Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS)
Tóm tắt
Sleep-related disorders are among the important risk factors for neurovascular diseases. Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, excessive daytime sleepiness, and insomnia. Our aim was to investigate the presence of glaucoma in patients with OSAS and to reveal vascular pathology related to the pathogenesis of glaucoma in those patients. The study included 31 patients with OSAS and 25 control subjects. Orbital Doppler ultrasonography was used to determine the resistivity index (RI) in the ophthalmic artery and central retinal artery. All patients and controls underwent perimetric examination. The prevalence of glaucoma in the group of patients with OSAS was 12.9% (4/31); all of these 4 patients with glaucoma were in the “severe” OSAS group. No statistically significant difference was found between ophthalmic artery resistivity index (OARI), central retinal artery resistivity index (CRARI), and intraocular pressure (IOP) between patients and controls (p > 0.05). There was a positive correlation between OARI and mean defect (MD), CRARI and MD, and CRARI and loss variance (LV) values (p < 0.05). There was also a positive correlation between IOP and the apnea-hypopnea index (AHI) (p = 0.001). In patients with OSAS, a high prevalence was found and it is interesting to note that all of the four glaucoma patients were in the severe OSAS group. The positive correlation observed between IOP and AHI suggests that increased IOP values may reflect the severity of OSAS. The positive correlation between OARI and MD and also between CRARI and MD as well as LV suggests that visual field defects may be due to optic nerve perfusion defects and these field defects also increase as the RI increases.
Tài liệu tham khảo
Arimoto T, Toratani A, Ito K, Iwasaki Y, Nakamura T, Nakagawa M (1995) Relationship between sleep stage and blood pressure variability during apnea in patients with sleep apnea syndrome. Nihon Kyobu Shikkan Gakkai Zasshi 33:917–923
Bucci FA, Krohel GB (1986) Optic nerve swelling secondary to the obstructive sleep apnea syndrome. Am J Ophthalmol 105:428–430
Culbertson WW, Ostler HB (1981) The floppy eyelid syndrome. Am J Ophthalmol 92:568–575
Dielemans I, Vidgerling JR, Algara D, Hofman A, Grobbee DE, Jong PT (1995) Primary open-angle glaucoma, intraocular pressure and systemic blood pressure in the general elderly population. The Rotterdam Study. Ophthalmology 102:54–60
Douglass AB, Bornstein R, Nino-Murcia G, Keenan S, Miles L, Zarcona VP Jr, Guilleminault C, Dement WC (1994) The Sleep Disorders Questionnaire. I: creation and multivariate structure of SDQ. Sleep 17:160–167
Drance SM, Schulzer M, Thomas B, Douglas GR (1981) Multivariate analysis in glaucoma. Use of discriminant analysis in predicting glaucomatous visual field damage. Arch Ophthalmol 99:1019–1022
Fincher RME, Borger HE, Chaudhary BA (1986) Sleep apnea and optic disc swelling. Pak J Ophthalmol 2:13–15
Geyer O, Cohen N, Segev E, Rath EZ, Melamud L, Peled R, Lavie P (2003) The prevalence of glaucoma in patients with sleep apnea syndrome: same as in the general population. Am J Ophthalmol 136:1093–1096
Girkin CA, McGwin G Jr, McNeal SF, Owsley C (2006) Is there an association between pre-existing sleep apnea and the development of glaucoma? Br J Ophthalmol 90:679–681
Graham SL, Drance SM, Wijsman K, Douglas GR, Mikelberg FS (1995) Ambulatory blood pressure monitoring in glaucoma. Ophthalmology 102:61–69
Guilleminault C, van den Hoed J, Mitler M (1978) Clinical overview of the sleep apnea syndromes. In: Guilleminault C, Dement W (eds) Sleep apnea syndromes. Liss, New York, pp 1–12
Guilleminault C (1994) Clinical features and evaluation of obstructive sleep apnea. In: Karger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine. Saunders, London, pp 667–677
Hayreh SS, Zimmerman MB, Podhjasky P, Alward WL (1994) Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol 117:603–624
Hayreh SS (1996) Acute ischemia disorders of the optic nerve: pathogenesis, clinical manifestations and management. Ophthalmol Clin North Am 9:407–442
Kargi SH, Altin R, Koksal M, Kart L, Cinar F, Ugurbas SH, Ayoglu F (2005) Retinal nerve fibre layer measurements are reduced in patients with obstructive sleep apnea syndrome. Eye 19:575–579
Leroy M, Van Surell C, Pilliere R, Hagenmuller MP, Aegerter P, Raffestin B, Foucher A (1996) Short-term variability of blood pressure during sleep in snorers with or without apnea. Hypertension 28:937–943
Marcus DM, Costarides AP, Gokhale P, Papastergiou G, Miller JJ, Johnson MH, Chaudhary BA (2001) Sleep disorders: a risk factor for normal-tension glaucoma? J Glaucoma 10:177–183
McNab AA (1997) Floppy eyelid syndrome and obstructive sleep apnea. Ophthal Plast Reconstr Surg 13:98–114
Meyer JH, Brandi-Dohrn JB, Funk J (1996) Twenty four hour blood pressure monitoring in normal tension glaucoma. Br J Ophthalmol 80:864–867
Mojon DS, Mathis J, Zulauf M, Koerner F, Hess CW (1998) Optic neuropathy associated with sleep apnea syndrome. Ophthalmology 105:874–877
Mojon DS, Hess CW, Goldblum D, Fleischhauer J, Koerner F, Bassetti C, Mathis J (1999) High prevalence of glaucoma in patients with sleep apnea syndrome. Ophthalmology 106:1009–1012
Mojon DS, Goldblum D, Fleischhauer J, Chiou AGY, Frueh BE, Hess CW, Gugger M, Bassetti C, Boehnke M, Mathis J (1999) Eyelid, conjunctival and corneal finding in sleep apnea syndrome. Ophthalmology 106:1182–1185
Mojon DS, Hess CW, Goldblum D, Boehnke M, Koerner F, Gugger M, Bassetti C, Mathis J (2002) Normal-tension glaucoma is associated with sleep apnea syndrome. Ophthalmologica 216:180–184
Onen SH, Mouriaux F, Berramdane L, Dascotte JC, Kulik JF, Rouland JF (2000) High prevalence of sleep-disordered breathing in patients with primary open-angle glaucoma. Acta Ophthalmol Scand 78:638–641
Purvin VA, Kawasaki A, Yee RD (2000) Papilledema and obstructive sleep apnea syndrome. Arch Ophthalmol 118:1626–1630
Richler M, Werner EB, Thomas D (1982) Risk factors for progression of visual field defect in medically treated patients with glaucoma. Can J Ophthalmol 17:245–248
Robert PY, Adenis JP, Tapie P, Melloni B (1997) Eyelid hyperlaxity and obstructive sleep apnea syndrome. Eur J Ophthalmol 7:211–215
Shepard JW (1985) Gas exchange and hemodynamics during sleep. Med Clin North Am 69:1243–1264
Tsang CS, Chong SL, Ho CK, Li MF (2006) Moderate to severe obstructive sleep apnoea patients is associated with a higher incidence of visual field defect. Eye 20:38–42
Wellington DP, Johnstone MA (1994) Normal-tension glaucoma (low tension glaucoma). In: Albert DM, Jakobiec FA (eds) Principles and practice of ophthalmology. Saunders, Philadelphia, pp 1350–1365