was not statistically significant. When we compared the controls, migraine and tension-type headache patients' GCLT values, we found a significant difference (ANOVA, p = 0.001). Migraine patients had thinner GCLT compared to all non-migraine headache patients (p = 0.01). Intraocular pressure values of migraine patients and non-migraine patients were not statistically significantly different (p = 0.13). The only clinical parameter that correlated with GCLT was pain duration (r = -0.43 and p = 0.01). The patients with white matter lesions had thinner GCLT (p = 0.046). CONCLUSION Our results suggest that not long-term suffering from pain but migraine pathophysiology itself seems to affect neuroretinal tissue. Pain duration was moderately and inversely correlated to GCLT, meaning that the longer the headache, the thinner the ganglion cell layer is.
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Affiliation(s)
- Aslihan Taskiran-Sag
- Department of Neurology, Faculty of Medicine, TOBB Economics and Technology University, Ankara, Turkey
| | - Hare Yazgi
- Faculty of Medicine, TOBB Economics and Technology University, Ankara, Turkey
| | - Kemal Ozulken
- Department of Ophthalmology, Faculty of Medicine, TOBB Economics and Technology University, Ankara, Turkey
| | - Erdal Eroglu
- Department of Neurology, Faculty of Medicine, TOBB Economics and Technology University, Ankara, Turkey
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Cheong AJY, Wang SKX, Woon CY, Yap KH, Ng KJY, Xu FWX, Alkan U, Ng ACW, See A, Loh SRH, Aung T, Toh ST. Obstructive sleep apnoea and glaucoma: a systematic review and meta-analysis. Eye (Lond) 2023; 37:3065-3083. [PMID: 36977937 PMCID: PMC10564942 DOI: 10.1038/s41433-023-02471-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/13/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) has been thought to be associated with glaucoma, however there are many conflicting studies on this topic. With many new studies having been published since the previous meta-analysis, we believe it is important to clarify this association. Hence, in this study we meta-analyse the recent literature regarding the association between OSA and glaucoma. METHODS Pubmed, Embase, Scopus and Cochrane Library were searched from inception till the 28th February 2022 for observational as well as cross-sectional studies examining the association between OSA and glaucoma. Two reviewers selected studies, extracted data, graded the quality of included non-randomized studies using the Newcastle-Ottawa scale. The overall quality of evidence was assessed using GRADE. Random-effects models were used to meta-analyse the maximally covariate- adjusted associations. RESULTS 48 studies were included in our systematic review, with 46 suitable for meta-analysis. Total study population was 4,566,984 patients. OSA was associated with a higher risk of glaucoma (OR 3.66, 95% CI 1.70 to 7.90, I2 = 98%, p < 0.01). After adjustment for various important confounders including age, gender and patient comorbidities such as hyperlipidaemia, hypertension, cardiovascular diseases and diabetes, patients with OSA had up to 40% higher odds of glaucoma. Substantial heterogeneity was eliminated through subgroup and sensitivity analyses after consideration of glaucoma subtype, OSA severity and adjustment for confounders. CONCLUSIONS In this meta-analysis, OSA was associated with higher risk of glaucoma, as well as more severe ocular findings characteristic of the glaucomatous disease process. We suggest more clinical studies looking into the effects of OSA treatment on the progression of glaucoma to help clinical decision making for patients.
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Affiliation(s)
- Alex Jia Yang Cheong
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Sean Kang Xuan Wang
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Chang Yi Woon
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Ki Han Yap
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Kevin Joo Yang Ng
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Flora Wen Xin Xu
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Uri Alkan
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adele Chin Wei Ng
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Anna See
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shaun Ray Han Loh
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Tin Aung
- Singapore National Eye Centre and Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Song Tar Toh
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Surgery Academic Clinical Program, SingHealth, Singapore, Singapore.
- Singhealth Duke-NUS Sleep Centre, Singhealth, Singapore, Singapore.
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Lee TE, Kim JS, Yeom SW, Lee MG, Lee JH, Lee HJ. Long-term effects of obstructive sleep apnea and its treatment on open-angle glaucoma: a big-data cohort study. J Clin Sleep Med 2023; 19:339-346. [PMID: 36305582 PMCID: PMC9892736 DOI: 10.5664/jcsm.10334] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES The relationship between open-angle glaucoma (OAG) and obstructive sleep apnea (OSA) is unclear. The long-term risk for OAG after OSA diagnosis has not been investigated. Therefore, we assessed the risk for OAG among patients with OSA over a 12-year follow-up period using nationwide, population-based data. METHODS The OSA group was randomly selected from among 3.5 million individuals registered with the National Health Insurance Service. The non-OSA group was obtained through propensity score matching considering several variables. The primary endpoint was glaucoma diagnosis. RESULTS The OSA and non-OSA groups both included 6,369 individuals. The overall hazard ratio for OAG in the OSA group was 1.42 (95% confidence interval [CI]: 1.19-1.69). In subgroup analysis, the hazard ratio for OAG was 1.94 (95% CI: 1.57-2.41) for those aged > 60 years, 1.50 (95% CI: 1.20-1.89) for those with diabetes mellitus, 1.53 (95% CI: 1.26-1.86) for those with hypertension, and 0.71 (95% CI: 0.52-0.96) for those with a history of OSA surgery. CONCLUSIONS Over the 12-year follow-up, the risk for OAG increased after OSA diagnosis. Further research will be necessary to determine if treating OSA can mitigate this association. CITATION Lee T-E, Kim JS, Yeom SW, Lee MG, Lee JH, Lee H-J. Long-term effects of obstructive sleep apnea and its treatment on open-angle glaucoma: a big-data cohort study. J Clin Sleep Med. 2023;19(2):339-346.
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Affiliation(s)
- Tae-Eun Lee
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jong Seung Kim
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Sang Woo Yeom
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Min Gyu Lee
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Jong Hwan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Naranjo-Bonilla P, Giménez-Gómez R, Muñoz-Villanueva MDC, Jurado-Gámez B. Retinal and Choroidal Effects of Continuous Positive Airway Pressure as Treatment for Sleep Apnea: Results at 12 Months. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12637. [PMID: 36231937 PMCID: PMC9566654 DOI: 10.3390/ijerph191912637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND To determine the impacts of continuous positive airway pressure (CPAP) treatment on retinal and choroidal thickness measurement in individuals with obstructive sleep apnea (OSA). METHODS Participants were 28 patients with OSA treated with CPAP who were enrolled immediately after diagnosis and graded according to the apnea hypopnea index (AHI) determined in an overnight polysomnography. Inclusion criteria were a new diagnosis of OSA and an indication for CPAP. Participants underwent a full ophthalmologic examination including standard automated perimetry (SAP) and optical coherence tomography (OCT) at the levels peripapillary, macular, and choroidal before CPAP onset, and after three and twelve months of CPAP. The data compared before and after treatment were intraocular pressure, SAP, and the thicknesses peripapillary retinal nerve fiber layer (pRNFL), total retinal (TR), retinal ganglion cell layer (RGCL), inner plexiform layer (IPL), photoreceptor layer (PL), and choroidal. RESULTS After 3 months of CPAP, we observed thickening of the pRNFL (in 5/6 subfields) (p < 0.004) and TR (in 5/9 subfields) (p < 0.010). At 12 months, thickening persisted in these layers, this time affecting 2/6 and 2/9 subfields, respectively (p < 0.012 and p < 0.001, respectively). Choroidal thinning was observed at the temporal level at both 3 and 12 months compared to measurements before starting CPAP treatment (p = 0.014 and p = 0.038, respectively). SAP remained unchanged. Intraocular pressure was higher at 12 months than at 3 months (p = 0.001). CONCLUSIONS 12 months of CPAP avoids retinal thinning and normalizes choroidal thickness in OSA patients.
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Affiliation(s)
- Pedro Naranjo-Bonilla
- Ophthalmology Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain
- Ophthalmology Department, University Hospital Juan Ramón Jiménez, 21005 Huelva, Spain
| | - Rafael Giménez-Gómez
- Ophthalmology Department, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), University Hospital Reina Sofía, 14004 Córdoba, Spain
| | | | - Bernabé Jurado-Gámez
- Respiratory Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University Hospital Reina Sofía, University of Córdoba, 14004 Córdoba, Spain
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5
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Dikmen N, Cakmak AI, Urfalioglu S. The effect of positive airway pressure therapy on intraocular pressure and retina in severe obstructive apnea syndrome. Sleep Biol Rhythms 2022; 20:267-273. [PMID: 38469251 PMCID: PMC10899910 DOI: 10.1007/s41105-021-00366-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Abstract
To identify and compare changes in intraocular pressure (IOP), macular, and peripapillary retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT) measurements before and after 3 months of positive airway pressure (PAP) therapy in patients with severe obstructive sleep apnea syndrome (OSAS). Twenty-five patients diagnosed with severe OSAS in the neurology sleep outpatient clinic were included in the study. Ophthalmologic examinations were performed at the time of diagnosis and after 3 months of PAP therapy. Statistical analysis of comparisons of pre-treatment and post-treatment measurements of IOP and OCT was performed. Before the PAP therapy, the correlations between central corneal thickness (CCT), body mass index (BMI), OCT, IOP, and sleep parameters were statistically analyzed. Compared to the pre-treatment measurements at the time of diagnosis, post-treatment measurements showed insignificant decrease in IOP, significant increase in mean macular thickness and significant thinning in superior nasal RNFL. There was no correlation found between pre-treatment measurements including IOP, OCT, CCT, BMI, and sleep parameters. The effect of intermittent hypoxia and hypercapnia on the IOP and macula may be reversible in severe OSAS patients receiving 3 months of PAP therapy, but the reversibility of the neurodegenerative effects of OSAS on RNFL with this treatment seems controversial. OCT can be considered to be a promising technique for monitoring disease progression under PAP therapy in patients with severe OSAS.
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Affiliation(s)
- Nursel Dikmen
- Department of Chest Diseases, Tayfur Ata Sokmen Medical School, Hatay Mustafa Kemal University, Antakya, Hatay Turkey
| | - Ayse Idil Cakmak
- Department of Ophthalmology, Tayfur Ata Sokmen Medical School, Hatay Mustafa Kemal University, 31040 Antakya, Hatay Turkey
| | - Selma Urfalioglu
- Department of Opthalmology, Kahramanmaras Sutcu Imam University Medical School, Onikişubat, Kahramanmaraş, Turkey
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Lee SSY, Nilagiri VK, Mackey DA. Sleep and eye disease: A review. Clin Exp Ophthalmol 2022; 50:334-344. [PMID: 35263016 PMCID: PMC9544516 DOI: 10.1111/ceo.14071] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 12/21/2022]
Abstract
There is a growing body of literature on the effects of sleep disorders, in particular obstructive sleep apnoea (OSA), on ocular health, with consistent evidence of an increased risk of floppy eyelid syndrome, non-arteritic anterior ischaemic optic neuropathy, diabetic macular oedema, and other retinal vasculature changes in individuals with OSA. However, reports on OSA's associations with glaucoma, papilloedema, diabetic retinopathy, central serous chorioretinopathy, and keratoconus have been conflicting, while links between OSA and age-related macular degeneration have only been described fairly recently. Despite numerous suggestions that OSA treatment may reduce risk of these eye diseases, well-designed studies to support these claims are lacking. In particular, the ocular hypertensive effects of continuous positive airway pressure (CPAP) therapy for OSA requires further investigation into its potential impact on glaucoma risk and management. Reports of ocular surface complications secondary to leaking CPAP masks highlights the importance of ensuring good mask fit. Poor sleep habits have also been linked with increased myopia risk; however, the evidence on this association remains weak.
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Affiliation(s)
- Samantha S Y Lee
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - Vinay K Nilagiri
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia.,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
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7
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Assessment of the Effectiveness of Obstructive Sleep Apnea Treatment Using Optical Coherence Tomography to Evaluate Retinal Findings. J Clin Med 2022; 11:jcm11030815. [PMID: 35160269 PMCID: PMC8837143 DOI: 10.3390/jcm11030815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
Retinal findings may change in patients with obstructive sleep apnea syndrome (OSAS). The present study aims to evaluate several retinal findings, such as macula layer thickness, the peripapillary retinal nerve fiber layer, and the optic nerve head in patients with OSAS, using optical coherence tomography (OCT); it also aims to monitor the result of several types of treatment of OSAS with OCT. A prospective comparative study was designed. Patients were recruited at a Sleep Unit of a University Hospital and underwent comprehensive ophthalmological examinations. Following exclusion criteria, fifty-two patients with OSAS were finally included. Patients were examined by OCT twice: once before treatment, and again after six months of treatment. In mild–moderate patients, where retinal swelling had been demonstrated, retinal thicknesses decreased [fovea (p = 0.026), as did inner ring macula (p = 0.007), outer ring macula (p = 0.015), and macular volume (p = 0.015)]. In severe patients, where retinal atrophy had been observed, retinal thickness increased [fovea (p < 0.001)]. No statistically significant differences in efficacy between treatments were demonstrated. In conclusion, OCT can evaluate the retina in patients with OSAS and help to monitor results after treatment. In severe OSAS, retinal thickness increased six months after treatment.
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8
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Sundaram V, Haridas S, Dhar M, Harikrishnan CP. Evaluation of retinal nerve fiber layer, ganglion cell layer, and optic nerve head morphological parameters in patients with obstructive sleep apnea and comparison with normal population. Indian J Ophthalmol 2022; 70:453-457. [PMID: 35086215 PMCID: PMC9023914 DOI: 10.4103/ijo.ijo_985_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 08/17/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To compare the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and optic nerve head (ONH) morphological parameters between obstructive sleep apnea (OSA) patients and age-matched controls using spectral domain optical coherence tomography (SD-OCT). METHODS This case control study was conducted in a multi-specialty tertiary care hospital from 2014 to 2016. Patients diagnosed to have OSA by overnight polysomnography were included in the study. Fifty eyes of 25 OSA patients with clinically normal optic disc were compared with 50 eyes of age-matched controls. The study population underwent detailed ophthalmological evaluation including SD-OCT. RESULTS There was significant thinning of the superior, inferior, and average RNFL in the OSA group when compared to controls. GCL analysis also showed a significant thinning of the six sectors as well as average and minimum ganglion cell layer + inner plexiform layer in OSA patients. The optic nerve head rim area was significantly decreased in OSA patients when compared to controls. CONCLUSION OSA patients even with clinically normal optic disc showed significant decrease in the RNFL thickness, GCL thickness, and rim area when compared to age-matched controls. Hence, these patients constitute a high-risk population who need to be regularly screened and followed up for ocular co-morbidities.
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Affiliation(s)
- Vandhana Sundaram
- Department of Cornea, Sankara Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Sujithra Haridas
- Department of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Meenakshi Dhar
- Department of Glaucoma, Centre for Sight, New Delhi, India
| | - CP Harikrishnan
- Cataract Services, Chaitanya Eye Hospital, Kochi, Kerala, India
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9
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Chan YH, Chuang LH, Yu CC, Lo YL, Chen HS, Huang PW, Yeung L, Lai CC. Prospective evaluation of the comorbidity of obstructive sleep apnea in patients with glaucoma. J Clin Sleep Med 2022; 18:47-56. [PMID: 34170230 PMCID: PMC8807909 DOI: 10.5664/jcsm.9488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES This study aimed to identify prospectively the correlation between obstructive sleep apnea (OSA) severity, ocular microcirculation changes, and visual function changes in patients with glaucoma. METHODS We prospectively enrolled patients with glaucoma who were willing to undergo overnight polysomnography. The enrolled patients were further divided into normal tension glaucoma, high-tension glaucoma, and control. Visual field progression was analyzed using sequential standard automated perimetry. Peripapillary and macular vessel density were assessed through optical coherence tomography angiography (OCT-angiography). The associations between polysomnography parameters, OCT-angiography parameters, and visual field progression were analyzed. RESULTS A total of 22 patients with normal tension glaucoma, 30 patients with high-tension glaucoma, and 24 control patients were enrolled. Through regression analysis, glaucoma was found to be an independent predictor of moderate-to-severe OSA (P = .035); furthermore, moderate-to-severe OSA was significantly associated with visual field progression (P = .008 in the high-tension glaucoma subgroup and P = .008 in the overall glaucoma). Additionally, OSA severity was negatively correlated with the ganglion cell complex thinning rate in the normal tension glaucoma subgroup. CONCLUSIONS Presence of glaucoma increased the risk of moderate-to-severe OSA compared with the control group. OSA severity was related to visual field deterioration in patients with glaucoma and further associated with structural progression in the normal tension glaucoma subgroup. Careful monitoring of the comorbid OSA status of patients with glaucoma is essential to prevent disease progression. CITATION Chan Y-H, Chuang L-H, Yu C-C, et al. Prospective evaluation of the comorbidity of obstructive sleep apnea in patients with glaucoma. J Clin Sleep Med. 2022;18(1):47-56.
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Affiliation(s)
- Yuan-Hsi Chan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Lan-Hsin Chuang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan,Address correspondence to: Lan-Hsin Chuang, MD, Department of Ophthalmology, Chang Gung Memorial Hospital, No. 222, Maijin Road, Anle District, Keelung City, 204, Taiwan; Tel: 886-2-24313131, ext.6314; Fax: 886-2-24311190;
| | - Chung-Chieh Yu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan,Department of Respiratory Therapy, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Lun Lo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Henry S.L. Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan,Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Wei Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ling Yeung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Naranjo-Bonilla P, Muñoz-Villanueva MC, Giménez-Gómez R, Jurado-Gámez B. Retinal and choroidal thickness measurements in obstructive sleep apnea: impacts of continuous positive airway pressure treatment. Graefes Arch Clin Exp Ophthalmol 2021; 259:3381-3393. [PMID: 34296347 DOI: 10.1007/s00417-021-05322-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To examine retinal and choroidal thicknesses in individuals with obstructive sleep apnea (OSA) and determine the impacts of continuous positive airway pressure (CPAP) treatment. METHODS Prospective follow-up study conducted at a university hospital. 40 patients with OSA, 28 treated with CPAP, and 12 untreated, were enrolled immediately after diagnosis and graded according to the apnea hypopnea index (AHI) determined in an overnight polysomnography. Inclusion criteria were a new diagnosis of OSA and CPAP indicated. Participants underwent a full ophthalmologic examination including optical coherence tomography (OCT) at the peripapillary, macular, and choroidal levels and the same examination 3 months later. Outcome measures were peripapillary retinal nerve fiber layer (RNFL), total retinal (TRT), retinal ganglion cell layer (RGCL), inner plexiform layer (IPL), photoreceptor layer (PL), and choroidal thicknesses. RESULTS At 3 months, RGCL thickness was reduced at the inner nasal macula segment in the no-CPAP group (P = 0.016). In + CPAP, increases were produced in RNFL thickness (5/6 segments) and TRT (7/ 9 segments), while choroidal thinning was observed temporally (P = 0.003). At baseline, positive correlation was detected between choroidal thickness and AHI (r = 0.352, P = 0.005) and between IPL thickness (7/9 segments) and AHI (r = 0.414, P < 0.001). CONCLUSIONS Initial retinal and choroidal thickening was followed by RGCL thinning over 3 months. In patients receiving CPAP, we observed no thinning of any retinal layer and normalization of choroidal thickness.
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Affiliation(s)
- P Naranjo-Bonilla
- Ophthalmology Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain. .,Ophthalmology Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain. .,, Cordoba, Spain.
| | | | - R Giménez-Gómez
- Ophthalmology Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain.,Ophthalmology Department, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - B Jurado-Gámez
- Respiratory Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain.,Respiratory Department, Hospital Universitario Reina Sofía, Cordoba, Spain
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11
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Guven S, Kilic D, Bolatturk OF. Thinning of the inner and outer retinal layers, including the ganglion cell layer and photoreceptor layers, in obstructive sleep apnea and hypopnea syndrome unrelated to the disease severity. Int Ophthalmol 2021; 41:3559-3569. [PMID: 34170478 DOI: 10.1007/s10792-021-01937-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to analyze the segmented layers of the macula in patients with obstructive sleep apnea and hypopnea syndrome (OSAS) using spectral domain optical coherence tomography (SD-OCT). MATERIAL AND METHODS This single-center, cross-sectional study included 31 OSAS patients and 31 age- and gender-matched control subjects. SD-OCT and overnight polysomnography were performed on all participants. The OSAS patients were categorized according to disease severity (mild, moderate, severe). The groups were compared in respect of each segmented macular layer through the use of segmentation software on SD-OCT. Total retinal thickness (RT), peripapillary retina nerve fiber layer (pRNFL) thickness, central corneal thickness (CCT) and intraocular pressure (IOP) values were also compared between the groups. RESULTS Mean CCT (p:0.015) and nasal pRNFL values (p:0.042) were lower and mean IOP was higher (p:0.018) in OSAS patients than in the control group. The statistical analysis revealed significantly thinner total RT, inner retinal layers (IRL), outer retinal layers (ORL), photoreceptor layers (PRL) and ganglion cell layer (GCL) thicknesses in the OSAS groups compared to healthy subjects. No significant differences were found between the three OSAS subgroups in all segmented macular layers and pRNFL measurements. CONCLUSION The results of this study showed relatively thinner nasal pRNFL, total RT, IRL, ORL, PRL and GCL layers in OSAS patients compared to healthy subjects. Moreover, this thinning of the segmented layers was unrelated to disease severity.
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Affiliation(s)
- Soner Guven
- Department of Ophthalmology, Kayseri City Hospital, Mevlana mh. Tamer cd. 5/14, Talas, Kayseri, Turkey.
| | - Deniz Kilic
- Department of Ophthalmology, Kayseri City Hospital, Mevlana mh. Tamer cd. 5/14, Talas, Kayseri, Turkey
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Ngoo QZ, A NF, A B, Wh WH. Evaluation of Retinal Nerve Fiber Layer Thickness and Optic Nerve Head Parameters in Obstructive Sleep Apnoea Patients. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 35:223-230. [PMID: 34120421 PMCID: PMC8200590 DOI: 10.3341/kjo.2020.0019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To study the retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) parameters in obstructive sleep apnoea (OSA) patients and their relationship with severity of the disease. METHODS A cross-sectional, hospital-based study. Fifty-four OSA subjects and 54 controls were recruited. Candidate that fulfil the criteria with normal ocular examinations then proceed with spectrum domain Cirrus optical coherence tomography examinations. ONH parameters and RNFL thickness were evaluated. Apnoea-hypopnoea index (AHI) of the OSA group were obtained from the medical record. RESULTS In OSA, mean of average RNFL thickness was 93.87 µm, standard deviation (SD) = 9.17, p = 0.008 (p < 0.05) while superior RNFL thickness was 113.59 µm, SD = 16.29, p ≤ 0.001 (p < 0.05). RNFL thickness fairly correlate with severity of the disease (AHI), superior RNFL with R = 0.293, R2 = 0.087, p = 0.030 (p < 0.05), and nasal RNFL R = 0.292, R2 = 0.085, p = 0.032. No significant difference and correlation observed on ONH parameters. In control group, mean of average RNFL thickness was 98.96 µm, SD = 10.50, p = 0.008 (p < 0.05) while superior RNFL thickness was 125.76 µm, SD = 14.93, p ≤ 0.001 (p < 0.05). CONCLUSIONS The mean of the average and superior RNFL thickness were significantly lower in the OSA group compare to control. Regression analysis showed RNFL thickness having significantly linear relationship with the AHI, specifically involving the superior and nasal quadrant.
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Affiliation(s)
- Qi Zhe Ngoo
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nazihatul Fikriah A
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Baharudin A
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Wan Hazabbah Wh
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Loureiro T, Rodrigues-Barros S, Lopes D, Carreira AR, Gomes R, Marques N, Telles P, Vide Escada A, Campos N. Retinal vascular impairment in patients newly diagnosed with obstructive sleep apnea syndrome. Multidiscip Respir Med 2021; 16:773. [PMID: 34858594 PMCID: PMC8581819 DOI: 10.4081/mrm.2021.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate retinal morphological and vascular parameters in patients recently diagnosed with obstructive sleep apnea syndrome (OSAS) and determine the correlation between retinal vascular density and the severity of OSAS. Methods We performed a retrospective study on the retinal vasculature of patients with OSAS and age-match healthy controls. OSAS was confirmed by full-night cardiorespiratory polygraphy. Patients were divided into three groups according to disease severity given by apnea-hypopnea index (AHI) i.e., mild, moderate or severe. Retinal thicknesses and vascular density were compared among groups, for both the macula and optic disc. Correlation between vascular density and clinical features were also assessed. Results The study included 30 eyes of patients with OSAS and 12 controls. No differences were found regarding retinal thickness in both the macula and the optic disc between OSAS patients and controls. In contrast, significant differences were found in the peripapillary vessel density between groups versus control patients. The greatest difference being between severe OSAS and controls (49.4% ± 2.1 versus 40.4% ± 4.2 respectively, p=0.01). Peripapillary vessel density was found to significantly and negatively correlate with AHI (p=0.02; r= -0.74) and directly correlate with the lowest percutaneous oxygen saturation (p=0.02; r= 0.58). Conclusions This study indicates that OSAS is associated with retinal microvasculature impairment, that seems to mainly affect the optic disc. This suggests that microvascular damage increases with the increasing severity of OSAS. As such, prospective trials are needed to clarify if this vascular peripapillary damage precedes glaucomatous optic neuropathy in OSAS patients.
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Affiliation(s)
| | | | | | | | - Ricardo Gomes
- Pneumology Department of Hospital Garcia de Orta, Almada, Portugal
| | | | - Paula Telles
- Pneumology Department of Hospital Garcia de Orta, Almada, Portugal
| | - Ana Vide Escada
- Pneumology Department of Hospital Garcia de Orta, Almada, Portugal
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Chalkiadaki E, Andreanos K, Karmiris E, Florou C, Tsiafaki X, Amfilochiou A, Georgalas I, Koutsandrea C, Papaconstantinou D. Ganglion cell layer thickening in patients suffering from Obstructive Sleep Apnea-Hypopnea syndrome with long Mean Apnea-Hypopnea Duration during sleep. Int Ophthalmol 2020; 41:923-935. [PMID: 33201446 DOI: 10.1007/s10792-020-01648-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To study the effects of mean apnea-hypopnea duration (MAD), a useful indicator of blood oxygenation, on peripapillary retinal nerve fiber layer (RNFL), macular ganglion cell to inner plexiform layer (GC-IPL) and macular retinal thickness in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS Sixty-five patients recently diagnosed with OSAHS and 35 healthy individuals were enrolled in this cross-sectional study. OSAHS patients were divided according to their MAD values into group 1 with 16 participants (MAD:10-15.5 s), group 2 with 17 participants (MAD:15.5-19 s), group 3 with 17 participants (MAD:19-30 s) and group 4 with 15 participants (MAD > 30 s). The average and sectorial values of RNFL, GC-IPL and retinal thickness were measured by SS-OCT (DRI OCT Triton, Topcon). Intraocular pressure was recorded by Goldmann Applanation and Pascal Dynamic Contour Tonometer (DCT-IOP). RESULTS The average RNFL and retinal thickness values were higher in group 4, but did not reach statistical significance. With the exception of the central 1 mm at the fovea, GC-IPL was always thickened in group 4, and significant differences were evident when its average value was compared with group 2 (p = 0.03), its superior and inferior-nasal values were compared with group 2 (p = 0.02, p = 0.006, respectively) and group 3 (p = 0.01, p = 0.02, respectively), its superior-temporal value was compared with group 3 (p = 0.003) and the control group (p = 0.03), and its superior-nasal value was compared with group 2 (p = 0.03), group 3 (p = 0.001) and the control group (p = 0.03). DCT-IOP was significantly positively correlated with the duration of sleep in which oxygen saturation (SaO2 ) was decreased under 90% (r = 0.359, p = 0.01). CONCLUSION We report a novel observation of GC-IPL thickening in OSAHS patients experiencing long MAD, a parameter which incorporates the severity of breathing events during sleep. Higher DCT-IOP was noted with advancing hypoxemia.
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Affiliation(s)
- Evangelia Chalkiadaki
- Department of Ophthalmology, 251 Hellenic Airforce General Hospital, P. Kanellopoulou Avenue, 11525, Athens, Greece. .,First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital "G. Gennimatas", Athens, Greece.
| | - Konstantinos Andreanos
- First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital "G. Gennimatas", Athens, Greece
| | - Efthymios Karmiris
- Department of Ophthalmology, 251 Hellenic Airforce General Hospital, P. Kanellopoulou Avenue, 11525, Athens, Greece
| | - Chrysoula Florou
- First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital "G. Gennimatas", Athens, Greece
| | - Xanthi Tsiafaki
- Respiratory Function & Sleep Study Unit, "Sismanoglio" General Hospital of Attica, Marousi, Athens, Greece
| | - Anastasia Amfilochiou
- Respiratory Function & Sleep Study Unit, "Sismanoglio" General Hospital of Attica, Marousi, Athens, Greece
| | - Ilias Georgalas
- First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital "G. Gennimatas", Athens, Greece
| | - Chrysanthi Koutsandrea
- First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital "G. Gennimatas", Athens, Greece
| | - Dimitrios Papaconstantinou
- First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital "G. Gennimatas", Athens, Greece
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Kısabay Ak A, Batum M, Göktalay T, Mayali H, Kurt E, Selçuki D, Yilmaz H. RETRACTED ARTICLE: Evaluation of macular thickness and visual pathways using optic coherence tomography and pattern visual evoked potential in different clinical stages of obstructive sleep apnea syndrome. Int J Neurosci 2020; 131:716-724. [PMID: 32990117 DOI: 10.1080/00207454.2020.1825418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM The present study aimed to investigate and compare possible changes in amplitude and latency of pattern visual evoked potentials (PVEP) and thickness of quadrants of the macula (TQM) using optic coherence tomography (OCT). MATERIALS AND METHODS According to polysomnography examinations, 30 mild, 30 severe, 30 controls were included in the study after approval from the ethics committee. RESULTS No significant difference was found in age and gender between the groups (p = 0.184 and p = 0.954). Significant difference was found between external and internal superior TQM, mean thickness of ganglion cell layer in comparison of all three groups (p = 0.011, p = 0.047, p = 0.030). In comparison between severe OSAS and control groups, significant difference was found in internal nasal, internal superior and external superior TQM (p = 0.048, p = 0.033, p = 0.014) while no significant difference was found TQM in comparison between the mild OSAS and control groups. In comparison between the group of severe OSAS and controls, significant increase was found in P100 as well as N145 latencies whereas only P100 latency was found to increase when mild OSAS was compared with controls. No significant correlation was found between TQM and PVEP parameters in mild and severe OSAS patients. DISCUSSION Latency and amplitude of PVEP altered in OSAS because edema and inflammation was remarkable in mild as well as severe stages of the disease. Furthermore, thinning in the macula was observed only in severe stages of the disease, explained with level of atrophy and exposure to extended hypoxia.
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Affiliation(s)
- Ayşın Kısabay Ak
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Melike Batum
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Tuğba Göktalay
- Department of Pulmonary Diseases, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Hüseyin Mayali
- Department of Eye Diseases, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Emin Kurt
- Department of Eye Diseases, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Deniz Selçuki
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Hikmet Yilmaz
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
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Kaya H, Pekel G, Kaya D, Kara CO, Hıraali MC. The Effects of Surgical Treatment on Retina-Choroidal Findings in Patients With Obstructive Sleep Apnea Syndrome. Ophthalmic Surg Lasers Imaging Retina 2020; 51:35-42. [PMID: 31935301 DOI: 10.3928/23258160-20191211-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/29/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to determine the effect of surgical treatment on ocular findings in obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS The authors studied 34 eyes of 34 newly diagnosed OSAS patients. The sleep study was performed before and 6 months after expansion sphincter pharyngoplasty (ESP). Retinal nerve fiber layer (RNFL), choroidal thickness (CT), and retinal arteriolar caliber (RAC) analyses were performed using spectral-domain optical coherence tomography. Intraocular pressure (IOP) and ocular pulse amplitude were performed using the Pascal dynamic contour tonometer. RESULTS The preoperative and postoperative Apnea Hypopnea Index scores and average oxygen saturation values were significantly different (P = .0001 and P = .001, respectively). There was no significant difference between the preoperative and postoperative RNFL thicknesses (P > .05). The preoperative subfoveal, nasal, temporal CT, and IOP were significantly different from the postoperative measurements (P = .006, P = .05, P = .036, and P = .0001, respectively). CONCLUSIONS ESP had a significant influence on CT and IOP in patients with OSAS, maintaining a decrease in CT and IOP 6 months after surgery. The determination of these ocular findings may be useful to show the positive effects of ESP. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:35-42.].
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Batum M, Kısabay A, Mayalı H, Göktalay T, Kurt E, Selçuki D, Yılmaz H. Evaluation of effects of positive airway pressure treatment on retinal fiber thickness and visual pathways using optic coherence tomography and visual evoked potentials in the patients with severe obstructive sleep apnea syndrome. Int Ophthalmol 2020; 40:2475-2485. [PMID: 32506292 DOI: 10.1007/s10792-020-01426-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/13/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hypoxia during sleep in obstructive sleep apnea syndrome (OSAS) increases intracranial pressure, decreases cerebral perfusion pressure, and alters vascular supply to the optic nerve. Pattern visual evoked potential (pVEP) has revealed that it causes alterations in the optic nerve, and optic coherence tomography has shown that it causes alterations in the retinal and macular layers. OBJECTIVES To detect and compare possible alterations in macula and peripapillary retinal nerve fiber thickness (pRNFL) using OCT and in the optic nerve pathways using pVEP before and after positive airway pressure (PAP) in the patients with severe OSAS. MATERIALS AND METHODS Thirty patients who were diagnosed as having severe OSAS in the neurology-sleep outpatient clinic and 30 healthy control subjects were included in the study. Ophthalmic examinations were performed prior to (month 0) and after (month 6) PAP treatment, and pVEP (peak time [PT] and amplitude) and OCT parameters (peripapillary retinal-macular layers) were compared. RESULTS In the comparison between the severe OSAS (before treatment) and control groups, thinning was found in pRNFL (average, nasal, inferior) and in the macular layers (external and internal superior quadrants) (p < 0.05). pVEP investigation revealed increased PT in P100 and N145 waves and decreased amplitude of N75-P100 waves. In the comparisons before and after PAP treatment, a decrease in PT of N75 and P100 waves and increase in N75-P100 amplitudes were found. In the pRNFL, significant thickening was found in the layers with thinning before treatment, whereas no significant thickening was found in macular layers, except for the fovea. DISCUSSION It was shown that PAP treatment in patients with severe OSAS prevents hypoxia without causing alterations in intraocular pressure and thus reduces inflammation and causes thickening in the pRNFL and macular layers.
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Affiliation(s)
- Melike Batum
- Department of Neurology, Celal Bayar University, 45000, Manisa, Turkey.
| | - Ayşın Kısabay
- Department of Neurology, Celal Bayar University, 45000, Manisa, Turkey
| | - Hüseyin Mayalı
- Department of Ophthalmology, Celal Bayar University, 45000, Manisa, Turkey
| | - Tuğba Göktalay
- Department of Chest Diseases, Celal Bayar University, 45000, Manisa, Turkey
| | - Emin Kurt
- Department of Ophthalmology, Celal Bayar University, 45000, Manisa, Turkey
| | - Deniz Selçuki
- Department of Neurology, Celal Bayar University, 45000, Manisa, Turkey
| | - Hikmet Yılmaz
- Department of Neurology, Celal Bayar University, 45000, Manisa, Turkey
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Uslu H, Kanra AY, Sarac S. Structural assessment of the optic nerve in patients with obstructive sleep apnea syndrome: Case-control study. Eur J Ophthalmol 2020; 31:1741-1748. [PMID: 32483999 DOI: 10.1177/1120672120926859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Obstructive sleep apnea syndrome has been identified as a possible risk factor for optic nerve pathology such as glaucoma, nonarteritic ischemic optic neuropathy, and optic disk edema. Accordingly, we aimed to evaluate structural changes of the apparently normal optic nerve in obstructive sleep apnea syndrome patients with effects of its severity. MATERIALS AND METHODS In this prospective case-control study, 47 eyes of 47 obstructive sleep apnea syndrome patients diagnosed with polysomnography and 40 eyes of 40 healthy subjects were included. Spectral-domain optical coherence tomography was used to evaluate the peripapillary retinal nerve fiber layer thickness, optic nerve head topographic parameters, and retinal ganglion cell-inner plexiform layer thickness. RESULTS The average peripapillary nerve fiber layer thickness was lower in obstructive sleep apnea syndrome patients than in controls (90.74 ± 7.98 vs 94.93 ± 6.13 μm; p = 0.008). The average cup/disk ratio and the vertical cup/disk ratio in patients with OSAS were significantly higher compared to the controls (both p < 0.001). However, no significant difference in retinal ganglion cell-inner plexiform layer thickness was found. CONCLUSION Even if the retinal ganglion cell-inner plexiform layer thicknesses did not significantly differ between the obstructive sleep apnea syndrome and control groups, obstructive sleep apnea syndrome patients showed a decreased peripapillary nerve fiber layer thickness and increased optic nerve head parameters. These findings can be used as an indicator of optic nerve damage in the early diagnosis of obstructive sleep apnea syndrome patients.
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Affiliation(s)
- Hasim Uslu
- Department of Ophthalmology, Hisar Hospital, Istanbul, Turkey
| | - Ayşe Yagmur Kanra
- Department of Ophthalmology, Dünyagöz Eye Hospital, Istanbul, Turkey
| | - Sema Sarac
- Süreyyapaşa Thoracic Diseases and Thoracic Surgery Hospital, Istanbul, Turkey
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Continuous intraocular pressure monitoring in patients with obstructive sleep apnea syndrome using a contact lens sensor. PLoS One 2020; 15:e0229856. [PMID: 32126130 PMCID: PMC7053760 DOI: 10.1371/journal.pone.0229856] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/16/2020] [Indexed: 01/12/2023] Open
Abstract
Purpose To analyse nocturnal intraocular pressure (IOP) fluctuations in patients with obstructive sleep apnea syndrome (OSAS) using a contact lens sensor (CLS) and to identify associations between the OSAS parameters determined by polysomnographic study (PSG) and IOP changes. Method Prospective, observational study. Twenty participants suspected of having OSAS were recruited. During PSG study, IOP was monitored using a CLS placed in the eye of the patient. The patients were classified according to the apnea-hypopnea index (AHI) in two categories, severe (>30) or mild/moderate (<30) OSAS. We evaluated several parameters determined by the IOP curves, including nocturnal elevations (acrophase) and plateau times in acrophase (PTs) defined by mathematical and visual methods. Results The IOP curves exhibited a nocturnal acrophase followed by PTs of varying extents at which the IOP remained higher than daytime measurement with small variations. We found significant differences in the length of the PTs in patients with severe OSAS compared to those with mild/moderate disease (P = 0.032/P = 0.028). We found a positive correlation between PTs and OSAS severity measured by the total number of apneic events (r = 0.681/0.751 P = 0.004/0.001) and AHI (r = 0.674/0.710, P = 0.004/0.002). Respiratory-related arousal and oxygen saturation also were associated significantly with the IOP PT length. Conclusions Periods of nocturnal IOP elevation lasted longer in severe OSAS patients than those with mild/moderate OSAS and correlate with the severity of the disease. The length of the nocturnal PT is also associated to respiratory parameters altered in patients with OSAS.
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Kısabay Ak A, Batum M, Göktalay T, Mayali H, Kurt E, Selçuki D, Yılmaz H. Evaluation of retinal fiber thickness and visual pathways with optic coherence tomography and pattern visual evoked potential in different clinical stages of obstructive sleep apnea syndrome. Doc Ophthalmol 2020; 141:33-43. [PMID: 31981012 DOI: 10.1007/s10633-020-09749-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the possible changes in retinal nerve fiber layer (RNFL) by optic coherence tomography and in the amplitudes and peak times (PTs) in pattern visual evoked potential (pVEP) and to compare them in obstructive sleep apnea syndrome (OSAS). METHODS This prospective study included patients with mild OSAS (n = 30), severe OSAS (n = 30), and 30 control subjects. All patients were assessed after obtaining the approval from our hospital's ethics committee. RESULTS There was no difference in age and gender between the groups (p = 0.184, p = 0.954). By analysis of variance, there was a significant difference in RNFL values among patients with mild OSAS, severe OSAS, and control for three measures of RNFL (average p = 0.044, nasal p = 0.003, inferior p = 0.027). In severe OSAS group, nasal and inferior quadrants of the RNFL were found to be thinner than the control group (p = 0.008, p = 0.031). We showed that the PT of P100 and N145 was prolonged in severe OSAS compared to the control group (p < 0.001) and that PT of P100 was prolonged in mild OSAS compared to the control group (p < 0.05). The amplitude of N75-P100 was significantly decreased in patients with both severe OSAS and mild OSAS compared to the control group (p < 0.001). Correlation of RNFL and pVEP values showed that the inferior quadrant RNFL thickness is correlated with both P100 and N145 PTs (r = 0.271*, p = 0.036 and r = 0.290*, p = 0.043, respectively) and N75-P100 amplitude (r = 0.378**, p = 0.003) in severe OSAS group. CONCLUSIONS In mild and severe stages of the disease, edema and inflammation were evident and VEP PT and amplitudes were affected in both groups. Furthermore, thinning in RNFL in the severe stage of the disease might be associated with higher atrophy levels and prolonged exposure to hypoxia.
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Affiliation(s)
- Ayşın Kısabay Ak
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Melike Batum
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey.
| | - Tuğba Göktalay
- Department of Pulmonary Diseases, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Hüseyin Mayali
- Department of Eye Diseases, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Emin Kurt
- Department of Eye Diseases, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Deniz Selçuki
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
| | - Hikmet Yılmaz
- Department of Neurology, Celal Bayar University Medical School Hafsa Sultan Hospital, Manisa, Turkey
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Lin PW, Lin HC, Friedman M, Chang HW, Salapatas AM, Lin MC, Chen YC. Effects of CPAP for patients with OSA on visual sensitivity and retinal thickness. Sleep Med 2019; 67:156-163. [PMID: 31927222 DOI: 10.1016/j.sleep.2019.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/16/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Obstructive sleep apnea/hypopnea syndrome (OSA) could compromise oxygenation of the optic nerve and cause glaucomatous optic neuropathy; there has been no study to investigate the microstructure changes of the optic nerve and retina in OSA patients before and after continuous positive airway pressure (CPAP) therapy. In this study, we assess whether treatment with CPAP might improve visual sensitivity and retinal thickness in patients with OSA. METHODS Patients with OSA were prospectively recruited and referred for ophthalmologic evaluation at baseline and three months after CPAP treatment. Each patient underwent an ophthalmological exam, standard automated perimetry (SAP), and optical coherence tomography (OCT) exam. Peripapillary retinal nerve fiber layer (RNFL) and macular layer (ML) thickness parameters were measured. The SAP, RNFL, and ML thickness parameters before and after treatment were compared. RESULTS A total of 32 OSA patients were consecutively enrolled. At baseline, the mean deviation (MD) of SAP was -2.15 ± 1.90 dB (dB). After CPAP treatment, the MD was -1.38 ± 1.37 dB (p = 0.017). Regarding the OCT parameters, the inferior quadrant and nasal-inferior sector of RNFL thickness significantly improved after treatment (p = 0.025 and 0.004, respectively). The ML thickness in the superior-inner sector, inferior-outer sector, nasal-outer sector, superior hemisphere, and inferior hemisphere were also significantly improved after treatment. Improvement of ML thickness in the superior-inner sector positively correlated with the apnea/hypopnea index (r = 0.405, p = 0.022) and desaturation index (r = 0.473, p = 0.006) on pre-treatment polysomnography. CONCLUSION The treatment of CPAP could improve visual sensitivity and increase retinal thickness in patients with OSA.
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Affiliation(s)
- Pei-Wen Lin
- Department of Ophthalmology, Division of Glaucoma, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Robotic Surgery Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Michael Friedman
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Rush University Medical Center, Chicago, IL, USA; Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Hsueh-Wen Chang
- Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Anna M Salapatas
- Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Meng-Chih Lin
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Che Chen
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Abdullayev A, Tekeli O, Yanık Ö, Acıcan T, Gülbay B. Investigation of the Presence of Glaucoma in Patients with Obstructive Sleep Apnea Syndrome Using and Not Using Continuous Positive Airway Pressure Treatment. Turk J Ophthalmol 2019; 49:134-141. [PMID: 31245974 PMCID: PMC6624468 DOI: 10.4274/tjo.galenos.2018.88614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the frequency of glaucoma in patients with obstructive sleep apnea syndrome (OSAS) using and not using continuous positive airway pressure treatment. Materials and Methods: This prospective study included 59 patients diagnosed with OSAS based on the Apnea-Hypopnea Index (AHI). OSAS patients were divided into 3 groups according to their AHI scores: 5-15 was considered mild (19 patients), 16-30 was considered moderate (16 patients), and >30 (24 patients) was considered severe. Twenty-eight (47.5%) of the OSAS patients had been using continuous positive airway pressure treatment. The control group included 19 healthy subjects. Retinal nerve fiber layer and ganglion cell complex (GCC) thickness analyses were performed. Results: Average GCC thickness in left eyes was significantly lower in the mild OSAS group than in the control group (p=0.013). The GCC was significantly thinner in the inferior and inferonasal sectors of both eyes in the mild OSAS group compared to the control group (p=0.029, p=0.022, p=0.037, and p=0.019 respectively). Minimum GCC thickness in the left eyes of all OSAS groups was significantly lower than in the control group (p<0.05). Conclusion: In OSAS patients, there may be changes in retinal nerve fiber layer and ganglion cell complex thickness before alterations in the visual field emerge.
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Affiliation(s)
- Ahmet Abdullayev
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Oya Tekeli
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Özge Yanık
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Turan Acıcan
- Ankara University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
| | - Banu Gülbay
- Ankara University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
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23
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Kim YW, Park KH. Exogenous influences on intraocular pressure. Br J Ophthalmol 2019; 103:1209-1216. [PMID: 30910873 DOI: 10.1136/bjophthalmol-2018-313381] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/08/2019] [Accepted: 03/02/2019] [Indexed: 02/05/2023]
Abstract
Intraocular pressure (IOP), the pressure within the eyeball, is a function mainly of the production and elimination of aqueous humour. Balanced IOP helps to maintain the eyeball contour, allowing proper refraction of light in the anterior segment of the eye. Increases in IOP can cause injury to the ocular structure, typically the optic nerve head and retinal ganglion cells. IOP increase, additionally, is a risk factor for glaucoma progression. However, it is not unusual that glaucoma worsens despite well-managed IOP; indeed, glaucoma can develop and progress even within the normal IOP range. IOP measured once during daytime office hours might not provide sufficient information for effective glaucoma management. In fact, IOP is not a fixed value but rather changes over time: it fluctuates with the intrinsic circadian rhythm and can also change in various lifestyle-related situations (eg, with body posture, during exercise, while holding breath and according to dietary habits). It is therefore worth exploring the various factors that can affect IOP and glaucoma risk. In this review, the various exogenous influences on IOP in the literature are investigated.
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Affiliation(s)
- Yong Woo Kim
- Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ki Ho Park
- Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
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24
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Mukherjee C, Al-Fahad Q, Elsherbiny S. The role of optical coherence tomography in therapeutics and conditions, which primarily have systemic manifestations: a narrative review. Ther Adv Ophthalmol 2019; 11:2515841419831155. [PMID: 30923793 PMCID: PMC6431765 DOI: 10.1177/2515841419831155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 01/22/2019] [Indexed: 12/22/2022] Open
Abstract
Optical coherence tomography is designed to evaluate in vivo qualitative and quantitative changes of the anterior segment, optic nerve and the retina. Initial applications of this technology were confined mainly to ophthalmic diseases. However recently, numerous studies have evaluated its use in systemic conditions and in therapeutics where, optic nerve and retinal architecture can be assessed to monitor progression of systemic conditions and its response to treatment. This is a narrative review aimed at evaluating the debate surrounding the role of spectral domain optical coherence tomography, in systemic conditions where optic nerve affection can be measured and be used in the diagnosis, monitoring and assessment of treatment effect as a non-invasive, quick, novel technique.
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Affiliation(s)
| | - Qusay Al-Fahad
- Birmingham Midland Eye Centre, Birmingham, UK; Machen Eye Unit, South Warwickshire Foundation Trust, Warwick, UK
| | - Samer Elsherbiny
- Birmingham Midland Eye Centre, Birmingham, UK; Machen Eye Unit, South Warwickshire Foundation Trust, Warwick, UK
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25
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Optical coherence tomography (OCT) findings in obstructive sleep apnea. Sleep Med Rev 2018; 42:231. [PMID: 30274746 DOI: 10.1016/j.smrv.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/22/2018] [Indexed: 11/24/2022]
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26
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Response to letter to editor "Optical coherence tomography (OCT) findings in obstructive sleep apnea" by Piotr Kanclerz. Sleep Med Rev 2018; 42:232-233. [PMID: 30274745 DOI: 10.1016/j.smrv.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/20/2022]
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27
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Teberik K, Eski MT, Balbay EG, Kaya M. Evaluation of Intraocular pressure, Corneal thickness, and Retinal nerve fiber layer thickness in patients with Obstructive Sleep Apnea Syndrome. Pak J Med Sci 2018; 34:817-822. [PMID: 30190734 PMCID: PMC6115545 DOI: 10.12669/pjms.344.15018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the intraocular pressure (IOP), central corneal thickness (CCT), and peripapillary retinal nerve fiber layer (RNFL) thickness in Patients with Obstructive Sleep Apnea Syndrome. Methods: In this prospective study, 103 patients with OSAS (study group) and 37 healthy subjects were enrolled. All participants underwent comprehensive ophthalmic examinations. Mean outcome measures were intraocular pressure by Goldmann applanation tonometry, CCT measurement using ultrasound pachymeter and peripapillary RNFL thickness measured by spectral-domain optical coherence tomography. Results: The differences between the mean values of RNFL thickness in all quadrants were similar in both groups and were not statistically significant (p=0.274). The IOP and CCT measurement averages of all patients with OSAS were lower than the control group. However, this difference was not statistically significant. There was no correlation between the apnea-hypopnea index, lowest oxygen saturation (LAST) or Body Mass Index (BMI) and the peripapillary RNFL thickness, IOP or CCT when OSAS group was divided by severity. Conclusions: The study results suggest that peripapillary RNFL thickness, IOP or CCT did not differ significantly between OSAS and control groups. We also found no correlation between apnea severity (AHI), lowest oxygen saturation (LAST) and BMI and RNFL, CCT and IOP.
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Affiliation(s)
- Kuddusi Teberik
- Kuddusi Teberik, MD.Assistant Professor, Department of Ophthalmology, Duzce University Medical School, Duzce, Turkey
| | - Mehmet Tahir Eski
- Mehmet Tahir Eski, MD.Ministry of Health Bingol State Hospital, Bingol, Turkey
| | - Ege Gulec Balbay
- Ege Gulec Balbay, MD.Associate Professor, Department of Chest Diseases, Duzce University Medical School, Duzce, Turkey
| | - Murat Kaya
- Murat Kaya, MD.Professor, Department of Ophthalmology, Duzce University Medical School, Duzce, Turkey
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28
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Casas P, Ascaso FJ, Vicente E, Tejero-Garcés G, Adiego MI, Cristóbal JA. Visual field defects and retinal nerve fiber imaging in patients with obstructive sleep apnea syndrome and in healthy controls. BMC Ophthalmol 2018; 18:66. [PMID: 29499674 PMCID: PMC5833149 DOI: 10.1186/s12886-018-0728-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 02/21/2018] [Indexed: 11/22/2022] Open
Abstract
Background To assess the retinal sensitivity in obstructive sleep apnea hypopnea syndrome (OSAHS) patients evaluated with standard automated perimetry (SAP). And to correlate the functional SAP results with structural parameters obtained with optical coherence tomography (OCT). Methods This prospective, observational, case-control study consisted of 63 eyes of 63 OSAHS patients (mean age 51.7 ± 12.7 years, best corrected visual acuity ≥20/25, refractive error less than three spherical or two cylindrical diopters, and intraocular pressure < 21 mmHg) who were enrolled and compared with 38 eyes of 38 age-matched controls. Peripapillary retinal nerve fiber layer (RNFL) thickness was measured by Stratus OCT and SAP sensitivities and indices were explored with Humphrey Field Analyzer perimeter. Correlations between functional and structural parameters were calculated, as well as the relationship between ophthalmologic and systemic indices in OSAHS patients. Results OSAHS patients showed a significant reduction of the sensitivity for superior visual field division (p = 0.034, t-student test). When dividing the OSAHS group in accordance with the severity of the disease, nasal peripapillary RNFL thickness was significantly lower in severe OSAHS than that in controls and mild-moderate cases (p = 0.031 and p = 0.016 respectively, Mann-Whitney U test). There were no differences between groups for SAP parameters. We found no correlation between structural and functional variables. The central visual field sensitivity of the SAP revealed a poor Pearson correlation with the apnea-hipopnea index (0.284, p = 0.024). Conclusions Retinal sensitivity show minor differences between healthy subjects and OSAHS. Functional deterioration in OSAHS patients is not easy to demonstrate with visual field examination.
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Affiliation(s)
- Paula Casas
- Department of Ophthalmology, Hospital Clínico Universitario "Lozano Blesa", San Juan Bosco 15, ES-50009, Zaragoza, Spain.
| | - Francisco J Ascaso
- Department of Ophthalmology, Hospital Clínico Universitario "Lozano Blesa", San Juan Bosco 15, ES-50009, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Eugenio Vicente
- Department of Otolaryngology, Hospital Universitario "Miguel Servet", Zaragoza, Spain
| | - Gloria Tejero-Garcés
- Department of Otolaryngology, Hospital Universitario "Miguel Servet", Zaragoza, Spain
| | - María I Adiego
- Department of Otolaryngology, Hospital Universitario "Miguel Servet", Zaragoza, Spain
| | - José A Cristóbal
- Department of Ophthalmology, Hospital Clínico Universitario "Lozano Blesa", San Juan Bosco 15, ES-50009, Zaragoza, Spain
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Gao YY, Wang HJ, Wu Y. Superficial punctate keratopathy in a pediatric patient was related to adenoid hypertrophy and obstructive sleep apnea syndrome: a case report. BMC Ophthalmol 2018; 18:55. [PMID: 29471795 PMCID: PMC5824558 DOI: 10.1186/s12886-018-0720-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Known causes of superficial punctuate keratopathy (SPK) in children include entropion, viral infection, blepharokeratoconjunctivitis (BKC), and toxicity of eye drops. However, there are some SPK patients whose causes could not be identified well. Herein, we describe the history, diagnosis, treatment, and prognosis of a rare case. CASE PRESENTATION To report a case of superficial punctate keratopathy (SPK) which coexisted with floppy eyelid syndrome (FES) and presented as intermittent red eye and blurred vision in an 11-year-old boy who slept in the prone position. His condition did not improve despite treatment with topical antibiotics (levofloxacin, tobramycin), steroid eye drops (prednisolone), and artificial tears. The patient was diagnosed with tonsil hypertrophy and nasopharyngeal adenoid hypertrophy and obstructive sleep apnea syndrome (OSAS). He underwent tonsillectomy and adenoidectomy. Then he started sleeping in the supine position postoperatively. The SPK, red eye and blurred vision completely resolved after surgery without additional treatment. The corneal sensation also recovered gradually during the next 7 years. However, the floppy eyelid did not resolve. CONCLUSION Recurrent SPK of childhood might be related to tonsil hypertrophy, adenoid hypertrophy and OSAS, which can be rehabilitated by a surgical approach.
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Affiliation(s)
- Ying-Ying Gao
- Department of Ophthalmology, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, 362000, China.
| | - Hong-Juan Wang
- Department of Ophthalmology, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - You Wu
- Department of Ophthalmology, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian, 362000, China
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30
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Peripapillary retina nerve fiber layer thickness and macular ganglion cell layer thickness in patients with obstructive sleep apnea syndrome. Eye (Lond) 2017; 32:701-706. [PMID: 29271421 DOI: 10.1038/eye.2017.279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/12/2017] [Indexed: 12/30/2022] Open
Abstract
PurposeTo investigate the association of the severity of obstructive sleep apnea syndrome (OSAS) with peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GC-IPL).Materials and methodsIn this cross-sectional study, 145 patients with OSAS and 40 healthy subjects were enrolled. OSAS patients were further divided into mild (n=50), moderate (n=36), and severe (n=59) OSAS groups according to their apnea-hypopnea index (AHI) values. Spectral-domain optical coherence tomography was used to measure the peripapillary RNFL and GC-IPL thicknesses.ResultsThere was no statistical difference between the RNFL thickness in OSAS and control groups (P>0.05). Both average GC-IPL and minimum GC-IPL thicknesses were significantly lower in severe OSAS group than in healthy controls (P<0.05 for both). There was a significant negative correlation between AHI and both average GC-IPL (r=-0.232, P=0.005) and minimum GC-IPL (r=-0.233, P=0.005) thicknesses.ConclusionsOur study results suggest that although RNFL thickness did not differ significantly between OSAS and control groups, ganglion cell layer thickness in OSAS patients is much lower than in healthy population. Ganglion cell thickness showed a significant correlation with the severity of OSAS.
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31
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Ascaso FJ, Marco S, Mateo J, Martínez M, Esteban O, Grzybowski A. Optical Coherence Tomography in Patients with Chronic Migraine: Literature Review and Update. Front Neurol 2017; 8:684. [PMID: 29321760 PMCID: PMC5733482 DOI: 10.3389/fneur.2017.00684] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/30/2017] [Indexed: 01/27/2023] Open
Abstract
Migraine is a chronic disease characterized by unilateral, pulsating, and often moderate-to-severe recurrent episodes of headache with nausea and vomiting. It affects approximately 15% of the general population, yet the underlying pathophysiological mechanisms are not fully understood. Optical coherence tomography (OCT) is a safe and reproducible diagnostic technique that utilizes infrared wavelengths and has a sensitivity of 8–10 μm. It can be used to measure thinning of the retinal nerve fiber layer (RNFL) in some neurological disorders. Although ophthalmologists are often the first specialists to examine patients with migraine, few studies have addressed the involvement of the optic nerve and retino-choroidal structures in this group. We reviewed the literature on the etiological and pathological mechanisms of migraine and the relationship between recurrent constriction of cerebral and retrobulbar vessels and ischemic damage to the optic nerve, retina, and choroid. We also assessed the role of OCT for measuring peripapillary RNFL thickness and macular and choroidal changes in migraine patients. There is considerable evidence of cerebral and retrobulbar vascular involvement in the etiology of migraine. Transitory and recurrent constriction of the retinal and ciliary arteries may cause ischemic damage to the optic nerve, retina, and choroid in patients with migraine. OCT to assess the thickness of the peripapillary RNFL, macula, and choroid might increase our understanding of the pathophysiology of migraine and facilitate diagnosis of retino-choroidal compromise and follow-up of therapy in migraine patients. Future studies should determine the usefulness of OCT findings as a biomarker of migraine.
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Affiliation(s)
- Francisco J Ascaso
- Department of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IIS Aragon), Zaragoza, Spain
| | - Sara Marco
- Department of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Javier Mateo
- Department of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Mireya Martínez
- Department of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Olivia Esteban
- Department of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Andrzej Grzybowski
- Department of Ophthalmology, Poznan City Hospital, Poznan, Poland.,University of Warmia and Mazury, Olsztyn, Poland
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32
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Yazgan S, Erboy F, Celik HU, Ornek T, Ugurbas SH, Kokturk F, Ayar O, Akdemir MO, Celik E. Peripapillary Choroidal Thickness and Retinal Nerve Fiber Layer in Untreated Patients with Obstructive Sleep Apnea-Hypopnea Syndrome: A Case-Control Study. Curr Eye Res 2017; 42:1552-1560. [PMID: 28910165 DOI: 10.1080/02713683.2016.1266661] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate peripapillary choroidal thickness (PPCT), central macular choroidal thickness (CMCT), and retinal nerve fiber layer (RNFL) thickness in untreated patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS This prospective, randomized, and comparative study was conducted in a university ophthalmology clinic. 106 eyes of 106 patients with OSAHS and 44 eyes of 44 healthy individuals were evaluated in this study. Only right eyes were evaluated. The patients with OSAHS were divided into three groups as mild (group 1), moderate (group 2), and severe (group 3) according to apnea-hypopnea index. The PPCT, CMCT, and RNFL measurements were performed by using spectral domain optical coherence tomography with enhanced depth imaging technique. The main parameters assessed were PPCT-Temporal, PPCT-Superior, PPCT-Nasal, PPCT-Inferior quadrants, CMCT, and RNFL thicknesses. RESULTS The PPCT of all quadrants was significantly thicker in the control group compared with the moderate and severe subgroups of OSAHS (p < 0.05). The PPCT-Superior and PPCT-Temporal were significantly thinner in the mild subgroup compared with the control group (p = 0.003 and p = 0.028, respectively). There was no difference between the control and mild groups regarding the RNFL thicknesses except nasal RNFL and inferotemporal RNFL which are thinner in the mild group. The RNFL thicknesses of all quadrants were significantly thicker in the control group compared with moderate and severe subgroups (p < 0.05). The CMCT was significantly thicker in the control group compared with all subgroups of OSAHS (p < 0.05). CONCLUSIONS In OSAHS patients, PPCT, CMCT, and RNFL were significantly thinner compared with the control group. These results may explain why OSAHS patients are prone to normotensive glaucoma.
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Affiliation(s)
- Serpil Yazgan
- a Medical Faculty, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Fatma Erboy
- b Medical Faculty, Department of Ophthalmology , Medeniyet University , Istanbul , Turkey
| | - Haci Ugur Celik
- c Medical Faculty, Department of Thoracic Medicine , Bulent Ecevit University , Zonguldak , Turkey
| | - Tacettin Ornek
- b Medical Faculty, Department of Ophthalmology , Medeniyet University , Istanbul , Turkey
| | - Suat Hayri Ugurbas
- a Medical Faculty, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Firuzan Kokturk
- d Medical Faculty, Department of Biostastics , Bülent Ecevit University , Zonguldak , Turkey
| | - Orhan Ayar
- a Medical Faculty, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Mehmet Orcun Akdemir
- a Medical Faculty, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Erkan Celik
- a Medical Faculty, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
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33
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Wang JS, Xie HT, Jia Y, Zhang MC. Retinal nerve fiber layer thickness changes in obstructive sleep apnea syndrome: a systematic review and Meta-analysis. Int J Ophthalmol 2016; 9:1651-1656. [PMID: 27990371 DOI: 10.18240/ijo.2016.11.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 04/20/2016] [Indexed: 12/31/2022] Open
Abstract
AIM To evaluate the retinal nerve fiber layer (RNFL) thickness changes in patients with obstructive sleep apnoea syndrome (OSAS), and detect possible prevalence of glaucoma in this population. METHODS Comprehensive studies were conducted on the Cochrane Library, PubMed and Embase through March, 2015. Only studies that fit the selection criteria about RNFL and OSAS would be included. For the measures, we calculated the 95% confidence interval (CI) and weighted mean differences (WMD). The systematic review and Meta-analysis was performed by RevMan 5.2 software. RESULTS Nine case-control studies were analyzed containing a total of 1086 cases and 580 controls. Average RNFL thickness in OSAS was reduced significantly compared with healthy controls in random effects model (WMD=-2.56, 95% CI: -4.82 to -0.31, P =0.003, I2=57%). A significant RNFL thickness reduction were found between the two groups in inferior quadrant (WMD=-3.11, 95% CI: -5.53 to -0.69, P=0.01), superior quadrant (WMD=-2.37, 95%CI: -4.7 to 0.04, P=0.05). In nasal quadrant (WMD=-2.54, 95% CI: -6.53 to 1.45, P=0.21) and temporal quadrant (WMD=-1.26, 95% CI: -2.19 to 0.47, P=0.15) there was no difference of RNFL thickness between the two groups. CONCLUSION The results show that RNFL thickness is lower in patients with moderate or severe OSAS than in normal subjects or patients with mild OSAS according to the nine homogeneity studies.
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Affiliation(s)
- Jia-Song Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Ye Jia
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Ming-Chang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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34
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Wang W, He M, Huang W. Changes of Retinal Nerve Fiber Layer Thickness in Obstructive Sleep Apnea Syndrome: A Systematic Review and Meta-analysis. Curr Eye Res 2016; 42:796-802. [PMID: 27854132 DOI: 10.1080/02713683.2016.1238942] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE Many studies have assessed the changes of retinal nerve fiber layer (RNFL) thickness in patients with obstructive sleep apnea syndrome (OSAS), but the results were inconsistent. Therefore, a meta-analysis was performed to evaluate the RNFL changes in OSAS measured in vivo. METHODS Pertinent studies were identified by a comprehensive search of PubMed, Embase, Web of science, Cochrane library, Scopus, and Chinese biomedical disc databases from inception to August 2016. A fixed effects model was used to pool the weighted mean difference (WMD) and 95% confidence interval (CI) between OSAS group and control group. RESULTS Seventeen studies were included in the final analysis, with 12 for descriptive analysis and 5 for meta-analysis, involving a total of 1757 eyes (1106 in the OSAS group and 651 in the control group). The RNFL in OSAS was significantly lower than control group, with pooled WMD -3.53 (95%CI: -4.80 to -2.26, P < 0.001) for average RNFL, -3.69 (95%CI:-5.49 to -1.89 P < 0.001) for superior RNFL, -4.66 (95%CI: -6.92 to -2.39, P < 0.001) for inferior RNFL, -3.15 (95%CI:-5.19 to -1.10, P = 0.003) for nasal RNFL, and -2.45 (95%CI: -4.59 to -0.31, P = 0.025) for temporal RNFL. Along with severities of OSAS, a trend of more profound reduction of average RNFL was observed in advanced OSAS, with WMD of average RNFL thickness -1.75 (95%CI:-4.47 to -0.98, P = 0.209) for mild OSAS, -3.54 (95%CI:-6.33 to -0.73, P = 0.013) for moderate OSAS, and -7.17 (95%CI:-10.00 to -4.34, P < 0.001) for severe OSAS. The majority of studies in the descriptive review demonstrated similar findings. CONCLUSION The OSAS was associated with a reduced RNFL in all quadrants compared to controls. Evaluation of RNFL may serve as a tool for grading severities of OSAS. Considering the limited evidence, the conclusions should be interpreted cautiously.
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Affiliation(s)
- Wei Wang
- a Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology , Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Miao He
- a Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology , Sun Yat-Sen University , Guangzhou , People's Republic of China
| | - Wenyong Huang
- a Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology , Sun Yat-Sen University , Guangzhou , People's Republic of China
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Sun CL, Zhou LX, Dang Y, Huo YP, Shi L, Chang YJ. Decreased retinal nerve fiber layer thickness in patients with obstructive sleep apnea syndrome: A meta-analysis. Medicine (Baltimore) 2016; 95:e4499. [PMID: 27512867 PMCID: PMC4985322 DOI: 10.1097/md.0000000000004499] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To investigate the changes of retinal nerve fiber layer (RNFL) thickness in obstructive sleep apnea syndrome (OSAS) patients. METHODS Relevant studies were selected from 3 major literature databases (PubMed, Cochrane Library, and EMBASE) without language restriction. Main inclusion criteria is that a case-control study in which RNFL thickness was measured by a commercial available optical coherence tomography (OCT) in OSAS patients. Meta-analysis was performed using STATA 12.0 software. Efficacy estimates were evaluated by weighted mean difference with corresponding 95% confidence intervals (CIs). Primary outcome evaluations were: the average changes of RNFL thickness in total OSAS patients, subgroup analysis of RNFL thickness changes in patients of different OSAS stages, and subgroup analysis of 4-quadrant RNFL thickness changes in total OSAS patients. RESULTS Of the initial 327 literatures, 8 case-control studies with 763 eyes of OSA patients and 474 eyes of healthy controls were included (NOS scores ≥6). For the people of total OSAS, there had an average 2.92 μm decreased RNFL thickness compared with controls (95% CI: -4.61 to -1.24, P = 0.001). For subgroup analysis of OSAS in different stages, the average changes of RNFL thickness in mild, moderate, severe, and moderate to severe OSAS were 2.05 (95% CI: -4.40 to 0.30, P = 0.088), 2.32 (95% CI: -5.04 to 0.40, P = 0.094), 4.21 (95% CI: -8.36 to -0.06, P = 0.047), and 4.02 (95% CI: -7.65 to -0.40, P = 0.03), respectively. For subgroup analysis of 4-quadrant, the average changes of RNFL thickness in Superior, Nasal, Inferior, and Temporal quadrant were 2.43 (95% CI: -4.28 to -0.57, P = 0.01), 1.41 (95% CI: -3.33 to 0.51, P = 0.151), 3.75 (95% CI: -6.92 to -0.59, P = 0.02), and 0.98 (95% CI: -2.49 to 0.53, P = 0.203), respectively. CONCLUSION Our study suggests that RNFL thickness in OSAS patients is much thinner than healthy population, especially in superior and inferior quadrant. The impact of OSAS disease on RNFL and visual function should be taken seriously in the further study.
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Affiliation(s)
- Cheng-Lin Sun
- Department of Ophthalmology, The Fifth Affiliated Hospital of Zhengzhou University
| | - Li-Xiao Zhou
- Department of Ophthalmology, The Fifth Affiliated Hospital of Zhengzhou University
| | - Yalong Dang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yin-Ping Huo
- Department of Ophthalmology, The Fifth Affiliated Hospital of Zhengzhou University
| | - Lei Shi
- Department of Ophthalmology, The Fifth Affiliated Hospital of Zhengzhou University
| | - Yong-Jie Chang
- Department of Ophthalmology, The Fifth Affiliated Hospital of Zhengzhou University
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The association between ophthalmologic diseases and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath 2016; 20:1145-1154. [PMID: 27230013 DOI: 10.1007/s11325-016-1358-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/04/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the association between obstructive sleep apnea (OSA) and ophthalmologic diseases, specifically glaucoma, nonarteritic anterior ischemic optic neuropathy (NAION), retinal vein occlusion (RVO), central serous chorioretinopathy (CSR), and floppy eyelid syndrome (FES), by performing a systematic review and meta-analysis of published studies. METHODS PubMed, Embase, and Scopus databases were searched for observational studies on OSA and its association with select ophthalmologic diseases. Data was pooled for random-effects modeling. The association between OSA and ophthalmologic diseases was summarized using an estimated pooled odds ratio with a 95 % confidence interval. RESULTS Relative to non-OSA subjects, OSA subjects have increased odds of diagnosis with glaucoma (pooled odds ratio (OR) = 1.242; P < 0.001) and floppy eyelids syndrome (pooled OR = 4.157; P < 0.001). In reverse, the overall pooled OR for OSA was 1.746 (P = 0.002) in the glaucoma group, 3.126 (P = 0.000) in the NAION group, and 2.019 (P = 0.028) in the CSR group. For RVO, one study with 5965 OSA patients and 29,669 controls demonstrated a 1.94-fold odds increase in OSA patients. CONCLUSIONS Our results suggest significant associations between OSA and glaucoma, NAION, CSR, and FES. Screening for OSA should be considered in patients with glaucoma, NAION, CSR, or FES.
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Yu JG, Mei ZM, Ye T, Feng YF, Zhao F, Jia J, Fu XA, Xiang Y. Changes in Retinal Nerve Fiber Layer Thickness in Obstructive Sleep Apnea/Hypopnea Syndrome: A Meta-Analysis. Ophthalmic Res 2016; 56:57-67. [PMID: 27198559 DOI: 10.1159/000444301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/25/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate and compare changes in retinal nerve fiber layer (RNFL) thickness in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS The Cochrane Library, Medline, and Embase were screened using our key words. Results were carefully reviewed to ensure that the included studies met the inclusion/exclusion criteria, and the quality of the studies was assessed using the Newcastle-Ottawa Scale. All included studies categorized patients with OSAHS into 3 groups (mild, moderate, and severe), and measured average and 4-quadrant (temporal, superior, nasal, and inferior) RNFL thickness. All studies included a healthy control group. The weighted mean differences and 95% confidence intervals were calculated for the continuous outcomes. RESULTS Ten case-control studies were included in the meta-analysis, consisting of a total of 811 OSAHS group and 868 healthy eyes. A meta-analysis of the data showed that the average RNFL thicknesses in the mild, moderate, and severe OSAHS groups were significantly decreased compared to healthy controls. Additionally, RNFL thickness was significantly reduced in all but the temporal quadrant in the moderate and severe OSAHS groups when compared to healthy controls. CONCLUSIONS On the basis of these results, we suggest that peripapillary RNFL thickness as measured by optical coherence tomography could be a useful tool to monitor and assess the severity of OSAHS in patients. Further studies are required in order to differentiate these RNFL changes from glaucomatous changes. This has not been properly examined in any of the studies we were able to identify.
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Affiliation(s)
- Ji-Guo Yu
- Department of Ophthalmology, Central Hospital of Wuhan, Wuhan, China
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Ferrandez B, Ferreras A, Calvo P, Abadia B, Marin JM, Pajarin AB. Assessment of the retinal nerve fiber layer in individuals with obstructive sleep apnea. BMC Ophthalmol 2016; 16:40. [PMID: 27090783 PMCID: PMC4835866 DOI: 10.1186/s12886-016-0216-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 04/12/2016] [Indexed: 01/06/2023] Open
Abstract
Background The effect of obstructive sleep apnea (OSA) syndrome in the peripapillary retinal nerve fiber layer (RNFL) thicknesses remains unclear. The purpose of this study was to assess RNFL measurements acquired using scanning laser polarimetry (SLP) and optical coherence tomography (OCT) in patients with OSA. Methods The sample of this cross-sectional study included 40 OSA patients and 45 age-matched controls, consecutively and prospectively selected. All participants underwent at least one reliable standard automated perimetry (SAP) test, while RNFL measurements were obtained using the SLP and OCT. The OSA group was divided into 3 sub-groups based on the apnea/hypopnea index (AHI): mild, moderate, or severe OSA. SAP, SLP, and OCT outcomes were compared between the control and OSA groups. The relationship between AHI and RNFL parameters was also evaluated. Results Age was not different between both groups. Mean deviation of SAP was −0.47 ± 0.9 dB and −1.43 ± 2.3 dB in the control and OSA groups, respectively (p = 0.01). RNFL thickness measured with OCT was similar between groups. OSA patients showed increased nerve fiber indicator (NFI; 20.9 ± 7.9 versus 16.42 ± 7.82; p = 0.01) and decreased superior average (59.74 ± 10.35 versus 63.73 ± 6.58; p = 0.03) obtained with SLP compared with healthy individuals. In the total sample, NFI and AHI were moderately correlated (r = 0.358; p = 0.001). In severe OSA subjects (n = 22), NFI and AHI had a Spearman correlation coefficient of 0.44 (p = 0.04). Conclusion RNFL thickness measured with OCT did not differ significantly between groups. Severe OSA was related to a reduction of the RNFL thickness assessed by SLP.
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Affiliation(s)
- Blanca Ferrandez
- Department of Ophthalmology, IIS-Aragon, Miguel Servet University Hospital, Isabel la Catolica 1-3, 50009, Zaragoza, Spain
| | - Antonio Ferreras
- Department of Ophthalmology, IIS-Aragon, Miguel Servet University Hospital, Isabel la Catolica 1-3, 50009, Zaragoza, Spain. .,University of Zaragoza, Zaragoza, Spain.
| | - Pilar Calvo
- Department of Ophthalmology, IIS-Aragon, Miguel Servet University Hospital, Isabel la Catolica 1-3, 50009, Zaragoza, Spain.,University of Zaragoza, Zaragoza, Spain
| | - Beatriz Abadia
- Department of Ophthalmology, IIS-Aragon, Miguel Servet University Hospital, Isabel la Catolica 1-3, 50009, Zaragoza, Spain
| | - Jose M Marin
- University of Zaragoza, Zaragoza, Spain.,Department of Pneumology, Miguel Servet University Hospital, Zaragoza, Spain
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Ozge G, Dogan D, Koylu MT, Ayyildiz O, Akincioglu D, Mumcuoglu T, Mutlu FM. Retina nerve fiber layer and choroidal thickness changes in obstructive sleep apnea syndrome. Postgrad Med 2016; 128:317-22. [PMID: 26918297 DOI: 10.1080/00325481.2016.1159118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the effects of obstructive sleep apnea syndrome (OSAS) on the submacular and peripapillary retinal nerve fiber layer (RNFL) and choroidal thickness (ChT). METHODS Eighty-four eyes of 42 male patients with OSAS and 112 eyes of 56 aged-matched and body mass index-matched healthy male subjects were enrolled in this case-control study. The ChT and peripapillary RNFL thickness was measured using enhanced depth imaging optical coherence tomography. The ChT and RNFL thickness measurements of the groups were compared, and correlations among the Apnea Hypopnea Index (AHI) values and these measurements were calculated. Right and left eyes were separately evaluated. RESULTS There were no significant differences in the subfoveal and temporal ChT between the groups (p > 0.05). The OSAS group had significantly thicker ChT at 0.5 and 1.5 mm nasal to the fovea in both eyes than the control group (p < 0.05). The peripapillary ChT were significantly thicker in the OSAS group at all segments except for the temporal and superotemporal segments when compared with the control group (p < 0.05 for all quadrants except temporal and superotemporal). When compared with controls, the OSAS group had significantly thinner nasal RNFL thickness in the right eye (p = 0.01) and thinner mean RNFL thickness in both eyes (p < 0.001). Other RNFL thickness measurements were similar between groups (p > 0.05). Between AHI and mean RNFL thickness showed a median negative correlation (r = - 0.411, p = 0.001). CONCLUSION The choroidal thickening in patients with OSAS may be associated with the pathophysiology of the neurodegeneration process of the disease.
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Affiliation(s)
- Gokhan Ozge
- a Department of Ophthalmology , Gulhane Military Medical Academy , Ankara , Turkey
| | - Deniz Dogan
- b Department of Pulmonary Disease , Gulhane Military Medical Academy , Ankara , Turkey
| | - Mehmet Talay Koylu
- c Department of Ophthalmology , Tatvan Military Hospital , Bitlis , Turkey
| | - Onder Ayyildiz
- a Department of Ophthalmology , Gulhane Military Medical Academy , Ankara , Turkey
| | - Dorukcan Akincioglu
- a Department of Ophthalmology , Gulhane Military Medical Academy , Ankara , Turkey
| | - Tarkan Mumcuoglu
- a Department of Ophthalmology , Gulhane Military Medical Academy , Ankara , Turkey
| | - Fatih Mehmet Mutlu
- a Department of Ophthalmology , Gulhane Military Medical Academy , Ankara , Turkey
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Chaitanya A, Pai VH, Mohapatra AK, Ve RS. Glaucoma and its association with obstructive sleep apnea: A narrative review. Oman J Ophthalmol 2016; 9:125-134. [PMID: 27843225 PMCID: PMC5084493 DOI: 10.4103/0974-620x.192261] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Obstructive sleep apnea (OSA) is one of the systemic risk factors for glaucoma which causes irreversible visual field (VF) damage. We reviewed the published data of all types of studies on the association between these two conditions and papers regarding functional and structural changes related to glaucomatous damage using Scopus, web of science, and PubMed databases. There is evidence that the prevalence of glaucoma is higher in OSA patients, which independent of intraocular pressure (IOP). Studies have reported thinning of retinal nerve fiber layer (RNFL), alteration of optic nerve head, choroidal and macular thickness, and reduced VF sensitivity in patients of OSA with no history glaucoma. A negative correlation of apnea-hypopnea index with RNFL and VF indices has been described in some studies. Raised IOP was noted which is possibly related to obesity, supine position during sleep, and raised intracranial pressure. Diurnal fluctuations of IOP show more variations in OSA patients before and after continuous positive airway pressure (CPAP) therapy when compared with the normal cases. The vascular factors behind the pathogenesis include recurrent hypoxia with increased vascular resistance, oxidative stress damage to the optic nerve. In conclusion, comprehensive glaucoma evaluation should be recommended in patients with OSA and should also periodically monitor IOP during CPAP treatment which may trigger the progression of glaucomatous damage.
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Affiliation(s)
- Aditya Chaitanya
- Department of Optometry, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
| | - Vijaya H Pai
- OEU Institute of Ophthalmology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Aswini Kumar Mohapatra
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Ramesh S Ve
- Department of Optometry, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
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Ulusoy S, Erden M, Dinc ME, Yavuz N, Caglar E, Dalgic A, Erdogan C. Effects of Use of a Continuous Positive Airway Pressure Device on Glaucoma. Med Sci Monit 2015; 21:3415-9. [PMID: 26547930 PMCID: PMC4642866 DOI: 10.12659/msm.895897] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to investigate the prevalence of glaucoma in obstructive sleep apnea syndrome (OSAS) and to determine the efficacy of the equipment used in the treatment of this disease. Material/Methods In this cross-sectional study, 38 patients with OSAS used the continuous positive airway pressure (CPAP) device (Group 1) and 32 patients with OSAS refused CPAP device (Group 2). Thirty-six patients did not have OSAS (Group 3). Results Patient age, gender, height, weight, and neck circumference did not differ among groups (p>0.05); and the apnea-hypopnea index (AHI) and respiratory disturbance index (RDI) values did not differ between Groups 1 and 2 (p>0.05). Vision and pachymetric values did not differ among groups (p>0.05). The IOP was significantly higher in Group 2 than in Group 1 (p<0.05) but did not differ between Groups 1 and 3 (p>0.05). The fundus C/D ratio was significantly higher (p<0.05) in Group 2 than in the other groups but did not differ between Groups 1 and 3 (p>0.05). In Group 1, 2, and 3, 5.2%, 12.5%, and 0%, respectively, of patients had glaucoma. Conclusions OSAS should be considered a significant risk factor for glaucoma. Eye tests may help to identify individuals with undiagnosed OSAS, and such testing of patients with diagnosed OSAS may allow early detection of glaucoma and referral of such patients for CPAP therapy to prevent development of complications.
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Affiliation(s)
- Seckin Ulusoy
- ENT Clinics, TR Ministry of Health, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Meltem Erden
- Ophthalmology Clinics, TR Ministry of Health, Corlu State Hospital, Tekirdag, Turkey
| | - Mehmet Emre Dinc
- ENT Clinics, TR Ministry of Health, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | | | - Erdem Caglar
- ENT Clinics, TR Ministry of Health, Kiziltepe State Hospital, Mardin, Turkey
| | - Abdullah Dalgic
- ENT Clinics, TR Ministry of Health, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Coskun Erdogan
- Ophtalmology Clinics, Dunya Goz Eye Hospital, Erzincan, Turkey
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Cinici E, Tatar A. Thickness alterations of retinal nerve fiber layer in children with sleep-disordered breathing due to adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2015; 79:1218-23. [PMID: 26066851 DOI: 10.1016/j.ijporl.2015.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 05/13/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study is designed to assess whether hypoxia which is caused by apnea and hypopnea episodes, has an effect on retinal nerve fiber layer (RNFL) thickness, using optical coherence tomography (OCT) in pediatric patients with Adenotonsillar hypertrophy (ATH). METHODS Fifty-seven children patient with AHT, and 31 healthy non-AHT children (between 6 and 12 ages) were enrolled in this study. Obstructive symptoms of the patients with ATH were assessed by using OSA-18 survey. The patients were divided into 2 groups as mild (>60 and <80) and severe (>80) OSAS patients, according to OSA-18 survey total scores. RNFL thickness, in the four quadrants (superior, nasal, inferior and temporal) patient's both eyes, was measured by optical coherence tomography. RNFL parameters of control and patient groups were compared. Correlation between OSA survey scores and RNFL thickness of the patient groups were examined. RESULTS A positive correlation was found between ages and RNLF thickness of all subjects enrolled in this study (r=+0.107, p<0.05). And also a poor correlation was found between OSA-18 survey scores and RNFL parameters in patient group (between -0.031 and +0.016 at right and left eyes, p>0.05). No statistically significant alteration in RNFL thickness was found between the patient and control groups (p>0.05). CONCLUSION Age range (6-12) of the patients with ATH in our study considers that possible OSAS time was not long enough to affect RNLF thickness. Remembering the risk of optic injury development in children with ATH (in a long term), tonsillectomy and/or adenoidectomy operations shouldn't be delayed.
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Affiliation(s)
- Emine Cinici
- Department of Ophthalmology, Regional Training and Research Hospital, Erzurum, Turkey
| | - Arzu Tatar
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
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Abstract
Over the last decade, there has been an emerging interest in the link between obstructive sleep apnea (OSA) and ocular health. Though the evidence for OSA playing a role in cerebrovascular disease risk seems clear, the same cannot be said for optic neuropathies. The association between OSA and glaucoma or non-arteritic anterior ischemic optic neuropathy (NAION) has been postulated to be secondary to direct hypoxia or mechanisms of optic nerve head vascular dysregulation. Papilledema and increased intracranial pressure have also been reported in OSA and are thought to be due to increased cerebral perfusion pressure and cerebral venous dilation secondary to hypoxia and hypercapnia. This article reviews the evidence for possible pathophysiological links between OSA and optic nerve pathology. The epidemiologic and clinical evidence for an association, direct or indirect, between OSA and glaucoma, non-arteritic anterior ischemic optic neuropathy (NAION), and papilledema or idiopathic intracranial hypertension is presented.
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Affiliation(s)
- Clare L Fraser
- Save Sight Institute, University of Sydney, 8 Macquarie Street, Sydney, NSW, 2000, Australia,
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Karalezli A, Eroglu FC, Kivanc T, Dogan R. Evaluation of choroidal thickness using spectral-domain optical coherence tomography in patients with severe obstructive sleep apnea syndrome: a comparative study. Int J Ophthalmol 2014; 7:1030-4. [PMID: 25540760 DOI: 10.3980/j.issn.2222-3959.2014.06.22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/09/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To assess choroidal thickness in patients with severe obstructive sleep apnea syndrome (OSAS) and compare them with healthy controls, using spectral domain optical coherence tomography (OCT). METHODS In this observational, cross-sectional study, choroidal thicknesses of 23 newly severe OSAS patients and 23 body mass index- age- and sex-matched healthy subjects were measured using a high-speed, high-resolution frequency domain-OCT device (λ=840 nm, 26000 A-scans/s, 5 µm axial resolution). All patients underwent a complete ophthalmic examination before the measurements. OCT measurements were taken at the same time of day (9:00 a.m.), in order to minimize the effects of diurnal variation. RESULTS There was a statistically significant difference in median choroidal thickness between the OSAS patients (201 µm; range 145-237 µm) and the controls (324 µm; range 296-383 µm; P<0.001). There were significant differences at all measurement points (P<0.001 for all). The apnea-hypopnea index (AHI) values were more than 30 in all OSAS patients and the mean AHI was 48.57±6.54. The interexaminer intraclass correlation coefficient (ICC) for the mean choroidal thickness was 0.938 (95%CI, 0.908-0.985) and ICC was greater than 0.90 for all measurement points. CONCLUSION The decreased choroidal thickness of patients with severe OSAS might be related to the the autonomic disregulation associated with this disease. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and OSAS.
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Affiliation(s)
- Aylin Karalezli
- Department of Ophthalmology, School of Medicine, Baskent University, Konya 42080, Turkey
| | - Fatma Corak Eroglu
- Department of Ophthalmology, School of Medicine, Baskent University, Konya 42080, Turkey
| | - Tulay Kivanc
- Department of Pulmonary Medicine, School of Medicine, Baskent University, Konya 42080, Turkey
| | - Rusina Dogan
- Department of Pulmonary Medicine, School of Medicine, Baskent University, Konya 42080, Turkey
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Bayhan HA, Aslan Bayhan S, İntepe YS, Muhafiz E, Gürdal C. Evaluation of the macular choroidal thickness using spectral optical coherence tomography in patients with obstructive sleep apnoea syndrome. Clin Exp Ophthalmol 2014; 43:139-44. [PMID: 24995937 DOI: 10.1111/ceo.12384] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 06/23/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND To assess the choroidal thickness (CT) in patients with obstructive sleep apnoea syndrome (OSAS) and healthy controls. DESIGN Prospective, cross-sectional study PARTICIPANTS Ninety-two eyes of 92 patients with OSAS and 32 eyes of 32 aged and body mass index-matched healthy subjects were enrolled. METHODS OSAS patients were further divided into mild, moderate and severe OSAS groups according to their apnoea hypopnea index (AHI) values. The macular CT and peripapillary retinal nerve fibre layer (RNFL) thickness measurements of the subjects were obtained using spectral domain optical coherence tomography (RTVue-100, Optovue). The CT and RNFL thickness measurements of the groups were compared, and correlations among the AHI values and these measurements were calculated. MAIN OUTCOME MEASURES Choroidal thickness. RESULTS There were no significant differences in subfoveal and temporal CT measurements of the groups. A pairwise comparison between the groups revealed that severe OSAS group has significantly thinner CT than mild OSAS group at 3.0 mm nasal to the fovea. Also, compared with severe OSAS group, the CT measurements at 1.5 mm and 3.0 mm nasal to the fovea were significantly thicker in control eyes (both, P < 0.05). There were weak negative correlations between the nasal CT measurements and AHI in the OSAS group (nasal 1.5 mm, P = 0.002, r = -0.358; nasal 3.0 mm, P = 0.004, r = -0.336). Compared with controls, severe OSAS group had significantly thinner nasal and superior RNFL thickness measurement. CONCLUSIONS Sleep apnoea patients had choroidal structural alterations that may have significance on the pathophysiology of the ophthalmic disorders associated with OSAS.
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Affiliation(s)
- Hasan A Bayhan
- Ophthalmology Department; Bozok University Faculty of Medicine; Yozgat Turkey
| | - Seray Aslan Bayhan
- Ophthalmology Department; Bozok University Faculty of Medicine; Yozgat Turkey
| | - Yavuz S İntepe
- Clinic of Chest Diseases; Bozok University Faculty of Medicine; Yozgat Turkey
| | - Ersin Muhafiz
- Ophthalmology Department; Bozok University Faculty of Medicine; Yozgat Turkey
| | - Canan Gürdal
- Ophthalmology Department; Bozok University Faculty of Medicine; Yozgat Turkey
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Shiba T, Takahashi M, Sato Y, Onoda Y, Hori Y, Sugiyama T, Bujo H, Maeno T. Relationship between severity of obstructive sleep apnea syndrome and retinal nerve fiber layer thickness. Am J Ophthalmol 2014; 157:1202-8. [PMID: 24508162 DOI: 10.1016/j.ajo.2014.01.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 01/26/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine whether there is a significant correlation among the peripapillary retinal nerve fiber layer (RNFL) thickness, foveal thickness, total macular volume, and severity of obstructive sleep apnea syndrome. DESIGN Prospective study. METHODS We studied 124 consecutive subjects who underwent polysomnography. Optical coherence tomography (OCT) was used to measure the peripapillary RNFL, foveal thickness, and total macular volume. The Pearson correlation coefficient was used to determine the relationship between the apnea-hypopnea index and OCT and other parameters. Multiple regression analysis was used to determine the independent factors for the RNFL sectors that were the most strongly correlated with the apnea-hypopnea index. RESULTS The apnea-hypopnea index was significantly and negatively correlated (right eye, r = -0.31, P = 0.0004; left eye, r = -0.39, P < 0.0001) with the nasal RNFL thickness (Pearson correlation analysis). The foveal thickness and total macular volume were not correlated. The intraocular pressure, body mass index, plaque score, and incidence of hypertension were negatively correlated, and the lowest oxygen saturation and mean oxygen saturation were positively correlated with the nasal RNFL thickness in the left eye. Multiple regression analysis showed that the apnea-hypopnea index and age were independent contributors to the nasal RNFL thickness in the left eye (apnea-hypopnea index, standard regression coefficient, -0.30, t value, -2.76, P = 0.007; age, -0.24, -2.36, 0.02, respectively). The nasal RNFL thickness in both eyes decreased significantly based on the severity of the obstructive sleep apnea syndrome. CONCLUSION Exacerbation of obstructive sleep apnea syndrome may produce unique retinal neurodegenerative disorders that decrease the nasal RNFL thickness.
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Obstructive sleep apnea-hypopnea syndrome (OSAHS) and glaucomatous optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2014; 252:1345-57. [PMID: 24859387 DOI: 10.1007/s00417-014-2669-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/17/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022] Open
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is becoming widely accepted as a risk factor for glaucoma. We discuss the proposed mechanism involved in the pathogenesis of glaucoma in OSAHS, and review the published data on the association between these two conditions, as well as papers regarding functional and structural tests related with glaucomatous damage. There is increasing evidence that the prevalence of glaucoma is higher in OSAHS patients, especially in those with severe disease with apnea-hypopnea index (AHI) >30, and also that sleep disorders may be more frequent in patients with glaucoma, especially in those with normal tension glaucoma (NTG). Several ophthalmic signs and symptoms have been associated with this condition. Raised intraocular pressure (IOP), possibly related to increased body mass index, thinning of retinal nerve fiber layer (RNFL), and alteration of visual field (VF) indices has been demonstrated in many studies, in patients with no history of glaucoma or evidence of glaucomatous changes in the ophthalmic examination. A correlation of AHI with RNFL and VF indices has been described in some studies. Finally, corneal thinning, suspicious glaucomatous disc changes and anomalies in electrophysiological tests such as multifocal visual evoked potential have been described in patients with OSAHS, even in patients with normal findings in the optic nerve and VF, suggesting subclinical optic nerve involvement not detectable in conventional ophthalmic examinations. The pathogenesis of optic nerve involvement has been related to vascular and mechanical factors. Vascular factors include recurrent hypoxia with increased vascular resistance, autonomic deregulation, oxidative stress and inflammation linked to hypoxia and subsequent reperfusion, decreased cerebral perfusion pressure and direct hypoxic damage to the optic nerve. Proposed mechanical factors include increased IOP at night related to supine position and obesity, raised intracranial pressure and elastic fiber depletion in the lamina cribosa and/or trabeculum. In conclusion, ophthalmic evaluation should be recommended in patients with severe OSAHS, and the presence of sleep disorders should be investigated in patients with glaucoma, especially in NTG patients and in those with progressive damage despite controlled IOP, as treatment with continuous positive airway pressure may contribute to stabilizing the progression of glaucomatous damage.
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Xin C, Zhang W, Wang L, Yang D, Wang J. Changes of visual field and optic nerve fiber layer in patients with OSAS. Sleep Breath 2014; 19:129-34. [PMID: 24807117 DOI: 10.1007/s11325-014-0978-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/25/2014] [Accepted: 03/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prevalence of primary open-angle glaucoma (POAG) increases in obstructive sleep apnea syndrome (OSAS). OSAS could increase cerebrospinal fluid pressure (CSFP) and binocular papilledema. METHODS In this cross-sectional study, intraocular pressure (IOP), CSFP, mean deviation (MD), pattern standard deviation (PSD), optic disc indices, and retinal nerve fiber layer (RNFL) were compared among four groups with different extents of OSAS. Regression analysis was performed to correlate MD, PSD, and RNFL to polysomnography (PSG) index. For subgroups with severe OSAS, IOP and CSFP were compared. The prevalence of POAG was calculated. RESULTS The severe OSAS had a significantly higher CSFP than the other three groups (p = 0.002, 0.036, and 0.017). Both moderate and severe groups showed significantly higher IOP than control group (p = 0.022 and 0.001). MD was correlated with average oxygen saturation (MSaO2) (p = 0.001). PSD was correlated with oxygen desaturation index (ODI) (p = 0.004). Significant differences were found in nasal RNFL and inferior RNFL among the four groups (p = 0.013, p = 0.004). Nasal RNFL correlated with the ODI (p = 0.048). For severe group, compared to normal RNFL group, CSFP was significantly lower in the thinned RNFL group (p = 0.039) and higher in the thickened RNFL group (p = 0.034). Totally, the prevalence of POAG was 5.49 %. CONCLUSIONS OSAS had a high prevalence of POAG. Visual field was damaged and the RNFL was thinned. Due to diverse CSFP, RNFL changed differently in the patients with severe OSAS.
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Affiliation(s)
- Chen Xin
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Street, Chaoyang District, Beijing, China, 100029
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Palau AEB, Morgan ML, Yalamanchili S, Lee AG. Neuro-Ophthalmology Annual Review. Asia Pac J Ophthalmol (Phila) 2014; 3:104-25. [PMID: 26107493 DOI: 10.1097/apo.0000000000000052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to update the practicing ophthalmologist on the English-language neuro-ophthalmology literature from the prior year. This study is a review of English-language literature from August 1, 2012, to August 1, 2013. The authors searched PubMed articles published from August 1, 2012, to August 1, 2013, limited to English-language publications including original articles, review articles, and case reports and excluding letters to the editor, unpublished work, and abstracts. We researched the following topics: pupillary abnormalities, eye movement dysfunction, neuromuscular diseases, optic neuropathies, optic neuritis and demyelinating disease including multiple sclerosis, lesions of the chiasm and posterior primary visual pathways, elevated intracranial pressure, tumors and aneurysms affecting the visual pathways, vascular diseases, higher visual functions, and neuroimaging advances. We intend to share clinically relevant literature of the past year with the practicing ophthalmologist. We aimed to highlight remarkable and interesting literature rather than exhaustively including all new neuro-ophthalmological publications of the year. We reviewed literature in the past year with a focus on relevance and novelty. This review updates the comprehensive ophthalmologist on neuro-ophthalmic topics.
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Affiliation(s)
- Angelina Espino Barros Palau
- From the *Department of Ophthalmology, Houston Methodist Hospital, Houston, TX; †Baylor College of Medicine, Houston, TX; ‡Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, TX; §University of Texas Medical Branch, Galveston, TX; ¶University of Texas M.D. Anderson Cancer Center, Houston, TX; and ∥The University of Iowa Hospitals and Clinics, Iowa City, IA
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