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Christian KH, Petitti C, Oretga-Schwartz K, Mulder E, Noppe A, von der Wiesche M, Stern C, Young M, Macias BR, Laurie SS, Lovering AT. Development of optic disc edema during 30 days of hypercapnic head-down tilt bed rest is associated with short sleep duration and blunted temperature amplitude. J Appl Physiol (1985) 2024; 136:753-763. [PMID: 38357726 DOI: 10.1152/japplphysiol.00211.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
Sleep and circadian temperature disturbances occur with spaceflight and may, in part, result from the chronically elevated carbon dioxide (CO2) levels on the international space station. Impaired sleep may contribute to decreased glymphatic clearance and, when combined with the chronic headward fluid shift during actual spaceflight or the spaceflight analog head-down tilt bed rest (HDTBR), may contribute to the development of optic disc edema. We determined if strict HDTBR combined with mildly elevated CO2 levels influenced sleep and core temperature and was associated with the development of optic disc edema. Healthy participants (5 females) aged 25-50 yr, underwent 30 days of strict 6° HDTBR with ambient Pco2 = 4 mmHg. Measures of sleep, 24-h core temperature, overnight transcutaneous CO2, and Frisén grade edema were made pre-HDTBR, on HDTBR days 4, 17, 28, and post-HDTBR days 4 and 10. During all HDTBR time points, sleep, core temperature, and overnight transcutaneous CO2 were not different than the pre-HDTBR measurements. However, independent of the HDTBR intervention, the odds ratios {mean [95% confidence interval (CI)]} for developing Frisén grade optic disc edema were statistically significant for each hour below the mean total sleep time (2.2 [1.1-4.4]) and stage 2 nonrapid eye movement (NREM) sleep (4.8 [1.3-18.6]), and above the mean for wake after sleep onset (3.6 [1.2-10.6]) and for each 0.1°C decrease in core temperature amplitude below the mean (4.0 [1.4-11.7]). These data suggest that optic disc edema occurring during HDTBR was more likely to occur in those with short sleep duration and/or blunted temperature amplitude.NEW & NOTEWORTHY We determined that sleep and 24-h core body temperature were unaltered by 30 days exposure to the spaceflight analog strict 6° head-down tilt bed rest (HDTBR) in a 0.5% CO2 environment. However, shorter sleep duration, greater wake after sleep onset, and lower core temperature amplitude present throughout the study were associated with the development of optic disc edema, a key finding of spaceflight-associated neuro-ocular syndrome.
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Affiliation(s)
- Kate H Christian
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Carla Petitti
- PeaceHealth Sleep Disorders Center, Springfield, Oregon, United States
| | - Kyra Oretga-Schwartz
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Edwin Mulder
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
| | - Alexandra Noppe
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
| | | | - Claudia Stern
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
| | | | | | | | - Andrew T Lovering
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
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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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Díaz DE Terán T, González P, González M, Cerveró A, Nicolini A, Banfi P, Solidoro P, Napal JJ, Valero C. Risk factors in developing retinal vein occlusion in subject with obstructive sleep apnea. Minerva Med 2023; 114:825-831. [PMID: 35315633 DOI: 10.23736/s0026-4806.22.07989-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with obstructive sleep apnea (OSA) have a higher risk of developing vascular diseases. In this study, we evaluated the clinical profile of patients with OSA who develop retinal vein occlusion (RVO) compared with a population of OSA patients without RVO. METHODS We analyzed patients with OSA diagnosed with RVO (21 cases; mean of age 61 years. range 44-87 years. 67% men), belonging to a large cohort of people with long-term follow-up for RVO (up to 12 years). We compared them with 21 patients with OSA, without RVO, matched by age and gender, selected from the Sleep Unit Registry (control group). RESULTS There were no differences in the prevalence of arterial hypertension (AHT) or Diabetes mellitus (DM), but the RVO patients presented a higher diastolic blood pressure compared to controls (87.6±12.6 mmHg vs. 77.9±10.1 mmHg respectively). The polygraphic parameters were similar in both groups. The Apnea-Hypopnea Index (IHA) similar in both groups (30.4±20.9 RVO vs. 33.7±22.1 controls). In addition, RVO patients had a less favorable lipid profile, with higher total cholesterol (218±52 mg/dL vs. 179±41 mg/dL), higher LDL cholesterol (139±47 mg/dL vs. 107±32 mg/dL) and higher atherogenic indices: LDL/HDL (2.78±0.95 RVO vs. 2.03±0.67 controls) and total cholesterol/HDL (4.37±1.08 vs. 3.45±0.84). Among the cases, 81% had peripheral RVO (superior temporal branch in 20 out of 21 cases) and 19% had central RVO. A percentage of 62% of the cases received intravitreal antiangiogenic therapy and dexamethasone implants and 33% received argon laser photocoagulation. CONCLUSIONS Poor control of cardiovascular risk factors, particularly dyslipidemias, in patients with OSA may lead to the development of this ocular complication.
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Affiliation(s)
- Teresa Díaz DE Terán
- Department of Internal Medicine, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Cantabria University, Santander, Spain
| | - Paula González
- Department of Internal Medicine, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Cantabria University, Santander, Spain
| | - Mónica González
- Department of Internal Medicine, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Cantabria University, Santander, Spain
| | - Andrea Cerveró
- Department of Ophthalmology, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | | | - Paolo Solidoro
- Division of Respiratory Diseases, Department of Cardiovascular and Thoracic Medicine, Città della Salute e della Scienza, Turin, Italy
| | - José J Napal
- Department of Internal Medicine, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Cantabria University, Santander, Spain
| | - Carmen Valero
- Department of Internal Medicine, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Cantabria University, Santander, Spain -
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Bulloch G, Seth I, Alphonse S, Sathe A, Jennings M, Sultan D, Rahmeh R, McNab AA. Prevalence of Obstructive Sleep Apnea With Floppy Eyelid Syndrome: A Systematic Review and Meta-analysis. Ophthalmic Plast Reconstr Surg 2023; 39:243-253. [PMID: 36700854 DOI: 10.1097/iop.0000000000002298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE This study investigated the prevalence of obstructive sleep apnea (OSA) in floppy eyelid syndrome (FES) patients and evaluated the severity of OSA with FES prevalence. METHODS Cochrane CENTRAL, Medline, Science Direct, Google Scholar, and PubMed databases were searched for studies on FES patients and its association with OSA syndrome, of any design, published from January 1, 1997, to January 1, 2022. A random-effects model that weighted the studies was used when there was heterogeneity between studies ( p < 0.10) and if I 2 values were more than 50%. All p values were 2-tailed and considered statistically significant if <0.05. RESULTS A total of 12 studies comprising 511 patients were included in this meta-analysis. Of these, 368 were male (77.6%) and the average age was 55.10 years. The overall prevalence of OSA in FES patients was 57.1% (95% CI: 46.5-74.8%), M:F ratio was 48:1 (98% male), and 69.1% of patients received their OSA diagnosis at the time of the study. Of those with FES, tear film abnormalities were the most common ocular comorbidity (78.9%) followed by keratoconus (20.6%), glaucoma (9.8%), and lower eyelid ectropion (4.6%). Obesity was the most common systemic morbidity (43.7%) followed by hypertension (34.0%) and diabetes mellitus (17.9%). CONCLUSION This meta-analysis demonstrates OSA is a common comorbidity in the FES population. Ophthalmologists are often the first to evaluate patients with FES, and considering this coincidence, routine screens for sleep apnea symptoms in at-risk FES patients should be undertaken. Large case-control studies are required to better elucidate the exact prevalence of OSA and other morbidities in patients with FES, and to better understand the etiology of FES.
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Affiliation(s)
- Gabriella Bulloch
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital; Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Ishith Seth
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital; Centre for Eye Research Australia, Melbourne, Victoria, Australia
- Department of Surgery, Bendigo Hospital, Victoria, Australia
| | | | - Aditya Sathe
- Department of Surgery, Bendigo Hospital, Victoria, Australia
| | | | - Dana Sultan
- Department of Ophthalmology, Aleppo University Hospital; Aleppo University, Aleppo, Syria
| | - Rami Rahmeh
- Department of Ophthalmology, Aleppo University Hospital; Aleppo University, Aleppo, Syria
| | - Alan A McNab
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital; Centre for Eye Research Australia, Melbourne, Victoria, Australia
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Yvon C, Hunt S, Malhotra R. The Importance of Identifying Meibomian Gland Inversion in Patients With Floppy Eyelid Syndrome. Ophthalmic Plast Reconstr Surg 2023; 39:156-161. [PMID: 36095840 DOI: 10.1097/iop.0000000000002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Floppy eyelid syndrome (FES) is a common and underdiagnosed condition characterized by eyelid hyperlaxity with reactive palpebral conjunctivitis that can cause ocular irritation. It may be associated with meibomian gland dysfunction (MGD) and secondary tarsal curling, resulting in upper eyelid meibomian gland inversion (MGI) in the absence of obvious marginal entropion. PURPOSE To highlight the possible significance of MGI in patients with FES and report findings and outcomes in patients with concomitant MGI and FES undergoing correction of MGI with or without upper eyelid horizontal tightening. METHODS Retrospective, 5-year, noncomparative, single-center study of patients with FES and MGI, treated with MGI correction, with or without upper eyelid horizontal tightening, under the supervision of a single surgeon. Preoperative symptoms, surgical outcomes, complication rates, and postoperative symptoms were recorded. RESULTS A total of 13 eyes of 9 patients were treated with MGI surgery over the study period. Seven were male. Mean age at the surgery was 63 (range 42-81) years. Two OSs, 3 ODs, and 4 OUs were treated. All patients were "cotton-tip test" positive, and 77% (10/13) had MGI-related superior corneal fluorescein staining. Three patients (33%) had previous standard tightening procedures with recurrence of symptoms within 5 to 24 (mean 16) months. Repeat horizontal tightening had been considered in all these cases before referral to our unit. Mean follow-up was 20 months. Eight patients (88.9%) had improvement of symptoms (n = 3, full resolution; n = 5, partial resolution). All patients demonstrated restoration of the normal anatomical position of the meibomian glands. Superior punctate staining resolved in all eyes. CONCLUSION This study provides a proof of concept that upper eyelid MGI can be present and symptomatic in patients with FES. It may help explain cases where symptoms persist or recur early following standard upper eyelid horizontal tightening. Where superior corneal punctate staining and a positive cotton-tip test exist, surgical correction of MGI, alongside horizontal tightening, may provide better, and longer-lasting symptomatic relief. This study provides evidence for the need for a prospective study to evaluate the contribution of MGI in patients with FES.
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Affiliation(s)
- Camille Yvon
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, Sussex, United Kingdom
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6
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Weiler R, Ahmed OH, Mechelen WV, Verhagen E, Bolling C. Concussion through my eyes: a qualitative study exploring concussion experiences and perceptions of male English blind footballers. Br J Sports Med 2023; 57:578-589. [PMID: 36792363 DOI: 10.1136/bjsports-2022-106256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Athletes with impairments play sports with a risk of sustaining head injuries and concussions. However, the scientific knowledge needed to improve care is lacking. This qualitative study explores English blind 5-a-side footballers' perceptions of concussion, concussion risks and prevention to improve para concussion care. METHODS Nine semi-structured interviews were conducted with male English blind footballers (six current and three retired). Data were analysed by thematic analysis using a six-stage approach. RESULTS Blind footballers were not sure about the number of concussions they had sustained. They lacked an understanding of what to experience when concussed, and they perceived the diagnosis and experience of a concussion to be different for a person without vision. Perceived concussion severity and previous concussion experiences were key concepts affecting their concussion reporting behaviours. Participants mentioned spatial orientation and sleep are important to function in daily life and were affected by concussions. However, these factors are not adequately included in current assessment tools or clinical guidance for sports-related concussions. CONCLUSION Blind footballers suggested the quality and accuracy of reported concussions were impacted by lack of concussion experience, knowledge and concomitant impairment. A better understanding of concussion symptoms and injury mechanisms will improve concussion reporting for athletes with visual impairments. These athlete insights should guide future studies and para sports governing body initiatives to improve concussion reporting, diagnosis and management in para athletes.
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Affiliation(s)
- Richard Weiler
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands .,Para Football Foundation, Arnhem, The Netherlands.,Fortius Clinic, London, UK
| | - Osman Hassan Ahmed
- University Hospitals Dorset NHS Foundation Trust, Poole, UK.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK.,The Football Association, Burton-upon-Trent, UK
| | - Willem van Mechelen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia.,Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline Bolling
- Amsterdam Collaboration on Health & Safety in Sports, Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Floppy Eyelid Syndrome: an Overlooked Comorbidity Among Bariatric Patients. Obes Surg 2023; 33:523-529. [PMID: 36567378 DOI: 10.1007/s11695-022-06410-4] [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: 08/23/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Floppy eyelid syndrome (FES) is a clinical entity characterized by palpebral hyperlaxity and chronic conjunctivitis. Patients' eyelids evert ("flip inside out"), leading to eye irritation, dryness, grittiness, and tearing. More severe cases can lead to significant ocular complications, such as keratoconus and impaired eyesight. Research has revealed an association between FES and obstructive sleep apnea syndrome (OSAS). OSAS is also one of the most common comorbidities among patients with obesity and an indication for bariatric surgery. This is one of the first studies to explore FES in a group of patients who have undergone bariatric surgery. MATERIALS AND METHODS This was a retrospective study. A total of 88 patients completed a survey by mail or telephone. Additional data on demographics and baseline preoperative clinical information was extracted from the online medical records and the MBSAQIP database. RESULTS Thirty-nine patients (44%) recalled having chronic ocular symptoms before their bariatric surgery, among whom six reported palpebral laxity and/or an established diagnosis of FES. The majority of them (67%) rated their symptoms postoperatively as "somewhat" or "significantly improved." The patients that reported improvement in their ocular symptoms also experienced an improvement in their OSAS severity. CONCLUSION Bariatric surgery might affect the clinical course of FES and the severity of symptoms. Treating OSAS, the underlying mechanism of FES, is a possible mechanism of how bariatric surgery can help patients. It is also critical for bariatric surgeons to consider FES when patients with obesity, particularly those with OSAS, present with chronic eye symptoms.
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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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Ava S, Erdem S, Karahan M, Dursun ME, Hazar L, Sen HS, Keklikci U. EVALUATİON OF THE EFFECT OF OBSTRUCTİVE SLEEP APNEA SYNDROME ON RETİNAL MİCROVASCULARİTY BY OPTİCAL COHERENCE TOMOGRAPHY ANGİOGRAPHY. Photodiagnosis Photodyn Ther 2022; 38:102761. [PMID: 35181509 DOI: 10.1016/j.pdpdt.2022.102761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/03/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Using optical coherence tomography angiography (OCTA), we sought to determine whether there are retinal microvascular changes in patients with obstructive sleep apnea syndrome (OSAS). METHOD The study included 56 patients diagnosed with OSAS by polysomnography [21 patients with mild OSAS (group 1), 14 with moderate OSAS (group 2) and 21 with severe OSAS (group 3)], and 26 healthy individuals as a control group (group 4). The vascular densities of the superficial capillary plexus and deep capillary plexus of the retinal segmentations, together with the foveal avascular zone (FAZ) width, were measured for all participants, using OCTA. RESULT Compared with the control group, vascular densitiy in whole image of superficial capillary plexus were found to be significantly lower in group 2. In addition, vascular densitiy in fovea region of superficial capillary plexus was significantly lower in group 1 than the control group. In deep capillary plexus, vascular densitiy of whole image, superior hemi and nasal regions were found to be significantly lower in group 2 and group 3 compared with the control group. Parafoveal region in group 3 had significantly lower vascular densities than the controls. A significantly larger FAZ was also found in group 1 and group 3 in the deep capillary plexus, compared with the controls. CONCLUSION We detected smaller vascular densities in both the superficial capillary plexus and deep capillary plexus and a larger deep capillary plexus FAZ in OSAS patients. Therefore, OCTA may be useful as a non-invasive method to understand the systemic effects of OSAS.
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Affiliation(s)
- Sedat Ava
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
| | - Seyfettin Erdem
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey.
| | - Mine Karahan
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
| | - Mehmet Emin Dursun
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
| | - Leyla Hazar
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
| | - Hadice Selimoglu Sen
- Department of Chest Diseases and Tuberculosis, Dicle University, Faculty of Medicine, Diyarbakir, Turkey
| | - Ugur Keklikci
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakır, Turkey
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Ulutas HG, Balıkcı Tufekci A, Gunes A. Evaluation of corneal, ocular surface, and meibomian gland changes in obstructive sleep apnea syndrome. J Fr Ophtalmol 2021; 45:191-200. [PMID: 34961649 DOI: 10.1016/j.jfo.2021.09.007] [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: 07/21/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the ocular surface, eyelid changes, meibomian gland morphology, corneal endothelial morphology, and corneal topographic measurements in patients with obstructive sleep apnea syndrome (OSAS). METHODS There were 47 patients diagnosed with OSAS and 47 healthy volunteers included in the study. Non-invasive tear break-up time (NITBUT), corneal topography, meibography, and specular microscopy were performed. RESULTS The mean ages of the study and control groups were 45.77±9.65 years and 44.26±8.54 years, respectively (P=0.229). The presence of floppy eye lid (17% vs. 0%; P=0.006) and lid margin abnormality score (1.09±0.8 vs. 0.21±0.51; P<0.001) were significantly different between the study and the control groups. There were insignificant differences between the groups in NITBUT and corneal topographic measurements, except for the ACT (556.96±42.4μm vs. 569±103μm, P=0.037). The mean endothelial cell density (CD) in the OSAS and control groups were 2609±259.96 and 2756±179 cells/mm2, respectively (P=0.002). Meibomian gland loss in the lower and upper eyelids was significantly higher in the OSAS group (P<0.001 for both). CONCLUSION OSAS patients develop eyelid margin abnormalities, loss of meibomian glands, and morphological changes in the meibomian glands. A significant reduction in corneal endothelial CD indicates that systemic hypoxia in OSAS has an effect on the cornea.
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Affiliation(s)
- H G Ulutas
- Department of Ophthalmology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, 16310 Bursa, Turkey.
| | - A Balıkcı Tufekci
- Department of Ophthalmology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, 16310 Bursa, Turkey
| | - A Gunes
- Department of Neurology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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11
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Lee CY, Yeung L, Kuan Jen C, Sun MH, Sun CC. Relationship between Obstructive Sleep Apnea and Central Serous Chorioretinopathy: A Health Insurance Database Study. Ophthalmic Epidemiol 2021; 29:302-309. [PMID: 34016006 DOI: 10.1080/09286586.2021.1925306] [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: 10/21/2022]
Abstract
Purpose: To evaluate the association between obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSCR).Methods: A retrospective, cohort, longitudinal study was conducted using the national health insurance database in Taiwan between 1996 and 2013. Patients diagnosed with OSA were enrolled after exclusion, and a control group with similar age, gender, and major systemic co-morbidities were included in a 1:1 ratio by propensity score matching. The primary outcome is the occurrence of CSCR, and patients with CSCR were categorized via severity for further analysis. The percentage of incident CSCR in the OSA group and control groups and the adjusted hazard ratios (aHR) of CSCR were determined by Cox proportional hazard regression.Results: There were 13,084 patients enrolled in both the OSA group and control groups, respectively. The total event of CSCR was 50 (0.4%) in the OSA group and 25 (0.2%) in the control group (P < .001). Moreover, the OSA group has an increased aHR of 1.9 (P = .012) for developing CSCR. In the subgroup analysis, patients with OSA aged from 30 to 39 and 50 to 59 demonstrated higher risk of developing CSCR compared to the control group, and the presence of OSA would lead to a higher incidence of mild CSCR (all P < .05).Conclusions: OSA patients aged from 30 to 39 and 50 to 59 have a higher risk of developing CSCR, while the severity of CSCR will not be worsen by OSA.
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Affiliation(s)
- Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ling Yeung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen Kuan Jen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Hui Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Research and Development, Chang Gung Memorial Hospital, Keelung, Taiwan
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12
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Links between obstructive sleep apnea and glaucoma neurodegeneration. PROGRESS IN BRAIN RESEARCH 2020; 257:19-36. [PMID: 32988471 DOI: 10.1016/bs.pbr.2020.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the last few years, the possible link between obstructive sleep apnea (OSAS) and glaucoma, has attracted the interest of many scientists, especially in those forms of primary open angle glaucoma (POAG) and normal tension glaucoma (NTG), in which a progression of the disease occurs, even though intraocular pressure (IOP) is in the range of normality. The increased prevalence of POAG or NTG in patients affected by OSAS, and vice versa, has stimulated interest in the pathogenetic mechanisms that could trigger these two diseases. Hypoxia generated by apnea/hypopnea cycles has been identified as the main cause of many changes in the vascular and neurological systems, which alter the functioning not only of the optic nerve, but also of the whole organism. However, many other factors could be involved, like mechanical factors, obesity, hormonal imbalance and other sleep disorders. Furthermore, the demonstration of typical glaucomatous or glaucoma-like changes in the anatomy or function of the optic nerve and retinal nerve fiber layer by sensitive specific and diagnostic methods, such as perimetry, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA) and electrophysiological exams keeps interest high for this field of study. For this reason, further investigations, hopefully a source of stronger scientific evidences, are needed.
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13
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Takahashi A, Negishi K, Ayaki M, Uchino M, Tsubota K. Nocturnal Lagophthalmos and Sleep Quality in Patients with Dry Eye Disease. Life (Basel) 2020; 10:life10070105. [PMID: 32635438 PMCID: PMC7399990 DOI: 10.3390/life10070105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022] Open
Abstract
Nocturnal lagophthalmos (NL) refers to the inability to close the eyelids during sleep, which is known to affect dry eye disease (DED) symptoms and sleep quality. This study aimed to evaluate the prevalence of NL and sleep quality in DED patients. We launched a survey website to recruit 2000 Japanese. The participants were asked to answer a questionnaire about DED, sleep quality, and happiness. Participants were divided into two groups according to the presence of DED, and responses were compared between the groups. The DED group was comprised of 890 subjects (44 ± 13.8 years, 359 males) and women were predominant (p < 0.001). Sleep duration was significantly shorter (p = 0.008), sleep latency was longer (p < 0.001), and sleep efficacy was worse compared with the non-DED group (p < 0.001). Furthermore, people belonging to the DED group were more frequently working night shifts (p < 0.001). NL was more prevalent in the DED group (p = 0.007). Logistic regression analysis showed that NL correlated with younger age, symptomatic DED, and eye symptoms upon waking. The current study suggested that NL was associated with worsened DED symptoms and poor sleep quality. Preventative eye care for lagophthalmos before and during sleep may be helpful for DED and sleep quality.
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Affiliation(s)
- Aya Takahashi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo160-5852, Japan; (M.U.); (K.T.)
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba 272-8513, Japan
- Correspondence: (A.T.); (K.N.); (M.A.)
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo160-5852, Japan; (M.U.); (K.T.)
- Correspondence: (A.T.); (K.N.); (M.A.)
| | - Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo160-5852, Japan; (M.U.); (K.T.)
- Otake Clinic Moon View Eye Center, Kanagawa 242-0001, Japan
- Correspondence: (A.T.); (K.N.); (M.A.)
| | - Miki Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo160-5852, Japan; (M.U.); (K.T.)
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo160-5852, Japan; (M.U.); (K.T.)
- Tsubota Laboratory, Inc., Tokyo 160-8582, Japan
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14
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Duque-Chica GL, Gracitelli CPB, Moura ALA, Nagy BV, Vidal KS, de Melo G, Paranhos A, Cahali MB, Ventura DF. Contributions of the Melanopsin-Expressing Ganglion Cells, Cones, and Rods to the Pupillary Light Response in Obstructive Sleep Apnea. Invest Ophthalmol Vis Sci 2019; 60:3002-3012. [PMID: 31310657 DOI: 10.1167/iovs.19-26944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the impact of obstructive sleep apnea (OSA) on the contribution of inner and outer retinal photoreceptors to the pupillary light response (PLR). Methods Ninety-three eyes from 27 patients with OSA and 25 healthy controls were tested. OSA severity was graded according to the apnea-hypopnea index. PLR was measured monocularly with an eye tracker in a Ganzfeld in response to 1-second blue (470 nm) and red (640 nm) flashes at -3, -2, -1, 0, 1, 2, and 2.4 log cd/m2. Peak pupil constriction amplitude, peak latency, and the postillumination pupil response were measured. The Cambridge Colour Test, standard automatic perimetry, spectral domain optical coherence tomography, polysomnography, and the Pittsburgh Sleep Quality Index were used. Results OSA patients have a significantly decreased peak pupil constriction amplitude for blue stimuli at -3, -2, -1, 1 log cd/m2 and at all red flash luminances (P < 0.050), revealing reduction of outer retina contributions to PLR. OSA patients showed reduced peak latency for blue (-2, 0, 2, 2.4 log cd/m2) and red stimuli (-2, 0 log cd/m2; P < 0.040). No significant difference was found in the melanopsin-mediated PLR. Conclusions This study is the first to evaluate the inner and outer retinal contributions to PLR in OSA patients. The results showed that the outer retinal photoreceptor contributions to PLR were affected in moderate and severe OSA patients. In contrast, the inner retina contributions to PLR are preserved.
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Affiliation(s)
- Gloria L Duque-Chica
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Department of Psychology, University of Medellin, Medellin, Colombia
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ana L A Moura
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Balázs V Nagy
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Department of Mechatronics, Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Kallene S Vidal
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Prevent Senior institute, Sao Paulo, Brazil
| | - Geraldine de Melo
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Michel B Cahali
- Department of Otolaryngology, Hospital das Clínicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Dora F Ventura
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil
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Salinas R, Puig M, Fry CL, Johnson DA, Kheirkhah A. Floppy eyelid syndrome: A comprehensive review. Ocul Surf 2019; 18:31-39. [PMID: 31593763 DOI: 10.1016/j.jtos.2019.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/21/2019] [Accepted: 10/03/2019] [Indexed: 01/11/2023]
Abstract
Floppy eyelid syndrome (FES) is defined as eyelid hyperlaxity with reactive palpebral conjunctivitis. It is a common condition that can be associated with significant ocular irritation. FES presents with easily everted eyelids and chronic papillary conjunctivitis in the upper eyelids. It is frequently associated with ocular and systemic diseases, notably keratoconus and obstructive sleep apnea, respectively. This comprehensive review describes the epidemiology, pathological changes, proposed pathogenesis, clinical manifestations, and a variety of treatment options for this condition. Conservative treatment of FES includes aggressive lubrication, nighttime eye shield, and avoiding sleeping on the affected eye. Patients with FES and obstructive sleep apnea may have an improvement in their ocular signs and symptoms after long-term therapy with continuous positive airway pressure. In refractory cases, a corrective surgery that addresses the eyelid laxity can result in significant improvement. All patients with ocular irritation should be evaluated for the presence of FES.
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Affiliation(s)
- Ricardo Salinas
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Madeleine Puig
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Constance L Fry
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Daniel A Johnson
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA.
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16
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Toh ST, Phua CQ, Loh S. Holistic Management of Obstructive Sleep Apnea: Translating Academic Research to Patient Care. Sleep Med Clin 2019; 14:1-11. [PMID: 30709524 DOI: 10.1016/j.jsmc.2018.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A holistic approach is pertinent in managing obstructive sleep apnea (OSA). It goes beyond integrated multidisciplinary assessment and management in the hospital setting. Although clinicians should be aware of different treatment modalities and adjunctive measures, proactive management of OSA is as important. The future of OSA management lies in identifying patients at risk of developing OSA and developing strategy to prevent OSA from taking root. It involves active screening of patients with OSA and treating them and identifying patients with OSA with high risk of preventable serious morbidity and death and intervening early to prevent these from happening.
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Affiliation(s)
- Song Tar Toh
- Department of Otolaryngology, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore.
| | - Chu Qin Phua
- Department of Otolaryngology, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore
| | - Shaun Loh
- Department of Otolaryngology, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore
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Sun MH, Lee CY, Liao YJ, Sun CC. Nonarteritic anterior ischaemic optic neuropathy and its association with obstructive sleep apnoea: a health insurance database study. Acta Ophthalmol 2019; 97:e64-e70. [PMID: 30171667 DOI: 10.1111/aos.13832] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 04/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nonarteritic anterior ischaemic optic neuropathy (NAION) is the most common acute optic neuropathy in old age. Although there are several known risk factors, the influence of obstructive sleep apnoea (OSA) has not been completely elucidated. The aim of this study was to evaluate the association between NAION and OSA. METHODS This retrospective, longitudinal cohort study used the national health insurance database of Taiwan covering the period 1996-2013. Patients without NAION at the diagnosis of OSA or who developed NAION 1 year after the diagnosis of OSA were enrolled. The patients were followed until death or the last day of the study. Cox proportional hazard regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) to investigate the association between OSA and NAION. RESULTS There were 8488 patients in the OSA group and 33 952 in the control group (without OSA), for a ratio of approximately 1:4. The percentages of NAION were 0.36% and 0.2% in the OSA and control groups, respectively, with a statistically significant difference (p < 0.01; chi-square test), and this significant difference remained in multivariate analysis (p = 0.019) with a significantly higher HR (1.66; 95% CI: 1.08-2.55). There was significant difference in the 30-39 years age group in multivariate analysis (p < 0.01, HR: 6.30; 95% CI: 2.28-17.40). CONCLUSION There was a strong association between NAION and OSA, and the patients with OSA had a higher risk of NAION. Further large-scale, prospective studies are warranted to evaluate the effect of OSA on developing NAION.
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Affiliation(s)
- Ming-Hui Sun
- Department of Ophthalmology; Chang Gung Memorial Hospital; Linkou Taiwan
- Department of Medicine; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Chia-Yi Lee
- Department of Ophthalmology; Show Chwan Memorial Hospital; Changhua Taiwan
| | - Yaping Joyce Liao
- Department of Ophthalmology; School of Medicine; Stanford University; Stanford California USA
| | - Chi-Chin Sun
- Department of Ophthalmology; Chang Gung Memorial Hospital; Keelung Taiwan
- Department of Chinese Medicine; College of Medicine; Chang Gung University; Taoyuan Taiwan
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18
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Martinho Nicolau ZF, Tufik S, Hachul H. Influence of lifestyle on postmenopausal women's sleep. Biomedicine (Taipei) 2018; 8:13. [PMID: 30141400 PMCID: PMC6108230 DOI: 10.1051/bmdcn/2018080313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/02/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Sergio Tufik
-
Department of Psychobiology, Federal University of São Paulo SP 04021-002 São Paulo Brazil
| | - Helena Hachul
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Department of Psychobiology, Federal University of São Paulo SP 04021-002 São Paulo Brazil
, Corresponding author. Department of Psychobiology, Federal University of São Paulo, Rua Napoleão de Barros 925, Vila Clementino, SP 04021-002, São Paulo, Brazil. E-mail address: (H. Hachul)
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19
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Postnikoff CK, Nichols KK. Neutrophil and T-Cell Homeostasis in the Closed Eye. Invest Ophthalmol Vis Sci 2017; 58:6212-6220. [PMID: 29222551 PMCID: PMC6110127 DOI: 10.1167/iovs.17-22449] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose This study sought to examine the changes and phenotype of the tear neutrophil and T-cell populations between early eyelid closure and after a full night of sleep. Methods Fourteen healthy participants were recruited and trained to wash the ocular surface with PBS for at-home self-collection of ocular surface and tear leukocytes following up to 1 hour of sleep and a full night of sleep (average 7 hours), on separate days. Cells were isolated, counted, and incubated with fluorescently labeled antibodies to identify neutrophils, monocytes, and T cells. For neutrophil analysis, samples were stimulated with lipopolysaccharide (LPS) or calcium ionophore (CaI) before antibody incubation. Flow cytometry was performed. Results Following up to 1 hour of sleep, numerous leukocytes were collected (2.6 × 105 ± 3.0 × 105 cells), although significantly (P < 0.005) more accumulated with 7 hours of sleep (9.9 × 105 ± 1.2× 106 cells). Neutrophils (65%), T cells (3%), and monocytes (1%) were identified as part of the closed eye leukocyte infiltration following 7 hours of sleep. Th17 cells represented 22% of the total CD4+ population at the 7-hour time point. Neutrophil phenotype changed with increasing sleep, with a downregulation of membrane receptors CD16, CD11b, CD14, and CD15, indicating a loss in the phagocytic capability of neutrophils. Conclusions Neutrophils begin accumulating in the closed eye conjunctival sac much earlier than previously demonstrated. The closed eye tears are also populated with T cells, including a subset of Th17 cells. The closed eye environment is more inflammatory than previously thought and is relevant to understanding ocular homeostasis.
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Affiliation(s)
- Cameron K Postnikoff
- School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
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20
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Floppy Eyelid Syndrome and Its Determinants in Iranian Adults: A Population-Based Study. Eye Contact Lens 2017; 43:406-410. [DOI: 10.1097/icl.0000000000000297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Fox TP, Schwartz JA, Chang AC, Parvin-Nejad FP, Yim CK, Feinsilver SH, Wu AY. Association Between Eyelid Laxity and Obstructive Sleep Apnea. JAMA Ophthalmol 2017; 135:1055-1061. [PMID: 28880982 DOI: 10.1001/jamaophthalmol.2017.3263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance While much has been reported on the relationship between floppy eyelid syndrome and obstructive sleep apnea (OSA), the diagnostic criteria of floppy eyelid syndrome are often subjective and vague. Objective To evaluate the association between OSA and quantitative markers of eyelid laxity or secondary ocular surface disease in a sleep clinic population. Design, Setting, and Participants This investigation was a cross-sectional observational study at the Center for Sleep Medicine at Icahn School of Medicine at Mount Sinai. Participants were individuals referred for overnight polysomnography from March 1 to August 30, 2015. Main Outcomes and Measures Eyelid laxity and ocular surface disease were assessed on bedside ophthalmologic examination. The presence and severity of OSA were determined from polysomnography results. Initial correlation between OSA and ocular surface and eyelid markers was calculated through bivariate linear regression analysis, and the association between ocular symptoms was obtained through bivariate ordered logistic regression. Analysis was repeated adjusting for known associations between OSA and sex, age, body mass index, and medical comorbidities through multivariable analysis. Results In total, 201 individuals (402 eyes) were enrolled in the study. Their mean (SD) age was 53.2 (13.5) years, 43.3% (n = 87) were female, 56.7% (n = 114) were of white race/ethnicity, 26.9% (n = 54) were black/African American, 4.0% (n = 8) were Asian, 8.0% (n = 16) were multiracial or other, and 4.5% (n = 9) were of unknown race/ethnicity, with 21.9% (n = 44) of all individuals self-identifying as Hispanic and 75.1% (n = 151) self-identifying as non-Hispanic. After adjustment, no association was observed between OSA severity and an eyelid laxity score (regression coefficient, 0.85; 95% CI, -0.33 to 0.62; P = .40) or an ocular surface score (regression coefficient, 1.09; 95% CI, -0.32 to 0.29; P = .93). Through subset analysis, male sex was associated with a higher ocular surface score, while older age and diabetes were associated with a higher eyelid laxity score. Only one patient (0.5%) exhibited findings of floppy eyelid syndrome. Conclusions and Relevance Among individuals referred for overnight polysomnography, quantitative markers of eyelid laxity were not associated with the presence or severity of OSA. Subset analysis suggests that prior studies may have been limited by confounding variables or the technique of identifying eyelid laxity.
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Affiliation(s)
- Timothy P Fox
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey A Schwartz
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aimee C Chang
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fatemeh P Parvin-Nejad
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cindi K Yim
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Albert Y Wu
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
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Altaf QA, Dodson P, Ali A, Raymond NT, Wharton H, Fellows H, Hampshire-Bancroft R, Shah M, Shepherd E, Miah J, Barnett AH, Tahrani AA. Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study. Am J Respir Crit Care Med 2017; 196:892-900. [PMID: 28594570 DOI: 10.1164/rccm.201701-0175oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Obstructive sleep apnea (OSA) is associated with several pathophysiological deficits found in diabetic retinopathy (DR). Hence, it's plausible that OSA could play a role in the pathogenesis of sight-threatening DR (STDR). OBJECTIVES To assess the relationship between OSA and DR in patients with type 2 diabetes and to assess whether OSA is associated with its progression. METHODS A longitudinal study was conducted in diabetes clinics within two U.K. hospitals. Patients known to have any respiratory disorder (including OSA) were excluded. DR was assessed using two-field 45-degree retinal images for each eye. OSA was assessed using a home-based multichannel cardiorespiratory device. MEASUREMENTS AND MAIN RESULTS A total of 230 patients were included. STDR and OSA prevalence rates were 36.1% and 63.9%, respectively. STDR prevalence was higher in patients with OSA than in those without OSA (42.9% vs. 24.1%; P = 0.004). After adjustment for confounders, OSA remained independently associated with STDR (odds ratio, 2.3; 95% confidence interval, 1.1-4.9; P = 0.04). After a median (interquartile range) follow-up of 43.0 (37.0-51.0) months, patients with OSA were more likely than patients without OSA to develop preproliferative/proliferative DR (18.4% vs. 6.1%; P = 0.02). After adjustment for confounders, OSA remained an independent predictor of progression to preproliferative/proliferative DR (odds ratio, 5.2; 95% CI confidence interval, 1.2-23.0; P = 0.03). Patients who received continuous positive airway pressure treatment were significantly less likely to develop preproliferative/proliferative DR. CONCLUSIONS OSA is associated with STDR in patients with type 2 diabetes. OSA is an independent predictor for the progression to preproliferative/proliferative DR. Continuous positive airway pressure treatment was associated with reduction in preproliferative/proliferative DR. Interventional studies are needed to assess the impact of OSA treatment on STDR.
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Affiliation(s)
- Quratul A Altaf
- 1 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,2 Centre of Endocrinology, Diabetes, and Metabolism, Birmingham Heath Partners, Birmingham, United Kingdom.,3 Department of Diabetes and Endocrinology and
| | - Paul Dodson
- 3 Department of Diabetes and Endocrinology and.,4 Heart of England Diabetic Retinopathy Screening Centre, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.,5 School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Asad Ali
- 6 Department of Respiratory Medicine, University Hospital of Coventry and Warwickshire, Coventry NHS Trust, United Kingdom; and
| | - Neil T Raymond
- 7 Epidemiology, Research Design and Statistical Consulting (ERDASC), Leicestershire, United Kingdom
| | - Helen Wharton
- 3 Department of Diabetes and Endocrinology and.,4 Heart of England Diabetic Retinopathy Screening Centre, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Hannah Fellows
- 3 Department of Diabetes and Endocrinology and.,4 Heart of England Diabetic Retinopathy Screening Centre, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Rachel Hampshire-Bancroft
- 3 Department of Diabetes and Endocrinology and.,4 Heart of England Diabetic Retinopathy Screening Centre, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Mirriam Shah
- 3 Department of Diabetes and Endocrinology and.,4 Heart of England Diabetic Retinopathy Screening Centre, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Emma Shepherd
- 3 Department of Diabetes and Endocrinology and.,4 Heart of England Diabetic Retinopathy Screening Centre, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Jamili Miah
- 3 Department of Diabetes and Endocrinology and.,4 Heart of England Diabetic Retinopathy Screening Centre, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Anthony H Barnett
- 1 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,2 Centre of Endocrinology, Diabetes, and Metabolism, Birmingham Heath Partners, Birmingham, United Kingdom.,3 Department of Diabetes and Endocrinology and
| | - Abd A Tahrani
- 1 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,2 Centre of Endocrinology, Diabetes, and Metabolism, Birmingham Heath Partners, Birmingham, United Kingdom.,3 Department of Diabetes and Endocrinology and
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24
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Chirapapaisan N, Likitgorn T, Pleumchitchom M, Sakiyalak D, Banhiran W, Saiman M, Chuenkongkaew W. Diurnal changes in retinal nerve fiber layer thickness with obstructive sleep apnea/hypopnea syndrome. Int J Ophthalmol 2016; 9:979-83. [PMID: 27500104 DOI: 10.18240/ijo.2016.07.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 11/04/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the retinal nerve fiber layer (RNFL) thickness in the morning and evening in Thai patients with varying degrees of obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS In this cross-sectional study, potential OSAHS patients at Siriraj Hospital underwent polysomnography to determine the severity of OSAHS and an eye examination (including best corrected visual acuity, slit-lamp examination, and Goldmann applanation tonometry). RNFL thickness was recorded once in the morning and once in the evening, using spectral domain optical coherence tomography. Thickness was expressed as an average and given for each quadrant. Patients with ocular or systemic diseases that might affect RNFL thickness were excluded. RESULTS Forty-one eyes of 41 patients were classified into 4 OSAHS groups. The average and mean RNFL thickness in most of the four quadrants of the severe OSAHS group trended toward being less than those in the comparable quadrants of the other groups in both the morning and evening. In the moderate OSAHS group, the average RNFL thickness and temporal and superior quadrant thickness in the morning were significantly higher than in the evening (P=0.01, P=0.01, and P=0.03, respectively). In the severe OSAHS group, the inferior quadrant thickness in the morning was significantly higher than in the evening (P=0.03). CONCLUSION The RNFL thickness in the morning was higher than in the evening in moderate OSAHS.
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Affiliation(s)
- Niphon Chirapapaisan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Bangkok 10700, Thailand
| | - Techawit Likitgorn
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Bangkok 10700, Thailand
| | - Mintra Pleumchitchom
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Bangkok 10700, Thailand
| | - Darin Sakiyalak
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Bangkok 10700, Thailand
| | - Wish Banhiran
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Bangkok 10700, Thailand
| | - Manatsawin Saiman
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Bangkok 10700, Thailand
| | - Wanicha Chuenkongkaew
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Bangkok 10700, Thailand
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Is Floppy Eyelid Syndrome More Prevalent in Obstructive Sleep Apnea Syndrome Patients? J Ophthalmol 2016; 2016:6980281. [PMID: 27366328 PMCID: PMC4913017 DOI: 10.1155/2016/6980281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/06/2016] [Accepted: 05/09/2016] [Indexed: 11/18/2022] Open
Abstract
Controversial findings are reported about the relationship between floppy eyelid syndrome (FES) and obstructive sleep apnea syndrome (OSAS). The main goal of this study was to evaluate whether FES is more prevalent in OSAS patients by performing a meta-analysis. A comprehensive literature search of Pubmed, Embase, and Cochrane databases was performed. Only studies related to the prevalence of FES in OSAS were included in the meta-analysis. We estimated a pooled odds ratio (OR) for the prevalence of FES in OSAS. In total, 6 studies with 767 participants met the inclusion criteria. Using a fixed-effects model, the pooled OR was 4.12. The test for the overall effect revealed that FES was statistically prevalent in OSAS patients when compared with that in non-OSAS subjects (Z = 4.98, p < 0.00001). In the subgroup analysis by OSAS severity, the incidence of FES in OSAS increased with severity of OSAS as indicated with increased OR values (OR = 2.56, 4.62, and 7.64 for mild, moderate, and severe OSAS). In conclusion, the results indicate that FES is more prevalent in OSAS patients. However, this result was based only on unadjusted estimates. Prospective cohort studies are needed to determine whether OSAS is an independent risk factor for FES.
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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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Murphy C, Duponsel N, Huang XS, Wittich W, Koenekoop RK, Overbury O. Retinal Disorders and Sleep Disorders: Are They Genetically Related? JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2015. [DOI: 10.1177/0145482x1510900505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Sleep is important for optimal physical health and vitality. Recent studies have shown that individuals with visual impairments may be at risk for sleep problems. This research examines the prevalence of sleep problems among those with retinal disorders and the possibility of a genetic link. Methods Subjects with retinitis pigmentosa ( n = 33), Stargardt's disease ( n = 31) and age-related macular degeneration ( n = 43) were recruited from the ophthalmology department of Montreal Children's Hospital. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Genetic testing was conducted by the Radboud University Medical Center in Nijmegen, Netherlands. Retinal genes were identified as having retina only or pineal and retinal expression. Results The expression patterns of genes causing retinal disorders did not predict sleep quality. The PSQI indicated poor sleep quality in 56% of participants with retinitis pigmentosa, 48% of those with Stargardt's disease, and 53% of those with age-related macular degeneration. The ESS showed that daytime sleepiness was experienced by 20% of individuals with retinitis pigmentosa or Stargardt's disease, and by only one individual with age-related macular degeneration. Discussion Approximately 50% of people with retinal disease have sleep problems. This number compares with up to one-third of the general population. Gene expression did not correlate with sleep quality, and the explanation for such a large percentage of sleep disorders needs further investigation. Implications for practitioners Eye care and rehabilitation specialists need to be aware of the high prevalence of poor sleep quality in individuals with retinal disorders, since this situation may have an important impact on memory and learning, both of which are vital in successful rehabilitation.
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Affiliation(s)
- Caitlin Murphy
- School of Optometry, University of Montreal, P.O. Box 6128, Station Centre-ville, Montreal, Quebec H3C 3J7, Canada
| | - Nathalie Duponsel
- Concordia University, Department of Education, Room LB-579 1455 de Maisonneuve Boulevard West, Montreal, Quebec H3G 1M8, Canada
| | - Xi Sheila Huang
- CSSS du Suroit, St. Mary's Hospital and Jewish General Hospital, 160 Rue Saint Thomas, Salaberry-de-Valleyfield, Qc J6T 2N6, Canada
| | - Walter Wittich
- School of Optometry, University of Montreal; resident researcher, CRIR/MAB-Mackay Rehabilitation Centre; Department of Psychology, Concordia University; adjunct professor, School of Physical and Occupational Therapy, University of Montreal
| | - Robert K. Koenekoop
- Pediatric Ophthalmology, Montreal Children's Hospital, 1001 Boulevard Decarie, Montreal, Quebec H4A 3J1, Canada; clinician-scientist and director, McGill Ocular Genetics Laboratory; associte professor of ophthalmology, McGill University
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Abstract
PURPOSE The aim of this study was to study prevalence, risk factors, and morbidity of eyelid laxity in a veteran population. METHODS This prospective cross-sectional study with a retrospective chart review included 150 subjects evaluated from either an outpatient eye clinic or a geriatric clinic at the Miami Veterans Affairs Hospital from June through August 2013. Clinical data were gathered from a questionnaire and a computerized medical record system including demographics, medical history, and ocular irritation history. Upper and lower eyelid laxity was clinically graded. Main outcome measures were prevalence of eyelid laxity, risk factors for its presence, and its correlation to ocular surface symptoms. RESULTS Fifty-four percent of participants (n = 81) had laxity (grade 1 or higher) in either upper and/or lower eyelids. Risk factors for eyelid laxity in our population included older age, higher body mass index, and a diagnosis of sleep apnea. Patients with any eyelid laxity (grade 1 or more in any eyelid) had a 2.23-fold risk of severe ocular surface symptoms (score of 12 or higher on the dry eye questionnaire 5) compared with those without laxity (95% confidence interval, 1.15-4.31; P = 0.017), and this was primarily driven by the presence of upper eyelid laxity. CONCLUSIONS We found high prevalence of eyelid laxity in our population, and its presence was associated with significant ocular surface morbidity. This study reinforces the need to incorporate dynamic eyelid testing into ophthalmic examination in patients with ocular surface discomfort.
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Abstract
PURPOSE Floppy eyelid syndrome is a condition that is difficult to identify and diagnose and with no clear guidelines on its management. We propose a method of reliably grading this syndrome and have proposed a management algorithm based on the grading. MATERIALS AND METHODS Retrospective data collection of patients diagnosed with Floppy eyelid syndrome and treated under the care of a single oculoplastic surgeon over a 9 year period. RESULTS First, 102 patients were included and were classified into 3 groups. Grade 1 (F1) 7.5%, Grade 2 (F2) 36.5% and Grade 3 (F3) 56%. Only 12% of our cohort required surgery, and 92% of these patients demonstrated improvement in their symptoms. DISCUSSION Clinical grading of Floppy eyelid syndrome patients will help determine patient's management plan. In our experience, operating on both upper and lower eyelids at the same time where indicated helps to maintain the normal anatomical relationship and improve epiphora.
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Affiliation(s)
- Aaron M Yeung
- University Hospital Coventry and Warwickshire NHS Trust , Coventry, West Midlands , United Kingdom
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31
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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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Ferré A, Vila J, Arcalís N. [Usefulness of the basic exploration of the upper airways and neighbor structures in patients with adult obstructive sleep apnea-hypopnea syndrome]. Med Clin (Barc) 2014; 142:310-6. [PMID: 23830550 DOI: 10.1016/j.medcli.2013.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/11/2013] [Accepted: 04/18/2013] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a prevalent disease in the general population, associated with an increase in the cardiovascular morbimortality. A basic and/or standardized otolaryngologic exploration could help us to detect the structural abnormalities that alter the upper airway collapsibility and offer a high pre-test risk factor, improve the CPAP adherence or even the possibility of offering alternative treatments. This article offers a revision of the exploration in OSAHS patients. We describe a guideline to identify the main structural abnormalities related to OSAHS. We also include a short algorithm for the diagnosis of OSAHS, when is suspected by primary care physicians.
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Affiliation(s)
- Alex Ferré
- Unidad Multidisciplinar del Sueño, Hospital Universitario Vall d'Hebrón, Barcelona, España; Servicio de Neurofisiología Clínica, Hospital Universitario Vall d'Hebrón, Barcelona, España.
| | - Javier Vila
- Unidad Multidisciplinar del Sueño, Hospital Universitario Vall d'Hebrón, Barcelona, España; Servicio de Otorrinolaringología, Hospital Universitario Vall d'Hebrón, Barcelona, España
| | - Núria Arcalís
- Servicio de Radiología, Fundació Hospital de Mollet, Universidad Autónoma de Barcelona, Barcelona, España
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Sleep position and the ocular surface in a high airflow environment. Saudi J Ophthalmol 2014; 28:66-8. [PMID: 24526862 PMCID: PMC3923194 DOI: 10.1016/j.sjopt.2013.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the relationship between sleep position and ocular surface symptoms and signs in an high air flow environment. Methods Prospective observational study of new patients attending the dry eye clinic was performed. Patients with pre-existing ocular history, relevant systemic history (e.g. Sjogren’s syndrome) or who were using topical or systemic therapy for dry eye were not included. Data were collected from the patient to document their dry eye symptoms; preferred dependent sleeping side and their bedroom airflow. All patients were examined by a clinician blind to the patient’s responses where Schirmer’s test and slit lamp examination were performed looking for the presence of lagophthalmos and corneal epitheliopathy. Results 48 patients enrolled into the study of which 23 were males and 25 were females with a normal and comparable age distribution. The study found a strong association between patients’ preferred sleeping side and the incidence of corneal epitheliopathy in the contralateral eye particularly in patients with evidence of lagophthalmos. Dry eye symptoms were found to be worse and tear production lower on the contralateral side to the preferred sleeping side particularly in patients who sleep in a high airflow environment. Conclusion In patients sleeping in a high airflow environment with nocturnal lagophthalmos, this study observed an association between preferred dependent sleep position and increased dry eye symptoms, lower Schirmer’s scores and increased corneal epitheliopathy in the contralateral eye.
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Floppy Eyelid Syndrome as an Indicator of the Presence of Glaucoma in Patients With Obstructive Sleep Apnea. J Glaucoma 2014; 23:e81-5. [DOI: 10.1097/ijg.0b013e31829da19f] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Archer EL, Pepin S. Obstructive sleep apnea and nonarteritic anterior ischemic optic neuropathy: evidence for an association. J Clin Sleep Med 2013; 9:613-8. [PMID: 23772197 DOI: 10.5664/jcsm.2766] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nonarteritic anterior ischemic optic neuropathy (NAION) is the most prevalent optic nerve disorder among patients over 50 years of age, characterized by sudden onset, painless visual loss, with an accompanying relative afferent pupillary defect and optic disc edema. Although the pathophysiology of NAION has not been fully elucidated, several risk factors have been considered, including advanced age, systemic hypertension, diabetes mellitus, and certain optic disc morphologies. An association between obstructive sleep apnea (OSA) and NAION has also been recognized. One prospective cohort study indicated that the relative risk of OSA among patients with NAION was 4.9; a later retrospective cohort study demonstrated that patients with OSA not treated with continuous positive airway pressure (CPAP) had a 16% increased hazard of developing NAION compared to patients without OSA.The following review will discuss the most recent understanding of the relationship between OSA and NAION, with implications for further research and prevention strategies.
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Affiliation(s)
- Erica L Archer
- Mary Imogene Bassett Hospital, Bassett Healthcare Network, Cooperstown, NY, USA
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36
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Lin CC, Hu CC, Ho JD, Chiu HW, Lin HC. Obstructive sleep apnea and increased risk of glaucoma: a population-based matched-cohort study. Ophthalmology 2013; 120:1559-64. [PMID: 23601803 DOI: 10.1016/j.ophtha.2013.01.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/18/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Previous studies had reported an increased prevalence of glaucoma in patients with obstructive sleep apnea (OSA). However, the risk of open-angle glaucoma (OAG) among patients with OSA remains unclear. Using a nationwide, population-based dataset in Taiwan, this study aimed to examine the prevalence and risk of OAG among patients with OSA during a 5-year follow-up period after a diagnosis of OSA. DESIGN A retrospective, matched-cohort study. PARTICIPANTS AND CONTROLS This study used data sourced from the Longitudinal Health Insurance Database 2000. We included 1012 subjects with OSA in the study cohort and randomly selected 6072 subjects in the comparison group. METHODS Each subject in this study was individually traced for a 5-year period to identify those subjects who subsequently received a diagnosis of OAG. Cox proportional hazards regression was performed to calculate the 5-year risk of OAG between the study and comparison cohorts. MAIN OUTCOME MEASURES The incidence and risk of OAG between the study and comparison groups. RESULTS During the 5-year follow-up period, the incidence rate per 1000 person-years was 11.26 (95% confidence interval [CI], 8.61-14.49) and 6.76 (95% CI, 5.80-7.83) for subjects with and without OSA, respectively. After adjusting for monthly income, geographic region, diabetes, hypertension, coronary heart disease, obesity, hyperlipidemia, renal disease, hypothyroidism, and the number of outpatient visits for ophthalmologic care during the follow-up period, stratified Cox proportional hazards regression revealed that the hazard ratio for OAG within the 5-year period for subjects with OSA was 1.67 (95% CI, 1.30-2.17; P<0.001) that of comparison subjects. CONCLUSIONS Our results suggest that OSA is associated with an increased risk of subsequent OAG diagnosis during a 5-year follow-up period. FINANCIAL DISCLOSURES(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Affiliation(s)
- Ching-Chun Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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Muniesa M, Huerva V, Sánchez-de-la-Torre M, Martínez M, Jurjo C, Barbé F. The relationship between floppy eyelid syndrome and obstructive sleep apnoea. Br J Ophthalmol 2013; 97:1387-90. [DOI: 10.1136/bjophthalmol-2012-303051] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
PURPOSE To report a case of floppy eyelid associated with Down's syndrome in a 2-year-old child. CASE REPORT A 2-year-old child associated with Down's syndrome presented with a history of eversion of both upper lids during sleep and while crying since birth. There was no history of sleep apnea and no mechanical stimuli over eyelids. Examination under anesthesia revealed gross laxity with thick and rubbery tarsi in both the upper and lower lids. Vascularized corneal scar was present in both eyes. The laxity in the upper eyelids was corrected by pentagonal wedge resection and in the lower lids by lateral tarsal sling. No recurrence was observed up to 6-month follow-up. CONCLUSION Although floppy eyelid is more common in middle-aged obese patients, it should be carefully looked for children particularly while dealing with Down's syndrome.
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Affiliation(s)
- Murtuza Nuruddin
- Chittagong Eye Infirmary and Training complex, Pahartali, Chittagong, Bangladesh.
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Moghimi S, Ahmadraji A, Sotoodeh H, Sadeghniat K, Maghsoudipour M, Fakhraie G, Latifi G, Nassiri N, Giaconi JA. Retinal nerve fiber thickness is reduced in sleep apnea syndrome. Sleep Med 2012; 14:53-7. [PMID: 22948081 DOI: 10.1016/j.sleep.2012.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 07/06/2012] [Accepted: 07/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the prevalence of glaucoma, visual field abnormalities, as well as changes in retinal nerve fiber layer in patients with obstructive sleep apnea syndrome (OSAS). METHODS In this cross-sectional study, 51 patients with OSAS were included. Based on apnea hypopnea index (AHI), there were 26, 6 and 19 cases of severe (AHI⩾30), moderate (15⩽AHI<30), and mild (5⩽AHI<15) OSAS, respectively. The control group was matched for age, sex and body mass index. Prevalence of glaucoma and ocular hypertension as well as the following values were assessed and compared between two groups: best-corrected visual acuity, intraocular pressure, central corneal thickness (CCT), cup:disk ratio, mean deviation (MD), pattern standard deviation, and retinal nerve fiber layer (RNFL) parameters using glaucoma diagnosis measurement (GDx). RESULTS Seven eyes (6.7%) had intraocular pressure (IOP)>21mmHg; of these, four eyes (3.9%) had glaucoma. No significant difference was detected in CCT between the two groups. IOP was significantly higher in the OSAS group before (p<0.001) and after (p<0.001) correcting for CCT. There was a significant difference between groups in MD and most GDx parameters including DISK (temporal-superior-nasal-inferior-temporal) average (p=0.002), superior average (p=0.05) and nerve fiber indicator (NFI) (p=0.03), where those in the patient group showed lower values. There was a significant positive correlation between AHI and both IOP and NFI. CONCLUSIONS OSAS patients had a higher prevalence of glaucoma and ocular hypertension. OSAS patients also had higher IOP, worse visual field indices, and lower RNFL parameters compared with the control group.
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Affiliation(s)
- Sasan Moghimi
- Farabi Eye Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran.
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Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol 2012; 40:408-19. [PMID: 22339817 DOI: 10.1111/j.1442-9071.2012.02768.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glaucoma is increasingly recognized as a manifestation of both ocular and systemic risk factors. A number of disorders associated with reduced blood flow and ischaemia, collectively termed vascular risk factors, such as migraine, Raynaud's phenomenon, atrial fibrillation and reduced nocturnal blood pressure, lead to decreased ocular perfusion pressure. During sleep, alterations occur in cardiovascular physiology that are balanced by autoregulation to maintain homeostasis. However, in obstructive sleep apnoea (OSA), the normal physiological balance is upset. A potentially modifiable risk factor, OSA has been increasingly associated with glaucoma independent of intraocular pressure. OSA may alter blood flow to the optic nerve head and, in combination with other predisposing factors, lead to decreased ocular perfusion pressure. This in turn may directly affect the optic nerve or it may indirectly increase its susceptibility to other insults. The purpose of this review is to shed light on the association between OSA and glaucoma.
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Affiliation(s)
- Omar Faridi
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, NY, NY 10003, USA
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Abstract
Metabolic syndrome is a cluster of diseases including central obesity, dyslipidemia, hyperglycemia, and high blood pressure. People with metabolic syndrome have been shown to be at an increased risk of developing cardiovascular disease, beyond the risk associated with individual components of the syndrome. The association of diabetes and hypertension with retinopathy, cataract, and raised intraocular pressure is well known. This review highlights the association of metabolic syndrome, including all its components, with various ocular conditions such as retinopathy, central retinal artery occlusion, cataracts, and raised intraocular pressure.
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Affiliation(s)
- Rupali Chopra
- Department of Ophthalmology, Christian Medical College, Ludhiana, India
| | - Ashish Chander
- Department of Ophthalmology, Christian Medical College, Ludhiana, India
| | - Jubbin J. Jacob
- Department of Medicine, Christian Medical College, Ludhiana, India
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Kim CY, Yoon JS, Bae JM, Lee SY. Prediction of postoperative eyelid height after frontalis suspension using autogenous fascia lata for pediatric congenital ptosis. Am J Ophthalmol 2012; 153:334-342.e2. [PMID: 21982105 DOI: 10.1016/j.ajo.2011.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 07/26/2011] [Accepted: 07/28/2011] [Indexed: 10/16/2022]
Abstract
PURPOSE To predict eyelid height after frontalis suspension using autogenous fascia lata for congenital ptosis. DESIGN Retrospective, observational case series. METHODS Eighty eyes of 54 children who underwent frontalis suspension using autogenous fascia lata were included. The amount of intraoperative eyelid lift and the postoperative change in eyelid height were assessed 6 months after surgery by reviews of photographs and medical records. The amount of operative eyelid lift was measured from 2 different baselines, and each amount was compared with the amount of real change in eyelid height after surgery. The difference between those was measured. RESULTS The postoperative eyelid height stabilized 3 months after surgery. The average amount of operative eyelid lift was 5.91 mm with anesthesia-induced lagophthalmos and 3.51 mm without. The amount of real change in eyelid height after surgery was 3.24 ± 1.14 mm. In less severe ptosis (< 3 mm of lift), an average operative lift of 2.03 mm resulted in 2.53 mm of elevation, whereas in more severe ptosis (≥ 4 mm of lift), an average operative lift of 3.98 mm resulted in only 3.72 mm of elevation 6 months after surgery. The preoperative palpebral fissure (P = .002) and anesthesia-induced lagophthalmos (P < .001) were significant factors influencing postoperative eyelid height. CONCLUSIONS Postoperative eyelid height may predicted be more accurately by compensating for anesthesia-induced lagophthalmos and adjusting the palpebral fissure to be larger than the desired eyelid height for patients with more severe ptosis.
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Grixti A, Sadri M, Edgar J, Datta AV. Common Ocular Surface Disorders in Patients in Intensive Care Units. Ocul Surf 2012; 10:26-42. [DOI: 10.1016/j.jtos.2011.10.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 10/20/2011] [Accepted: 10/20/2011] [Indexed: 10/28/2022]
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Floppy eyelid syndrome as a subset of lax eyelid conditions: relationships and clinical relevance (an ASOPRS thesis). Ophthalmic Plast Reconstr Surg 2010; 26:195-204. [PMID: 20489546 DOI: 10.1097/iop.0b013e3181b9e37e] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To better define the wide spectrum of lax eyelid conditions, especially the subtype referred to as floppy eyelid syndrome, and to clarify its relationship with associated ophthalmic findings. METHODS A case-based retrospective review of all patients seen at UNC Department of Ophthalmology with a diagnosis of floppy eyelid syndrome or lax upper eyelid was performed. The period of review was from March 2002 to March 2007. A literature review was also performed using the term "floppy eyelid syndrome" and "lax eyelid syndrome" as the keywords in a PubMed search. Charts and cases were reviewed for the following information: age, sex, presence or absence of obesity, presence or absence of upper eyelid laxity, presence or absence of lower eyelid laxity, symmetry or asymmetry of eyelid laxity, sleeping position preference, diagnosis of obstructive sleep apnea (OSA), history of eye rubbing, diagnosis of keratoconus (KCN), lash ptosis, history of spontaneous eyelid eversion, papillary conjunctivitis, systemic hyperlaxity, diagnosis of meibomianitis, signs of anterior segment inflammation, and smoking or excessive sun exposure history. RESULTS From our UNC case review, 14 patients involving 17 eyelids were identified. From the literature review, 72 articles were recovered and evaluated to yield a total of 324 reported cases through February 2007. From the combined data (n = 338), the overall minimum prevalence of sleep apnea in patients with lax eyelid condition was 16% compared with an estimated 9% to 24% in the general population. Of patients with lax eyelid syndrome, those identified with OSA had significantly more individuals with obesity (76% vs. 20%) and male gender (89% vs. 61%) than the group without OSA. The prevalence of KCN in patients with lax eyelid syndrome was a minimum of 6.8%, which is considerably higher than the estimated prevalence in the general population of 0.6%. However, KCN appears to show a significant association with the patient's side of sleeping preference. CONCLUSIONS Eyelid laxity can result from a number of involutional, local, and systemic diseases but is frequently of unknown etiology. When it is consistently associated with papillary conjunctivitis and dry eyes it can be referred to as lax eyelid syndrome (LES). A number of specific subsets of LES can be identified. One such subset, occurring primarily though not exclusively in males and associated with obesity, has been defined as the floppy eyelid syndrome (FES). OSA has been associated with FES where it occurs with greater frequency than in the general population, but no greater than seen in obese males without FES, and therefore appears to represent an epiphonomenom only. However, given the demographics of FES, this condition offers some predictive value for OSA and should alert the physician to evaluate the sleep habits of all such patients. Keratoconus also shows some association with FES and with LES. However, data suggest that the causative factors are sleep preference for the involved side and nocturnal eyelid eversion, rather than any underlying physiologic or anatomic relationship.
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Garcia DM, Messias A, Costa LO, Pinto CT, Barbosa JC, Velasco Cruz AA. Spontaneous Blinking in Patients With Graves’ Upper Eyelid Retraction. Curr Eye Res 2010; 35:459-65. [DOI: 10.3109/02713681003642713] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The Associations of Floppy Eyelid Syndrome: A Case Control Study. Ophthalmology 2010; 117:831-8. [DOI: 10.1016/j.ophtha.2009.09.029] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 09/12/2009] [Accepted: 09/18/2009] [Indexed: 11/20/2022] Open
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Ezra DG, Beaconsfield M, Collin R. Floppy Eyelid Syndrome: Stretching the Limits. Surv Ophthalmol 2010; 55:35-46. [DOI: 10.1016/j.survophthal.2009.02.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 02/26/2009] [Accepted: 02/27/2009] [Indexed: 12/30/2022]
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Kadyan A, Asghar J, Dowson L, Sandramouli S. Ocular findings in sleep apnoea patients using continuous positive airway pressure. Eye (Lond) 2009; 24:843-50. [PMID: 19680276 DOI: 10.1038/eye.2009.212] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To describe ocular findings in patients with established obstructive sleep apnoea hypopnoea syndrome (OSAHS) using continuous positive airway pressure (CPAP). METHODS hundred and fifteen referrals investigated for OSAHS were included. Patients with OSAHS were compared with those with normal sleep study controls. Subgroup analysis for CPAP users and non-users was also carried out. RESULTS OSAHS patients (n=89) compared with the controls (n=26) had higher ocular irritation symptoms (P<0.001), abnormal tear break-up time (P<0.05) with increased upper (P<0.001) and lower (P<0.001) lid laxity. Floppy eyelid syndrome (FES) was noted in 31.5% (28/89) OSAHS patients vs 3.8% (1/26) controls (P=0.005). Open angle glaucoma prevalence in OSAHS patients (3/89, 3.4%) was similar to the controls (1/26, 3.8%) (P=0.92). Sixty-seven (75.3%) OSAHS patients were using CPAP (average duration: 19.6+/-15.3 months). All CPAP users maintained a supine sleep posture to prevent mask edge leaks. A fifth of CPAP users (14/67) had experienced earlier episodes of conjunctivitis secondary to leaks. CPAP users had similar upper and lower lid laxity (P=0.746 and 0.633) to non-CPAP users, but a better tear film (P=0.029) and less ocular irritation (P=0.134). CONCLUSION OSAHS patients showed increased ocular irritation, abnormal tear film, lid laxity, and FES. The prevalence of glaucoma in our series was similar to normal population data of 2%, P=0.429, and may relate to use of CPAP in majority of the patients. More stable tear film in CPAP users was probably secondary to the supine sleep postures necessarily adopted with CPAP use.
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Affiliation(s)
- A Kadyan
- Birmingham and Midland Eye Centre, City Hospital, Birmingham, UK.
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Nieto Enríquez J, Torres Blanch J, Badal Lafulla J. [Ocular disease in sleep apnea syndrome]. Med Clin (Barc) 2009; 133:594-8. [PMID: 19473675 DOI: 10.1016/j.medcli.2009.02.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 02/26/2009] [Indexed: 11/25/2022]
Abstract
Sleep apnea syndrome is characterised by recurrent episodes of partial or complete upper airway flow interruption during sleep. In the last twenty years, the relationship of sleep apnea with cardiovascular disease has been recognised. More recently, several ocular disorders have been associated with sleep apnea syndrome, including floppy eyelid syndrome, glaucoma, non-arteritic ischemic optic neuropathy and papilledema. Based on the published evidence, we discuss these associations along with the possible pathophysiological mechanisms and clinical management. It is needed that the ophthalmologist, the primary care physician and the sleep physician are aware of this association so that both sleep disorders and the related ophthalmologic disorders can be better diagnosed and treated.
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