Nocturnal Intraocular Pressure in Primary Open Angle Glaucoma and Obstructive Sleep Apnea Patient with CPAP Treatment
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Abstract
Objective: To compare nocturnal intraocular pressure (IOP) in primary open-angle glaucoma (POAG) and obstructive sleep apnea (OSA) patient with and without continuous positive airway pressure (CPAP) machine
Methods: Prospective control study in 16 eyes of patients who diagnosed POAG and OSA. First night patients obtained sleep study to confirm diagnosis of OSA and measured intraocular pressure (IOP) every 2 hours. Second night patients also obtained sleep study additional CPAP pressure adjust for treatment OSA and measured IOP every 2 hours in the same procedure.
Results: Eight patients (sixteen eyes) were enrolled for the study. Mean age was 60.6 ± 4.53 years, 75 % were male, mean BMI was 26.64 ± 1.84 kg/m2 and mean apnea-hypopnea index (AHI) was 37.42 ± 15.62 /hour. Average IOP in the first night (no CPAP use) sleep study were differ from average IOP in the second night (CPAP use) at each time (22.00, 24.00, 02.00, 04.00 and 06.00) non significant ( p value = 0.35). Average IOP in the first night were 19.06 ± 0.9 mm Hg with peak IOP 19.87 mm Hg at 06.00. Average IOP in the second night were 17.26 ± 1.48 with peak IOP 19 mm Hg at 04.00.
Conclusions: The first line treatment option for moderate or severe obstructive sleep apnea is CPAP. Beside of elimination apnea, hypopnea or respiratory effort related arousal (RERA) events, it improve sleep quality, desaturation during sleep and may reduce IOP in POAG or delay glaucomatous progression. However further study for CPAP use and long term outcome of glaucoma change such as retinal fiber layer thickness visual field change should be beneficial.
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References
2. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.
3. Parish JM, Somers VK. Obstructive sleep apnea and cardiovascular disease. Mayo Clin. Proc. 2004;79(8):1036–46.
4. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–41.
5. De Moraes CGV, Juthani VJ, Liebmann JM, Teng CC, Tello C, Susanna R Jr, et al. Risk factors for visual field progression in treated glaucoma. Arch Ophthalmol. 2011 May;129(5):562–8.
6. McNab AA. The eye and sleep apnea. Sleep Med Rev. 2007;11(4):269–76.
7. Sergi M, Salerno DE, Rizzi M, Blini M, Andreoli A, Messenio D et al. Prevalence of normal tension glaucoma in obstructive sleep apnea syndrome patients. J. Glaucoma. 2007;16(1):42–6.
8. Lin P-W, Friedman M, Lin H-C, Chang H-W, Pulver TM, Chin C-H. Decreased retinal nerve fiber layer thickness in patients with obstructive sleep apnea/hypopnea syndrome. Graefes Arch. Clin. Exp. Ophthalmol. 2011;249(4):585–93.
9. Kiekens S, Veva De Groot, Coeckelbergh T, Tassignon M-J, Van de Heyning P, Wilfried De Backer et al. Continuous positive airway pressure therapy is associated with an increase in intraocular pressure in obstructive sleep apnea. Invest. Ophthalmol. Vis. Sci. 2008;49(3):934–40.
10. Pépin J-L, Chiquet C, Tamisier R, Lévy P, Almanjoumi A, Romanet J-P. Frequent loss of nyctohemeral rhythm of intraocular pressure restored by nCPAP treatment in patients with severeapnea. Arch. Ophthalmol.2010;128(10):1257–63.
11. Bengtsson B, Leske MC, Hyman L, Heijl A. Fluctuation of intraocular pressure and glaucoma progression in the early manifest glaucoma trial. Ophthalmology. 2007;114(2):205–9.
12. Blondeau P, Tétrault JP, Papamarkakis C. Diurnal variation of episcleral venous pressure in healthy patients: a pilot study. J. Glaucoma. 2001;10(1):18–24.
13. Williams BI, Peart WS. Effect of posture on the intraocular pressure of patients with retinal vein obstruction. Br J Ophthalmol 1978; 62: 688-693.