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Meurisse PL, Onen F, Zhao Z, Bastelica P, Baudouin C, Bonay M, Labbe A. [Primary open angle glaucoma and sleep apnea syndrome: A review of the literature]. J Fr Ophtalmol 2024; 47:104042. [PMID: 38306728 DOI: 10.1016/j.jfo.2023.104042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/16/2023] [Indexed: 02/04/2024]
Abstract
The relationship between glaucoma and Obstructive Sleep Apnea Syndrome (OSAS) has long been discussed, with conflicting study findings. OSAS appears in the most recent studies to be more of an aggravating factor than an independent risk factor for glaucoma. Patients with OSAS may develop a more rapid progression of primary open-angle glaucoma (POAG). OSAS may damage the optic nerve not only by increasing the intraocular pressure (IOP) but also by altering the blood supply to the optic nerve as shown by more recent work with OCT-Angiography. Although the systemic benefits of Continuous Positive Airway Pressure (CPAP) have been demonstrated, few studies have evaluated its effect on the optic nerve. CPAP might act on glaucomatous neuropathy by improving the blood supply to the optic nerve. The study of this mechanism of action might provide new insights into the relationship between OSAS and glaucoma.
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Affiliation(s)
- P L Meurisse
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - F Onen
- Department of respiratory physiology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Z Zhao
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - P Bastelica
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - C Baudouin
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28 rue de Charenton, 75012 Paris, France; Sorbonne Universités, Inserm, CNRS, Institut de la vision, IHU FOReSIGHT, 17 rue Moreau, 75012 Paris, France
| | - M Bonay
- Department of respiratory physiology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - A Labbe
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28 rue de Charenton, 75012 Paris, France; Sorbonne Universités, Inserm, CNRS, Institut de la vision, IHU FOReSIGHT, 17 rue Moreau, 75012 Paris, France
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Karabulut M, Bek S, Karabulut S, Karalezli A, Kutlu G. Effects of obstructive sleep apnea on retinal microvasculature. Int J Ophthalmol 2023; 16:1670-1675. [PMID: 37854376 PMCID: PMC10559037 DOI: 10.18240/ijo.2023.10.17] [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: 07/24/2023] [Accepted: 08/18/2023] [Indexed: 10/20/2023] Open
Abstract
AIM To detect retinal microvascular variations in obstructive sleep apnea syndrome patients. METHODS This prospective, observational case-control study included healthy controls and patients with mild, moderate, and severe obstructive sleep apnea syndrome. Vascular parameters, foveal avascular area, and flow areas in macula-centered, 6.00×6.00 mm2 scan size optical coherence tomography angiography images were compared. RESULTS The control group had the highest whole image, parafoveal, and perifoveal vessel density among the groups in both superficial and the deep capillary plexus (all P<0.05). Rapid eye movement sleep apnoea-hypopnoea index was reversely correlated with whole (Rho=-0.195, P=0.034), parafoveal (Rho=-0.242, P=0.008), perifoveal (Rho=-0.187, P=0.045) vessel density in the superficial capillary plexus, and whole (Rho=-0.186, P=0.046), parafoveal (Rho=-0.260, P=0.004), perifoveal (Rho=-0.189, P=0.043) vessel density in the deep capillary plexus, though the mean and non-rapid eye movement sleep apnoea-hypopnoea index related with only parafoveal vessel density in the superficial capillary plexus (Rho=-0.213, P=0.020; Rho=-0.191, P=0.038) and the deep capillary plexus (Rho=-0.254, P=0.005; Rho=-0.194, P=0.035). CONCLUSION This study shows decreased vessel density and its reverse correlation with the apnoea-hypopnoea index in patients with obstructive sleep apnea syndrome.
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Affiliation(s)
- Müjdat Karabulut
- Ophthalmology Department, Mugla Sıtkı Kocman University Training and Research Hospital, Mugla 48300, Türkiye
| | - Semai Bek
- Neurology Department, Mugla Sıtkı Koçman University Faculty of Medicine, Mugla 48300, Türkiye
| | - Sinem Karabulut
- Ophthalmology Department, Mugla Sıtkı Kocman University Training and Research Hospital, Mugla 48300, Türkiye
| | - Aylin Karalezli
- Ophthalmology Department, Mugla Sıtkı Koçman University Faculty of Medicine, Mugla 48300, Türkiye
| | - Gülnihal Kutlu
- Neurology Department, Mugla Sıtkı Koçman University Faculty of Medicine, Mugla 48300, Türkiye
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Altinel MG, Uslu H, Kanra AY, Dalkilic O. Effect of obstructive sleep apnoea syndrome and continuous positive airway pressure treatment on choroidal structure. Eye (Lond) 2022; 36:1977-1981. [PMID: 34621030 PMCID: PMC9500031 DOI: 10.1038/s41433-021-01790-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To evaluate the effect of obstructive sleep apnoea syndrome (OSAS) and continuous positive airway pressure (CPAP) therapy on choroidal structural changes and choroidal vascularity index (CVI) in patients with OSAS. METHODS Choroidal structural changes in patients with OSAS immediately after diagnosis and 12 months after CPAP treatment were evaluated and compared with healthy controls. The choroidal images on enhanced depth imaging optical coherence tomography (EDI-OCT) were binarized into luminal area (LA) and stromal area (SA) using the ImageJ software. CVI was calculated as the ratio of LA to total choroid area (TCA). The correlations between the results of polysomnography (PSG) and choroidal parameters were evaluated. RESULTS A total of 48 eyes of 48 patients (22 patients with OSAS, and 26 controls) were included. The mean age of the patients was 47.21 ± 8.82 (range, 30-63) years. The mean CVI values were 68.10 ± 1.80% in the OSAS group before CPAP therapy, and 69.22 ± 1.40% in the control group (p < 0.05). After 12 months of regular CPAP therapy, the mean CVI value increased significantly to 69.15 ± 1.77%, and SA decreased significantly from 0.51 ± 0.07 mm2 to 0.48 ± 0.07 mm2 in the OSAS group (p < 0.05). No statistically significant correlation was found between the results of PSG and choroidal structural parameters. CONCLUSION According to our results, OSAS was associated with increased stromal oedema in the choroid, which improved after 12 months of regular CPAP therapy. CVI can be an important parameter for the follow-up of patients with OSAS.
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Affiliation(s)
- Meltem Guzin Altinel
- Saglik Bilimleri University Fatih Sultan Mehmet Training and Research Hospital, Department of Ophthalmology, 34752, Istanbul, Turkey.
| | - Hasim Uslu
- Hisar Intercontinental Hospital, Department of Ophthalmology, 34768, Istanbul, Turkey
| | - Ayse Yagmur Kanra
- Saglik Bilimleri University Sultan Abdulhamid Han Training and Research Hospital, Department of Ophthalmology, 34668, Istanbul, Turkey
| | - Orhan Dalkilic
- Hisar Intercontinental Hospital, Department of Chest Diseases, 34768, Istanbul, Turkey
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Au SCL. Comments on choroidal changes due to long-term use of N95 face masks. Photodiagnosis Photodyn Ther 2021; 37:102656. [PMID: 34848377 DOI: 10.1016/j.pdpdt.2021.102656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Sunny Chi Lik Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, 9/F, MO Office, Lo Ka Chow Memorial Ophthalmic Centre, 19 Eastern Hospital Road, Causeway Bay, HKSAR, Hong Kong.
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Uslu H, Altinel MG. Comparison of the choroidal structural components and choroidal vascularity index between patients with obstructive sleep apnea syndrome and healthy controls. Photodiagnosis Photodyn Ther 2021; 36:102570. [PMID: 34619384 DOI: 10.1016/j.pdpdt.2021.102570] [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: 04/14/2021] [Revised: 09/11/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
AIM To compare the choroidal structural components and choroidal vascularity index (CVI) between patients with obstructive sleep apnea syndrome (OSAS) and healthy controls. METHODS The choroidal images of the eyes of patients with OSAS and healthy controls, which were obtained by using enhanced depth imaging optical coherence tomography (EDI-OCT), were binarized into luminal area (LA) and stromal area (SA) using the ImageJ software. CVI was calculated as the ratio of LA to the total choroid area (TCA). The CVI, LA, SA, and TCA measurements were compared between the groups. RESULTS Seventy-one eyes of 57 patients, 33 eyes of 27 patients with OSAS and 38 eyes of 30 healthy individuals, were included. The mean age of all patients was 46.77±9.75 (range, 30-67) years. There was no statistically significant difference for age, sex, axial length (AL) or the side of the eyes between the groups (p>0.05). The mean body mass index (BMI) of the patients was significantly higher in the OSAS group (p<0.05). The mean CVI value was 68.33±1.81% in the OSAS group and 69.21±1.27% in the control group (p<0.05). There was no statistically significant difference for the mean values of LA, SA, and TCA between the groups (p>0.05). No significant correlation was found between the polysomnography test results and the choroidal measurements (p>0.05). CONCLUSION In our study, CVI was found to be lower in patients with OSAS than in the healthy controls. Further studies with larger sample sizes are required to evaluate the role of CVI in OSAS.
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Affiliation(s)
- Hasim Uslu
- Hisar Intercontinental Hospital, Department of Ophthalmology, 34768 Istanbul, Turkey.
| | - Meltem Guzin Altinel
- Saglik Bilimleri University Fatih Sultan Mehmet Training and Research Hospital, Department of Ophthalmology, 34752 Istanbul, Turkey.
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The Associations of Obstructive Sleep Apnea and Eye Disorders: Potential Insights into Pathogenesis and Treatment. CURRENT SLEEP MEDICINE REPORTS 2021. [DOI: 10.1007/s40675-021-00215-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Abstract
Purpose of Review
Obstructive sleep apnea (OSA) patients are at significantly increased risks for cardiovascular and cerebrovascular morbidities. Recently, there has been heightened interest in the association of OSA with numerous ocular diseases and possible improvement of these conditions with the initiation of OSA treatment. We reviewed the current evidence with an emphasis on the overlapping pathogeneses of both diseases.
Recent Findings
Currently available literature points to a substantial association of OSA with ocular diseases, ranging from those involving the eyelid to optic neuropathies and retinal vascular diseases. Since the retina is one of the highest oxygen-consuming tissues in the body, the intermittent hypoxia and hypercapnia ensuing in OSA can have deleterious effects on ocular function and health. Tissue hypoxia, autonomic dysfunction, microvascular dysfunction, and inflammation all play important roles in the pathogenesis of both OSA and ocular diseases. Whether OSA treatment is capable of reversing the course of associated ocular diseases remains to be determined. It is anticipated that future therapeutic approaches will target the common underlying pathophysiologic mechanisms and promote favorable effects on the treatment of known associated ocular diseases.
Summary
Emerging evidence supports the association of ocular diseases with untreated OSA. Future studies focusing on whether therapeutic approaches targeting the common pathophysiologic mechanisms will be beneficial for the course of both diseases are warranted.
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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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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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ASSOCIATION OF OBSTRUCTIVE SLEEP APNEA WITH CENTRAL SEROUS CHORIORETINOPATHY AND CHOROIDAL THICKNESS: A Systematic Review and Meta-Analysis. Retina 2018; 38:1642-1651. [PMID: 29474303 DOI: 10.1097/iae.0000000000002117] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) has been associated with an array of ocular disorders. This systematic review aims to investigate the association of OSA with central serous chorioretinopathy (CSCR) and subfoveal choroidal thickness changes on enhanced depth imaging optical coherence tomography. METHODS Systematic review and meta-analysis of all articles published up to November 2017 examining rate of OSA in patients with CSCR versus controls or examining subfoveal choroidal thickness measurements on enhanced depth imaging optical coherence tomography in patients with OSA versus controls. Pooled odds ratios and weighted mean difference with 95% confidence intervals (CIs) were calculated. RESULTS For the CSCR/OSA analysis, 7,238 patients (1,479 with CSCR and 5,759 controls) from 6 studies were eligible. For the choroidal thickness/OSA analysis, 778 eyes of 778 patients (514 with OSA and 264 controls) from 9 studies were eligible. Patients with CSCR had a 1.56 increased odds of having OSA than controls (odds ratio, 1.56; 95% CI, 1.16-2.10). There was no statistically significant difference in choroidal thickness between mild OSA subjects and controls (weighted mean difference = -3.17; 95% CI, -19.10 to 12.76). Patients with moderate OSA (weighted mean difference = -24.14; 95% CI, -42.16 to -6.12) and severe OSA (weighted mean difference = -51.19; 95% CI, -99.30 to -3.08) had thinner choroidal thickness measurements than controls. CONCLUSION In summary, our results suggest that patients with CSCR are more likely to have OSA, and that moderate/severe OSA is associated with smaller subfoveal choroidal measurements on enhanced depth imaging optical coherence tomography.
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Farooq A, Frazier H, Marcus WB, Fechter C, Singh H, Marcus DM. Intravitreal Aflibercept for Neovascular Polypoidal Choroidal Vasculopathy in a Predominantly Non-Asian Population: RIVAL Results. Ophthalmic Surg Lasers Imaging Retina 2017; 48:34-52. [PMID: 28060392 DOI: 10.3928/23258160-20161219-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/02/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate safety and efficacy of intravitreal aflibercept (Eylea; Regeneron, Tarrytown, NY) injection (IAI) for the treatment of neovascular polypoidal choroidal vasculopathy (PCV) in a predominantly non-Asian population. PATIENTS AND METHODS This was an open-label, prospective, unmasked, nonrandomized clinical trial. Twenty eyes with neovascular PCV received monthly 2.0 mg IAI for 3 months followed by mandatory IAI every 2 months for 12 months. RESULTS The mean change in ETDRS best-corrected visual acuity from baseline to 1 year was +11 letters in the treatment-naïve group, +5 letters in the treatment non-naïve group, and +9 letters overall. There was an overall mean reduction of 70 µm from baseline central subfield thickness (CST) at 1 year. Patients received a mean of 6.2 mandatory and 0.7 additional IAI injections overall during the course of 1 year. No serious ocular adverse events were reported. CONCLUSION At 1 year, neovascular PCV in a predominantly non-Asian population treated with IAI demonstrated favorable visual, anatomic, and safety outcomes. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:34-44.].
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Wang XY, Wang S, Liu X, Ding X, Li M, Han DM. Retinal Vascular Morphological Changes in Patients with Extremely Severe Obstructive Sleep Apnea Syndrome. Chin Med J (Engl) 2017; 130:805-810. [PMID: 28345544 PMCID: PMC5381314 DOI: 10.4103/0366-6999.202728] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS) has been shown to generate hypertension and endothelial dysfunction. Retinal vessel is the only vessel that can be observed directly and noninvasively; retinal vascular abnormalities can serve as a predictive marker for the occurrence, clinical course, and prognosis of cardiovascular and cerebrovascular diseases. The objective of this study was to identify the effect of OSAS severity on the morphological changes of retinal vessels. METHODS Adult patients complained of snoring were included in this study. The patients' general information, polysomnography, and fundus photography parameters including central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole-to-venule ratio (AVR) were collected. Patients were divided into four groups according to their apnea-hypopnea index (AHI) results: Group I, AHI ≤5/h; Group II, 5/h < AHI ≤30/h; Group III, 30/h < AHI ≤60/h; and Group IV, AHI> 60/h. RESULTS A total of 133 patients were included in this study with 111 males (83.5%) and 22 females (16.5%). Mean age was 41.6 ± 9.9 years, and the mean body mass index was 28.1 ± 4.0 kg/m2. AHI ranged between 0 and 130.8/h with a mean of 39.1 ± 30.7/h. There were 24, 34, 35, and 40 patients in Group I, Group II, Group III, and Group IV, respectively. Significant differences were found for AHI (F = 388.368, P< 0.001), minimal pulse oxygen saturation (F = 91.902, P< 0.001), and arousal index (F = 31.014, P< 0.001) among four groups; no significant differences were found for CRAE (F = 0.460, P = 0.599) and CRVE (F = 0.404, P = 0.586) among groups; there were significant differences for AVR between Group I and Group IV (63.6 ± 5.1% vs. 67.2 ± 5.5%, P = 0.010) Group II and Group IV (64.5 ± 6.0% vs. 67.2 ± 5.5%, P = 0.030), and Group III and Group IV (64.7 ± 4.1% vs. 67.2 ± 5.5%, P = 0.043). A main group-by-AHI effect was found on the AVR: patients with higher AHI showed higher AVR results (r = 0.225, P = 0.009). Multivariate logistic regression analysis was used for multi-variable factors. A group-by-age effect was found on the AVR: younger patients showed higher AVR results (β = -0.001, P = 0.020). CONCLUSIONS This study indicated that increased AVR of retinal vessel can be observed in extremely severe OSAS patients. For patients with OSAS, retinal vascular abnormalities may become an early indication for further cardiovascular abnormalities.
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Affiliation(s)
- Xiao-Yi Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Shuang Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xue Liu
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Xiu Ding
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Meng Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - De-Min Han
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Mentek M, Aptel F, Godin-Ribuot D, Tamisier R, Pepin JL, Chiquet C. Diseases of the retina and the optic nerve associated with obstructive sleep apnea. Sleep Med Rev 2017; 38:113-130. [PMID: 29107469 DOI: 10.1016/j.smrv.2017.05.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 03/27/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
Many associations between ocular disorders and obstructive sleep apnea (OSA) have been studied, such as nonarteritic anterior ischemic optic neuropathy, glaucoma, papilledema, retinal vein occlusion, eyelid hyperlaxity, lower-eyelid ectropion and recurrent corneal erosions. The objective of this review is to synthetize the possible vascular disorders of the retina and the optic nerve associated with sleep apnea patients and to discuss the underlying pathophysiological hypotheses. Main mechanisms involved in the ocular complications of OSA are related to intermittent hypoxia, sympathetic system activation, oxidant stress, and deleterious effects of endothelin 1. The main evidence-based medicine data suggest that OSA should be screened in patients with ischemic optic neuropathy and diabetic retinopathy. The effect of OSA treatment and emerging therapies are discussed.
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Affiliation(s)
- Marielle Mentek
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France
| | - Florent Aptel
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Department of Ophthalmology, University Hospital of Grenoble, Grenoble, France
| | - Diane Godin-Ribuot
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France
| | - Renaud Tamisier
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Pôle Thorax et Vaisseaux, University Hospital of Grenoble, Grenoble, France
| | - Jean-Louis Pepin
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Pôle Thorax et Vaisseaux, University Hospital of Grenoble, Grenoble, France
| | - Christophe Chiquet
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France; Department of Ophthalmology, University Hospital of Grenoble, Grenoble, France.
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Li C, Fitzgerald MEC, Del Mar N, Reiner A. Stimulation of Baroresponsive Parts of the Nucleus of the Solitary Tract Produces Nitric Oxide-mediated Choroidal Vasodilation in Rat Eye. Front Neuroanat 2016; 10:94. [PMID: 27774055 PMCID: PMC5053990 DOI: 10.3389/fnana.2016.00094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/21/2016] [Indexed: 01/07/2023] Open
Abstract
Preganglionic parasympathetic neurons of the ventromedial part of the superior salivatory nucleus (SSN) mediate vasodilation of orbital and choroidal blood vessels, via their projection to the nitrergic pterygopalatine ganglion (PPG) neurons that innervate these vessels. We recently showed that the baroresponsive part of the nucleus of the solitary tract (NTS) innervates choroidal control parasympathetic preganglionic neurons of SSN in rats. As this projection provides a means by which blood pressure (BP) signals may modulate choroidal blood flow (ChBF), we investigated if activation of baroresponsive NTS evokes ChBF increases in rat eye, using Laser Doppler Flowmetry (LDF) to measure ChBF transclerally. We found that electrical activation of ipsilateral baroresponsive NTS and its efferent fiber pathway to choroidal SSN increased mean ChBF by about 40-80% above baseline, depending on current level. The ChBF responses obtained with stimulation of baroresponsive NTS were driven by increases in both choroidal blood volume (ChBVol; i.e., vasodilation) and choroidal blood velocity (ChBVel; possibly due to orbital vessel dilation). Stimulation of baroresponsive NTS, by contrast, yielded no significant mean increases in systemic arterial blood pressure (ABP). We further found that the increases in ChBF with NTS stimulation were significantly reduced by administration of the neuronal nitric oxide (NO) synthase inhibitor Nω-propyl-l-arginine (NPA), thus implicating nitrergic PPG terminals in the NTS-elicited ChBF increases. Our results show that the NTS neurons projecting to choroidal SSN do mediate increase in ChBF, and thus suggest a role of baroresponsive NTS in the BP-dependent regulation of ChBF.
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Affiliation(s)
- Chunyan Li
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, TN, USA
| | - Malinda E. C. Fitzgerald
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, TN, USA
- Department of Ophthalmology, The University of Tennessee Health Science CenterMemphis, TN, USA
- Department of Biology, Christian Brothers UniversityMemphis, TN, USA
| | - Nobel Del Mar
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, TN, USA
| | - Anton Reiner
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science CenterMemphis, TN, USA
- Department of Ophthalmology, The University of Tennessee Health Science CenterMemphis, TN, USA
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Choroidal thickness changes in obstructive sleep apnea syndrome: a systematic review and meta-analysis. Sleep Breath 2016; 20:369-78. [PMID: 26779899 DOI: 10.1007/s11325-015-1306-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/15/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Obstructive sleep apnea syndrome (OSAS) is a common chronic disorder associated with hypoxia and endothelial and vascular dysfunction. Many studies have analyzed choroidal thickness measurements in patients with different severities of OSAS versus normal subjects by optical coherence tomography (OCT), but the results have been inconsistent. Therefore, a meta-analysis was performed to evaluate the choroidal thickness changes in OSAS measured by OCT. METHODS Pertinent studies were retrieved by a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library from inception to August 2015. For continuous outcomes, the weighted mean difference (WMD) and 95 % confidence interval (CI) were calculated by using a random effects model. RESULTS Seven case-control studies were included in the final meta-analysis, containing a total of 784 eyes (558 in the OSAS group and 226 in normal controls). The results showed that subfoveal choroidal thickness (SFCT) was significantly reduced compared with normal controls, with pooled WMD -8.06 (95 % CI -15.72 to -0.41) for mild OSAS, -29.99 (95 % CI -52.40 to -7.58) for moderate OSAS, and -53.72 (95 % CI -88.95 to -18.48) for severe OSAS. Choroidal thickness at 1 mm temporal to the fovea and at 1 mm nasal to the fovea were also significantly lower than those in the normal controls (WMD = -28.94, 95 % CI -43.78 to -14.10 and WMD = -20.90, 95 % CI -36.62 to -5.18). CONCLUSION This meta-analysis suggests that choroidal thickness was reduced in OSAS. Considering the non-invasive nature of OCT, OCT could be a useful tool for grading the severity of OSAS.
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15
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Cheng RW, Yusof F, Tsui E, Jong M, Duffin J, Flanagan JG, Fisher JA, Hudson C. Relationship between retinal blood flow and arterial oxygen. J Physiol 2015; 594:625-40. [PMID: 26607393 DOI: 10.1113/jp271182] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/19/2015] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Vascular reactivity, the response of the vessels to a vasoactive stimulus such as hypoxia and hyperoxia, can be used to assess the vascular range of adjustment in which the vessels are able to compensate for changes in PO2. Previous studies in the retina have not accurately quantified retinal vascular responses and precisely targeted multiple PaO2 stimuli at the same time as controlling the level of carbon dioxide, thus precluding them from modelling the relationship between retinal blood flow and oxygen. The present study modelled the relationship between retinal blood flow and PaO2, showing them to be a combined linear and hyperbolic function. This model demonstrates that the resting tonus of the vessels is at the mid-point and that they have great vascular range of adjustment, compensating for decreases in oxygen above a PETCO2 of 32-37 mmHg but being limited below this threshold. Retinal blood flow (RBF) increases in response to a reduction in oxygen (hypoxia) but decreases in response to increased oxygen (hyperoxia). However, the relationship between blood flow and the arterial partial pressure of oxygen has not been quantified and modelled in the retina, particularly in the vascular reserve and resting tonus of the vessels. The present study aimed to determine the limitations of the retinal vasculature by modelling the relationship between RBF and oxygen. Retinal vascular responses were measured in 13 subjects for eight different blood gas conditions, with the end-tidal partial pressure of oxygen (PETCO2) ranging from 40-500 mmHg. Retinal vascular response measurements were repeated twice; using the Canon laser blood flowmeter (Canon Inc., Tokyo, Japan) during the first visit and using Doppler spectral domain optical coherence tomography during the second visit. We determined that the relationship between RBF and PaO2 can be modelled as a combination of hyperbolic and linear functions. We concluded that RBF compensated for decreases in arterial oxygen content for all stages of hypoxia used in the present study but can no longer compensate below a PETCO2 of 32-37 mmHg. These vessels have a great vascular range of adjustment, increasing diameter (8.5% arteriolar and 21% total venous area) with hypoxia (40 mmHg P ETC O2; P < 0.001) and decreasing diameter (6.9% arteriolar and 23% total venous area) with hyperoxia (500 mmHg PETCO2; P < 0.001) to the same extent. This indicates that the resting tonus is near the mid-point of the adjustment ranges at resting PaO2 where sensitivity is maximum.
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Affiliation(s)
- Richard W Cheng
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Firdaus Yusof
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.,Department of Optometry and Visual Science, International Islamic University of Malaysia, Bandar Indera Mahkota, Pahang, Malaysia
| | - Edmund Tsui
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Monica Jong
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Brien Holden Vision Institute, University of New South Wales, Sydney, NSW, Australia
| | - James Duffin
- Department of Physiology, University of Toronto, Toronto, ON, Canada.,Thornhill Research Inc, Toronto, ON, Canada.,Department of Anesthesiology, Toronto General Hospital, Toronto, ON, Canada
| | - John G Flanagan
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,School of Optometry, University of California Berkeley, Berkeley, CA, USA
| | - Joseph A Fisher
- Department of Physiology, University of Toronto, Toronto, ON, Canada.,Thornhill Research Inc, Toronto, ON, Canada.,Department of Anesthesiology, Toronto General Hospital, Toronto, ON, Canada
| | - Chris Hudson
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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16
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High-dose ranibizumab monotherapy for neovascular polypoidal choroidal vasculopathy in a predominantly non-Asian population. Eye (Lond) 2015; 29:1427-37. [PMID: 26337944 DOI: 10.1038/eye.2015.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/06/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine safety and efficacy of intravitreal high-dose ranibizumab in the treatment of active neovascular polypoidal choroidal vasculopathy (PCV). METHODS In this Phase I/II, single-center, randomized, controlled, double-masked study, predominantly non-Asian, previously treated or treatment-naive, male and female adult patients were randomized to receive high-dose (1.0/0.1 ml or 2.0 mg/0.05 ml; n=15) or standard-dose (0.5 mg/0.05 ml; n=5) ranibizumab in 3 monthly loading doses, followed by 9 months of criteria-based, as-needed retreatment. Safety was evaluated by a descriptive analysis of all non-serious and serious adverse events, angiographic assessments, physical examinations, vital signs, ocular examinations, and visual acuity measurements. Visual acuity and anatomic outcomes are described for the high-dose group. RESULTS Twenty patients (aged 35-76 years; 8 Black, 11 White, 1 Asian) were enrolled. At baseline, in the high-dose group, mean best-corrected visual acuity (BCVA) was 63.5 letters (Snellen equivalent ~20/50), and mean baseline central foveal thickness (CFT) was 253.7 μm. High-dose ranibizumab was generally well tolerated without evidence of ocular or systemic severe adverse events, including arterial thromboembolic events. At month 12, in the high-dose group, the mean overall change from baseline in BCVA was +6.7 letters and in CFT was -49.7 μm. CONCLUSION High-dose ranibizumab monotherapy is safe and efficacious for treating patients with PCV.
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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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18
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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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20
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Zengin MÖ, Öz T, Baysak A, Çinar E, Küçükerdönmez C. Changes in choroidal thickness in patients with obstructive sleep apnea syndrome. Ophthalmic Surg Lasers Imaging Retina 2014; 45:298-304. [PMID: 24972390 DOI: 10.3928/23258160-20140624-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/20/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate choroidal thickness using spectral-domain optical coherence tomography (SD-OCT) in patients with obstructive sleep apnea syndrome (OSAS) in comparison to healthy controls. PATIENTS AND METHODS This observational, comparative study consisted of 35 patients with OSAS and 32 age- and sex-matched controls. The controls did not have systemic or ocular diseases. All study participants underwent complete ophthalmic examination as well as choroidal thickness measurement using a high-speed, high-resolution SD-OCT device. RESULTS The mean horizontal and vertical choroidal thicknesses, respectively, were 237.84 ± 69.9 μm and 234.97 ± 62.0 μm (P = .654) in patients with OSAS and 244.09 ± 41.2 μm and 241.88 ± 40.9 μm (P = .590) in the healthy controls. The mean choroidal thicknesses were thinner in patients with OSAS, but the difference was not significant (P > .05 for all values). CONCLUSION No differences in choroidal thickness were found between patients with OSAS and healthy controls.
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21
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Fraser CL, Bliwise DL, Newman NJ, Lamirel C, Collop NA, Rye DB, Trotti LM, Biousse V, Bruce BB. A prospective photographic study of the ocular fundus in obstructive sleep apnea. J Neuroophthalmol 2014; 33:241-6. [PMID: 23736744 DOI: 10.1097/wno.0b013e318290194f] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of optic nerve and retinal vascular changes within the obstructive sleep apnea (OSA) population are not well-known, although it has been postulated that optic nerve ischemic changes and findings related to an elevated intracranial pressure may be more common in OSA patients. We prospectively evaluated the ocular fundus in unselected patients undergoing overnight diagnostic polysomnography (PSG). METHODS Demographic data, medical/ocular history, and nonmydriatic fundus photographs were prospectively collected in patients undergoing PSG at our institution and reviewed for the presence of optic disc edema for which our study was appropriately powered a priori. Retinal vascular changes were also evaluated. OSA was defined using the measures of both sleep-disordered breathing and hypoxia. RESULTS Of 250 patients evaluated in the sleep center, fundus photographs were performed on 215 patients, among whom 127 patients (59%) had an apnea/hypopnea index (AHI) ≥ 15 events per hour, including 36 with severe OSA. Those with AHI <15 served as the comparison group. None of the patients had optic disc edema (95% confidence interval [CI]: 0%-3%). There was no difference in rates of glaucomatous appearance or pallor of the optic disc among the groups. Retinal arteriolar changes were more common in severe OSA patients (odds ratio: 1.09 per 5 unit increase in AHI; 95% CI, 1.02-1.16; P = 0.01), even after controlling for mean arterial blood pressure. CONCLUSIONS We did not find an increased prevalence of optic disc edema or other optic neuropathies in our OSA population. However, retinal vascular changes were more common in patients with severe OSA, independent of blood pressure.
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Affiliation(s)
- Clare L Fraser
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
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22
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Prilipko O, Huynh N, Thomason ME, Kushida CA, Guilleminault C. An fMRI study of cerebrovascular reactivity and perfusion in obstructive sleep apnea patients before and after CPAP treatment. Sleep Med 2014; 15:892-8. [PMID: 24916094 DOI: 10.1016/j.sleep.2014.04.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/05/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Cerebrovascular reactivity is impaired in patients suffering from obstructive sleep apnea syndrome (OSAS) as demonstrated by transcranial Doppler studies. We use magnetic resonance imaging techniques to investigate the anatomical distribution of cerebrovascular reactivity changes in patients with OSAS, as well as their evolution after therapeutic and sham continuous positive airway pressure (CPAP) treatment. METHODS Twenty-three men with moderate or severe obstructive sleep apnea were compared to a healthy control group (n=7) using a breath-holding functional magnetic resonance imaging task and the flow-sensitive alternating inversion recovery (FAIR) imaging before and after 2 months of therapeutic (active) or sub-therapeutic (sham) CPAP treatment. RESULTS Significantly higher cerebrovascular reactivity was found in healthy controls as compared to patients in bilateral cortical and subcortical brain regions. Cerebrovascular reactivity increased with therapeutic CPAP in the thalamus and decreased with sham CPAP in medial frontal regions in OSAS patients. Duration of nocturnal hypoxemia and body mass index negatively correlated with cerebrovascular reactivity, particularly in the medial temporal lobe structures, suggesting a possible pathophysiological mechanism for hippocampal injury. There was no difference in perfusion between patients and control group, and no effect of CPAP or sham-CPAP treatment on perfusion in patients. CONCLUSIONS Observed cerebrovascular reactivity changes were neither homogeneous throughout the brain nor followed vascular territories, but rather corresponded to underlying neuronal networks, establishing a relationship between cerebrovascular reactivity and surrounding neuronal activity.
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Affiliation(s)
- Olga Prilipko
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, CA, USA.
| | - Nelly Huynh
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, CA, USA
| | - Moriah E Thomason
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA; Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI, USA
| | - Clete A Kushida
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, CA, USA
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Alberto EC, Tanigawa T, Maruyama K, Kawasaki Y, Eguchi E, Mori H, Yoshimura K, Tanno S, Sakurai S, Hitsumoto S, Saito I. Relationships between Nocturnal Intermittent Hypoxia, Arterial Stiffness and Cardiovascular Risk Factors in a Community-based Population: The Toon Health Study. J Atheroscler Thromb 2014; 21:1290-7. [DOI: 10.5551/jat.24505] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Phillips CL, Butlin M, Wong KK, Avolio AP. Is obstructive sleep apnoea causally related to arterial stiffness? A critical review of the experimental evidence. Sleep Med Rev 2012; 17:7-18. [PMID: 22658640 DOI: 10.1016/j.smrv.2012.03.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 03/07/2012] [Accepted: 03/07/2012] [Indexed: 12/11/2022]
Abstract
Large elastic arteries and smaller muscular conduit arteries become stiffer with ageing, a process that is accelerated in the presence of cardiovascular disease (CVD). In recent years, numerous techniques have been developed to measure arterial stiffness, either in single vessels or in entire muscular arterial trees. These techniques have increasingly been shown to improve stratification of cardiovascular risk and risk reduction beyond that provided by conventional risk factors. Obstructive sleep apnoea (OSA) has been increasingly linked with excess cardiovascular morbidity and mortality however the mechanisms are still not well understood. Robustly designed studies have shown that treatment of OSA with nasal continuous positive airway pressure improves important intermediate risk factors for CVD including hypertension and endothelial function. More recently, there has been increased exploration of arterial stiffness in both cross-sectional and interventional studies in OSA patients. This review aims to give the reader a better understanding of the measurement and pathophysiology of arterial stiffness as well as providing an indication of how well a prognostic indicator are the various measures of arterial stiffness for hard cardiovascular endpoints. A critical appraisal is then provided of cross-sectional and interventional studies that have explored these same techniques in OSA populations.
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Affiliation(s)
- Craig L Phillips
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia.
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