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Obstructive sleep apnea–hypopnea syndrome (OSAHS) and glaucomatous optic neuropathy

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Abstract

Obstructive sleep apnea–hypopnea syndrome (OSAHS) is becoming widely accepted as a risk factor for glaucoma. We discuss the proposed mechanism involved in the pathogenesis of glaucoma in OSAHS, and review the published data on the association between these two conditions, as well as papers regarding functional and structural tests related with glaucomatous damage. There is increasing evidence that the prevalence of glaucoma is higher in OSAHS patients, especially in those with severe disease with apnea-hypopnea index (AHI) >30, and also that sleep disorders may be more frequent in patients with glaucoma, especially in those with normal tension glaucoma (NTG). Several ophthalmic signs and symptoms have been associated with this condition. Raised intraocular pressure (IOP), possibly related to increased body mass index, thinning of retinal nerve fiber layer (RNFL), and alteration of visual field (VF) indices has been demonstrated in many studies, in patients with no history of glaucoma or evidence of glaucomatous changes in the ophthalmic examination. A correlation of AHI with RNFL and VF indices has been described in some studies. Finally, corneal thinning, suspicious glaucomatous disc changes and anomalies in electrophysiological tests such as multifocal visual evoked potential have been described in patients with OSAHS, even in patients with normal findings in the optic nerve and VF, suggesting subclinical optic nerve involvement not detectable in conventional ophthalmic examinations. The pathogenesis of optic nerve involvement has been related to vascular and mechanical factors. Vascular factors include recurrent hypoxia with increased vascular resistance, autonomic deregulation, oxidative stress and inflammation linked to hypoxia and subsequent reperfusion, decreased cerebral perfusion pressure and direct hypoxic damage to the optic nerve. Proposed mechanical factors include increased IOP at night related to supine position and obesity, raised intracranial pressure and elastic fiber depletion in the lamina cribosa and/or trabeculum. In conclusion, ophthalmic evaluation should be recommended in patients with severe OSAHS, and the presence of sleep disorders should be investigated in patients with glaucoma, especially in NTG patients and in those with progressive damage despite controlled IOP, as treatment with continuous positive airway pressure may contribute to stabilizing the progression of glaucomatous damage.

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References

  1. Stradling JR, Davies RJ (2004) Sleep 1: obstructive sleep apnoea/hypopnoea syndrome: definitions, epidemiology, and natural history. Thorax 59:73–78

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhorta A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5:263–276

    PubMed  Google Scholar 

  3. Muniesa M, Sánchez-de-la-Torre M, Huerva V, Lumbierres M, Barbé F (2013) Floppy eyelid syndrome as an indicator of the presence of glaucoma in patients with obstructive sleep apnea. J Glaucoma 23:e81–e85

    Article  Google Scholar 

  4. Stein JD, Kim DS, Mundy KM, Talwar N, Nan B, Chervin RD, Musch DC (2011) The association between glaucomatous and other causes of optic neuropathy and sleep apnea. Am J Ophthalmol 152:989–998

    Article  PubMed Central  PubMed  Google Scholar 

  5. Li J, McGwin G Jr, Vaphiades MS, Owsley C (2007) Non-arteritic anterior ischaemic optic neuropathy and presumed sleep apnoea syndrome screened by the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ). Br J Ophthalmol 91:1524–1527

    Article  PubMed Central  PubMed  Google Scholar 

  6. Mojon DS, Hedges TR 3rd, Ehrenberg B, Karam EZ, Goldblum D, Abou-Chebl A, Gugger M, Mathis J (2002) Association between sleep apnea syndrome and nonarteritic anterior ischemic optic neuropathy. Arch Ophthalmol 120:601–605

    Article  PubMed  Google Scholar 

  7. Palombi K, Renard E, Levy P, Chiquet C, Deschaux C, Romanet JP, Pépin JL (2006) Non-arteritic anterior ischaemic optic neuropathy is nearly systematically associ-ated with obstructive sleep apnoea. Br J Ophthalmol 90:879–882

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. 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

    Article  CAS  PubMed  Google Scholar 

  9. Sergi M, Salerno DE, Rizzi M, Blini M, Andreoli A, Messenio D, Pecis M, Bertoni G (2007) Prevalence of normal tension glaucoma in obstructive sleep apnea syndrome patients. J Glaucoma 16:42–46

    Article  PubMed  Google Scholar 

  10. Purvin VA, Kawasaki A, Yee RD (2000) Papilledema and obstructive sleep apnea syndrome. Arch Ophthalmol 118:1626–1630

    Article  CAS  PubMed  Google Scholar 

  11. Kloos P, Laube I, Thoelen A (2008) Obstructive sleep apnea in patients with central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 246:1225–1228

    Article  PubMed  Google Scholar 

  12. Leroux les Jardins G, Glacet-Bernard A, Lasry S, Housset B, Coscas G, Soubrane G (2009) Retinal vein occlusion and obstructive sleep apnea syndrome. J Fr Ophtalmol 32:420–424

    Article  CAS  PubMed  Google Scholar 

  13. Walsh JT, Montplaisir J (1982) Familial glaucoma with sleep apnoea: a new syndrome? Thorax 37:845–849

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Karakucuk S, Goktas S, Aksu M, Erdogan N, Demirci S, Oner A, Arda H, Gumus K (2008) Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS). Graefes Arch Clin Exp Ophthalmol 246:129–134

    Article  PubMed Central  PubMed  Google Scholar 

  15. 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 (Lond) 20:38–42

    Article  CAS  Google Scholar 

  16. Barcelo A, Elorza MA, Barbe F, Santos C, Mayoralas LR, Agusti AG (2001) Angiotensin converting enzyme in patients with sleep apnoea syndrome: plasma activity and gene polymorphisms. Eur Respir J 17:728–732

    Article  CAS  PubMed  Google Scholar 

  17. Kario K (2009) Obstructive sleep apnea syndrome and hypertension: ambulatory blood pressure. Hypertens Res 32:428–432

    Article  PubMed  Google Scholar 

  18. Nadeem R, Molnar J, Madbouly EM, Nida M, Aggarwal S, Sajid H, Naseem J, Loomba R (2013) Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med 9:1003–1012

    PubMed Central  PubMed  Google Scholar 

  19. Thurtell MJ, Bruce BB, Newman NJ, Biousse V (2010) An update on idiopathic intracranial hypertension. Rev Neurol Dis 7:e56–e68

    PubMed Central  PubMed  Google Scholar 

  20. Kent BD, Mitchell PD, McNicholas WT (2011) Hypoxemia in patients with COPD: cause, effects, and disease progression. Int J Chron Obstruct Pulmon Dis 6:199–208

    PubMed Central  PubMed  Google Scholar 

  21. Hara T, Hara T, Tsuru T (2006) Increase of peak intraocular pressure during sleep in reproduced diurnal changes by posture. Arch Ophthalmol 124:165–168

    Article  PubMed  Google Scholar 

  22. Cheung N, Wong TY (2007) Obesity and eye diseases. Surv Ophthalmol 52:180–195

    Article  PubMed Central  PubMed  Google Scholar 

  23. Waller EA, Bendel RE, Kaplan J (2008) Sleep disorders and the eye. Mayo Clin Proc 83:1251–1261

    Article  PubMed  Google Scholar 

  24. Bendel RE, Kaplan J, Heckman M, Fredrickson PA, Lin SC (2008) Prevalence of glaucoma in patients with obstructive sleep apnoea–a cross-sectional case-series. Eye (Lond) 22:1105–1109

    Article  CAS  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. Girkin CA, McGwin G Jr, McNeal SF, Owsley C (2006) Is there an association between pre-existing sleep apnoea and the development of glaucoma? Br J Ophthalmol 90:679–681

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Kadyan A, Asghar J, Dowson L, Sandramouli S (2010) Ocular findings in sleep apnoea patients using continuous positive airway pressure. Eye (Lond) 24:843–850

    Article  CAS  Google Scholar 

  28. Lin PW, Friedman M, Lin HC, Chang HW, Wilson M, Lin MC (2011) Normal tension glaucoma in patients with obstructive sleep apnea/hypopnea syndrome. J Glaucoma 20:553–558

    Article  PubMed  Google Scholar 

  29. Lin CC, Hu CC, Ho JD, Chiu HW, Lin HC (2013) Obstructive sleep apnea and increased risk of glaucoma: a population-based matched-cohort study. Ophthalmology 120:1559–1564

    Article  PubMed  Google Scholar 

  30. Moghimi S, Ahmadraji A, Sotoodeh H, Sadeghniat K, Maghsoudipour M, Fakhraie G, Latifi G, Nassiri N, Giaconi JA (2013) Retinal nerve fiber thickness is reduced in sleep apnea syndrome. Sleep Med 14:53–57

    Article  PubMed  Google Scholar 

  31. Nowak MS, Jurowski P, Gos R, Prost ME, Smigielski J (2011) Pulsatile ocular blood flow in subjects with sleep apnoea syndrome. Arch Med Sci 7:332–336

    Article  PubMed Central  PubMed  Google Scholar 

  32. 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

    Article  CAS  PubMed  Google Scholar 

  33. Wang H, Zhang Y, Ding J, Wang N (2013) Changes in the circadian rhythm in patients with primary glaucoma. PLoS One 8:e62841

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Roberts TV, Hodge C, Graham SL, Burlutsky G, Mitchell P (2009) Prevalence of nocturnal oxygen desaturation and self-reported sleep-disordered breathing in glaucoma. J Glaucoma 18:114–118

    Article  PubMed  Google Scholar 

  35. Blumen Ohana E, Blumen MB, Bluwol E, Derri M, Chabolle F, Nordmann JP (2010) Primary open angle glaucoma and snoring: prevalence of OSAS. Eur Ann Otorhinolaryngol Head Neck Dis 127:159–164

    Article  CAS  PubMed  Google Scholar 

  36. Mojon DS, Hess CW, Goldblum D, Böhnke M, Körner F, Mathis J (2000) Primary open-angle glaucoma is associated with sleep apnea syndrome. Ophthalmologica 214:115–118

    Article  CAS  PubMed  Google Scholar 

  37. 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

    Article  CAS  PubMed  Google Scholar 

  38. 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

    Article  PubMed  Google Scholar 

  39. Huseyinoglu N, Ekinci M, Ozben S, Buyukuysal C, Kale MY, Sanivar HS (2014) Optic disc and retinal nerve fiber layer parameters as indicators of neurodegenerative brain changes in patients with obstructive sleep apnea syndrome. Sleep Breath 18:95–102

    Article  PubMed  Google Scholar 

  40. Casas P, Ascaso FJ, Vicente E, Tejero-Garcés G, Adiego MI, Cristóbal JA (2013) Retinal and optic nerve evaluation by optical coherence tomography in adults with obstructive sleep apnea-hypopnea syndrome (OSAHS). Graefes Arch Clin Exp Ophthalmol 251:1625–1634

    Article  PubMed  Google Scholar 

  41. Lin PW, Friedman M, Lin HC, Chang HW, Pulver TM, Chin CH (2011) Decreased retinal nerve fiber layer thickness in patients with obstructive sleep apnea/hypopnea syndrome. Graefes Arch Clin Exp Ophthalmol 249:585–593

    Article  PubMed  Google Scholar 

  42. Ekinci M, Huseyinoglu N, Cagatay HH, Ceylan E, Keles S, Gokce G (2013) Is there a Relationship Between Sleep Apnea and Central Corneal Thickness? Curr Eye Res 38:1104–1109

    Article  PubMed  Google Scholar 

  43. Sagiv O, Fishelson-Arev T, Buckman G, Mathalone N, Wolfson J, Segev E, Peled R, Lavi I, Geyer O (2014) Retinal nerve fiber layer thickness measurements by optical coherence tomography in patients with sleep apnea syndrome. Clin Exp Ophthalmol 42:132–138

    Article  Google Scholar 

  44. Gutiérrez-Díaz E, Pérez-Rico C, de Atauri MJ, Mencía-Gutiérrez E, Blanco R (2012) Evaluation of the visual function in obstructive sleep apnea syndrome patients and normal-tension glaucoma by means of the multifocal visual evoked potentials. Graefes Arch Clin Exp Ophthalmol 250:1681–1688

    Article  PubMed  Google Scholar 

  45. Kargi SH, Altin R, Koksal M, Kart L, Cinar F, Ugurbas SH, Ayoglu F (2005) Retinal nerve fiber layer measurements are reduced in patients with obstructive sleep apnoea syndrome. Eye (Lond) 19:575–579

    Article  CAS  Google Scholar 

  46. Erdem CZ, Altin R, Erdem LO, Kargi S, Kart L, Cinar F, Ayoglu F (2003) Doppler measurement of blood flow velocities in extraocular orbital vessels in patients with obstructive sleep apnea syndrome. J Clin Ultrasound 31:250–257

    Article  PubMed  Google Scholar 

  47. Pépin JL, Chiquet C, Tamisier R, Lévy P, Almanjoumi A, Romanet JP (2010) Frequent loss of nyctohemeral rhythm of intraocular pressure restored by nCPAP treatment in patients with severe apnea. Arch Ophthalmol 128:1257–1263

    Article  PubMed  Google Scholar 

  48. Kiekens S, De Groot V, Coeckelbergh T, Tassignon MJ, van de Heyning P, De Backer W, Verbraecken J (2008) Continuous positive airway pressure therapy is associated with an increase in intraocular pressure in obstructive sleep apnea. Invest Ophthalmol Vis Sci 49:934–940

    Article  PubMed  Google Scholar 

  49. Buguet A, Py P, Romanet JP (1994) 24-hour (nyctohemeral) and sleep-related variations of intraocular pressure in healthy white individuals. Am J Ophthalmol 117:342–347

    CAS  PubMed  Google Scholar 

  50. Noël C, Kabo AM, Romanet JP, Montmayeur A, Buguet A (2001) Twenty-four-hour time course of intraocular pressure in healthy and glaucomatous Africans: relation to sleep patterns. Ophthalmology 108:139–144

    Article  PubMed  Google Scholar 

  51. Lundmark PO, Trope GE, Flanagan JG (2003) The effect of simulated obstructive apnoea on intraocular pressure and pulsatile ocular blood flow in healthy young adults. Br J Ophthalmol 87:1363–1369

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Goldmann DB, Waubke N (1989) A pilot study on the effect of atrial natriuretic peptide on intraocular pressure in the human. Fortschr Ophthalmol 86:494–496

    CAS  PubMed  Google Scholar 

  53. Krieger J, Laks L, Wilcox I, Grunstein RR, Costas LJ, McDougall JG, Sullivan CE (1989) Atrial natriuretic peptide release during sleep in patients with obstructive sleep apnoea before and during treatment with nasal continuous positive airway pressure. Clin Sci (Lond) 77:407–411

    CAS  Google Scholar 

  54. Chiquet C, Denis P (2004) The neuroanatomical and physiological bases of variations in intraocular pressure. J Fr Ophtalmol 27:S11–S18

    Article  Google Scholar 

  55. Liu JH, Dacus AC, Bartels SP (1991) Adrenergic mechanism in circadian elevation of intraocular pressure in rabbits. Invest Ophthalmol Vis Sci 32:2178–2183

    CAS  PubMed  Google Scholar 

  56. Minemura H, Akashiba T, Yamamoto H, Akahoshi T, Kosaka N, Horie T (1998) Acute effects of nasal continuous positive airway pressure on 24-hour blood pressure and catecholamines in patients with obstructive sleep apnea. Intern Med 37:1009–1013

    Article  CAS  PubMed  Google Scholar 

  57. Hedner J, Darpö B, Ejnell H, Carlson J, Caidahl K (1995) Reduction in sympathetic activity after long-term CPAP treatment in sleep apnoea: cardiovascular implications. Eur Respir J 8:222–229

    Article  CAS  PubMed  Google Scholar 

  58. Heitmann J, Ehlenz K, Penzel T et al (2004) Sympathetic activity is reduced by nCPAP in hypertensive obstructive sleep apnoea patients. Eur Respir J 23:255–262

    Article  CAS  PubMed  Google Scholar 

  59. Costagliola C, Verolino M, De Rosa ML, Iaccarino G, Ciancaglini M, Mastropasqua L (2000) Effect of oral losartan potassium administration on intraocular pressure in normotensive and glaucomatous human subjects. Exp Eye Res 71:167–171

    Article  CAS  PubMed  Google Scholar 

  60. Sebastian RT, Johns S, Gibson RA (2006) Treating obstructive sleep apnoea syndrome: does it improve visual field changes? Eye (Lond) 20:118–120

    Article  CAS  Google Scholar 

  61. Kremmer S, Niederdräing N, Ayertey HD, Steuhl KP, Selbach JM (2003) Obstructive sleep apnea syndrome, normal tension glaucoma, and nCPAP therapy–a short note. Sleep 26:161–162

    PubMed  Google Scholar 

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Acknowledgments

Supported in part by the Spanish government grants FIS PI11/00533, RETICS RD12/0034/0006 and TEC2011-26066.

Conflict of interest

No financial conflict of interest.

Author contribution

Substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data: C.P-R., E.G.-D., E.M-G. Drafting the article or revising it critically for important intellectual content: C.P-R., E.G.-D., E.M-G. Final approval of the version to be published: C.P-R., E.G.-D., M.J.D-A., R.B.

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Authors and Affiliations

  1. Department of Ophthalmology, University Hospital Príncipe de Asturias, University of Alcalá, Carretera Alcalá-Meco s/n, 28805, Alcalá de Henares, Madrid, Spain

    Consuelo Pérez-Rico

  2. Department of Ophthalmology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain

    Esperanza Gutiérrez-Díaz & Enrique Mencía-Gutiérrez

  3. Department of Pneumology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain

    María Josefa Díaz-de-Atauri

  4. Department of Surgery, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain

    Consuelo Pérez-Rico & Román Blanco

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  1. Consuelo Pérez-Rico
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  2. Esperanza Gutiérrez-Díaz
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Correspondence to Consuelo Pérez-Rico.

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Pérez-Rico, C., Gutiérrez-Díaz, E., Mencía-Gutiérrez, E. et al. Obstructive sleep apnea–hypopnea syndrome (OSAHS) and glaucomatous optic neuropathy. Graefes Arch Clin Exp Ophthalmol 252, 1345–1357 (2014). https://doi.org/10.1007/s00417-014-2669-4

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  • DOI: https://doi.org/10.1007/s00417-014-2669-4

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