Evaluation of ocular surface tear dynamics patients with obstructive sleep apnea syndrome

The purpose of this study is to determine the morbidity of probable dry eye disease and the relationship between the classification of the interference patterns of the lipid layer of the tear film and the severity of obstructive sleep apnea syndrome (OSAS). We studied 49 consecutive Japanese patients with OSAS (age 60.0 ± 11.8 years) who underwent standard overnight polysomnography. The Schirmer test, tear film break-up time and the incidence of keratoconjunctival epithelial damage evaluated by fluorescein staining were used for the diagnosis of probable dry eye disease. The classification of interference patterns of the tear film’s lipid layer used the DR-1™ dry eye monitor (Kowa). The apnea–hypopnea index, the lowest SpO₂%, the cumulative percentage of time at SpO₂ <90% in analysis times (CT90%), the mean SpO₂ and the Epworth Sleepiness Scale score were obtained in a sleep study. We evaluated the morbidity of probable dry eye disease and the relationship between the severity of the interference patterns of the tear film’s lipid layer and the severity of OSAS. Fourteen of the 39 (35.9%) men and 7 of the 10 (70%) women (21/49; 42.9% of the patients) were diagnosed with probable dry eye disease. The multiple regression analysis revealed only CT90% as a factor contributing independently to the grade of the tear film’s lipid layer in the right eye (standard regression coefficient = 0.30, P = 0.02, R = 0.58). When examining for or treating OSAS, physicians should consider the possibility of ocular surface abnormality in Japanese individuals.