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BMC Ophthalmology

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Open Access 01-12-2018 | Research article

Visual field defects and retinal nerve fiber imaging in patients with obstructive sleep apnea syndrome and in healthy controls

Authors: Paula Casas, Francisco J. Ascaso, Eugenio Vicente, Gloria Tejero-Garcés, María I. Adiego, José A. Cristóbal

Published in: BMC Ophthalmology | Issue 1/2018

Abstract

Background

To assess the retinal sensitivity in obstructive sleep apnea hypopnea syndrome (OSAHS) patients evaluated with standard automated perimetry (SAP). And to correlate the functional SAP results with structural parameters obtained with optical coherence tomography (OCT).

Methods

This prospective, observational, case-control study consisted of 63 eyes of 63 OSAHS patients (mean age 51.7 ± 12.7 years, best corrected visual acuity ≥20/25, refractive error less than three spherical or two cylindrical diopters, and intraocular pressure < 21 mmHg) who were enrolled and compared with 38 eyes of 38 age-matched controls. Peripapillary retinal nerve fiber layer (RNFL) thickness was measured by Stratus OCT and SAP sensitivities and indices were explored with Humphrey Field Analyzer perimeter. Correlations between functional and structural parameters were calculated, as well as the relationship between ophthalmologic and systemic indices in OSAHS patients.

Results

OSAHS patients showed a significant reduction of the sensitivity for superior visual field division (p = 0.034, t-student test). When dividing the OSAHS group in accordance with the severity of the disease, nasal peripapillary RNFL thickness was significantly lower in severe OSAHS than that in controls and mild-moderate cases (p = 0.031 and p = 0.016 respectively, Mann-Whitney U test). There were no differences between groups for SAP parameters.

We found no correlation between structural and functional variables. The central visual field sensitivity of the SAP revealed a poor Pearson correlation with the apnea-hipopnea index (0.284, p = 0.024).

Conclusions

Retinal sensitivity show minor differences between healthy subjects and OSAHS. Functional deterioration in OSAHS patients is not easy to demonstrate with visual field examination.

Karger RA, White WA, Park WC, et al. Prevalence of floppy eyelid syndrome in obstructive sleep apnea-hypopnea syndrome. Ophthalmology. 2006;113:1669–74.CrossRefPubMed

Leroux les Jardins G, Glacet-Bernard A, Lasry S, Housset B, Coscas G, Soubrane G. Retinal vein occlusion and obstructive sleep apnea syndrome. J Fr Ophtalmol. 2009;32:420–4.CrossRefPubMed

Jain AK, Kaines A, Schwartz S. Bilateral central serous chorioretinopathy resolving rapidly with treatment for obstructive sleep apnea. Graefes Arch Clin Exp Ophthalmol. 2010;248:1037–9.CrossRefPubMed

Kloos P, Laube I, Thoelen. Obstructive sleep apnea in patients with central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol. 2008;246:1225–8.CrossRefPubMed

Purvin VA, Kawasaki A, Yee RD. Papilledema and obstructive sleep apnea syndrome. Arch Ophthalmol. 2000;118:1626–30.CrossRefPubMed

Palombi K, Renard E, Levy P, et al. Non-arteritic anterior ischaemic optic neuropathy is nearly systematically associated with obstructive sleep apnoea. Br J Ophthalmol. 2006;90:879–82.CrossRefPubMedPubMedCentral

Mojon DS, Hess CW, Goldblum D, et al. High prevalence of glaucoma in patients with sleep apnea syndrome. Ophthalmology. 1999;106:1009–12.CrossRefPubMed

Mojon DS, Hess CW, Goldblum D, Böhnke M, Körner F, Mathis J. Primary open-angle glaucoma is associated with sleep apnea syndrome. Ophthalmologica. 2000;214:115–8.CrossRefPubMed

Bendel RE, Kaplan J, Heckman M, Fredrickson PA, Lin SC. Prevalence of glaucoma in patients with obstructive sleep apnoea—a cross-sectional case-series. Eye (Lond). 2008;22:1105–9.CrossRef

10.

Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40:408–19.CrossRefPubMed

11.

Lin PW, Friedman M, Lin HC, Chang HW, Pulver TM, Chin CH. Decreased retinal nerve fiber layer thickness in patients with obstructive sleep apnea/hypopnea syndrome. Graefes Arch Clin Exp Ophthalmol. 2011;249:585–93.CrossRefPubMed

12.

Sagiv O, Fishelson-Arev T, Buckman G, et al. Retinal nerve fiber layer thickness measurements by optical coherence tomography in patients with sleep apnea syndrome. Clin Exp Ophthalmol. 2014;42:132–8.CrossRefPubMed

13.

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

14.

Casas P, Ascaso FJ, Vicente E, Tejero-Garcés G, Adiego MI, Cristóbal JA. Retinal and optic nerve evaluation by optical coherence tomography in adults with obstructive sleep apnea-hypopnea syndrome (OSAHS). Graefes Arch Clin Exp Ophthalmol. 2013;251:1625–34.CrossRefPubMed

15.

Shiba T, Takahashi M, Sato Y, et al. Relationship between severity of obstructive sleep apnea syndrome and retinal nerve fiber layer thickness. Am J Ophthalmol. 2014;157:1202–8.CrossRefPubMed

16.

Kargi SH, Altin R, Koksal M, et al. Retinal nerve fibre layer measurements are reduced in patients with obstructive sleep apnoea syndrome. Eye (Lond). 2005;19:575–9.CrossRefPubMed

17.

Garway-Heath DF, Poinoosawmy D, Fitzke FW, Hitchings RA. Mapping the visual field to the optic disc in normal tension glaucoma eyes. Ophthalmology. 2000;107:1809–15.CrossRefPubMed

18.

Ferreras A, Pablo LE, Garway-Heath DF, Fogagnolo P, García-Feijoo J. Mapping standard automated perimetry to the peripapillary retinal nerve fiber layer in glaucoma. Invest Ophthalmol Vis Sci. 2008;49:3018–25.CrossRefPubMed

19.

Cheng H, Laron M, Schiffman JS, Tang RA, Frishman LJ. The relationship between visual field and retinal nerve fiber layer measurements in patients with multiple sclerosis. Invest Ophthalmol Vis Sci. 2007;48:5798–805.CrossRefPubMedPubMedCentral

20.

Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131:485–91.CrossRefPubMed

21.

Sharma SK, Sinha S, Banga A, Pandey RM, Handa KK. Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome. Indian J Med Res. 2006;124:281–90.PubMed

22.

Bowd C, Zangwill LM, Blumenthal EZ, et al. Imaging of the optic disc and retinal nerve fiber layer: effects of age, optic disc area, refractive error and gender. J Opt Soc Am A Opt Image Sci Vis. 2002;19:197–207.CrossRefPubMed

23.

Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross sectional results of the sleep heart health study. Am J Respir Crit Care Med. 2001;163:19–25.CrossRefPubMed

24.

Anderson DR. Glaucoma, capillaries and pericytes. 1. Blood flow regulation. Ophthalmologica. 1996;210:257–62.CrossRefPubMed

25.

Karakucuk S, Goktas S, Aksu M, et al. Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS). Graefes Arch Clin Exp Ophthalmol. 2008;246:129–34.CrossRefPubMed

26.

Budenz DL, Anderson DR, Varma R, et al. Determinants of normal retinal nerve fiber layer thickness measured by Stratus OCT. Ophthalmology. 2007;114:1046–52.CrossRefPubMedPubMedCentral

27.

Xie K, Liu CY, Hasso AN, Crow RW. Visual field changes as an early indicator of glioblastoma multiforme progression: two cases of functional vision changes before MRI detection. Clin Ophthalmol. 2015;9:1041–7.CrossRefPubMedPubMedCentral

28.

Bucci FA Jr, Krohel GB. Optic nerve swelling secondary to the obstructive sleep apnea syndrome. Am J Ophthalmol. 1988;105:428–30.CrossRefPubMed

29.

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. 2015;19:129–34.CrossRefPubMed

30.

McNab AA. The eye and sleep apnea. Sleep Med Rev. 2007;11:269–76.CrossRefPubMed

31.

West SD, Turnbull C. Eye disorders associated with obstructive sleep apnoea. Curr Opin Pulm Med. 2016;22:595-601.

32.

Leibovitch I, Selva D. Floppy eyelid syndrome: clinical features and the association with obstructive sleep apnea. Sleep Med. 2006;7:117–22.CrossRefPubMed

33.

Tsang CS, Chong SL, Ho CK, Li MF. Moderate to severe obstructive sleep apnoea patients is associated with a higher incidence of visual field defect. Eye. 2006;20:38–42.CrossRefPubMed

34.

Ferrandez B, Ferreras A, Calvo P, et al. Retinal sensitivity is reduced in patients with obstructive sleep apnea. Invest Ophthalmol Vis Sci. 2014;55:7119–25.CrossRefPubMed

35.

Gonzalez de la Rosa M, Pareja A. Influence of the “fatigue effect” on the mean deviation measurement in perimetry. Eur J Ophthalmol. 1997;7:29–34.PubMed

36.

Jurádo-Gámez B, Guglielmi O, Gude-Sampedro F, Buela-Casal G. Effect of CPAP therapy on job productivity and psychosocial occupational health in patients with moderate to severe sleep apnea. Sleep Breath. 2015;19:1293–9.CrossRefPubMed

37.

Tippin J, Sparks J, Rizzo M. Visual vigilance in drivers with obstructive sleep apnea. J Psychosom Res. 2009;67:143–51.CrossRefPubMedPubMedCentral

38.

Bjornsdottir E, Keenan BT, Eysteinsdottir B, et al. Quality of life among untreated sleep apnea patients compared with the general population and changes after treatment with positive airway pressure. J Sleep Res. 2015;24:328–38.CrossRefPubMed

39.

Saunders LJ, Russell RA, Crabb DP. Measurement precision in a series of visual fields acquired by the standard and fast versions of the Swedish interactive thresholding algorithm: analysis of large-scale data from clinics. JAMA Ophthalmol. 2015;133:74–80.CrossRefPubMed

40.

Hood DC. Relating retinal nerve fiber thickness to behavioral sensitivity in patients with glaucoma: application of a linear model. J Opt Soc Am A Opt Image Sci Vis. 2007;24:1426–30.CrossRefPubMed

41.

Leung CK, Chong KK, Chan WM, et al. Comparative study of retinal nerve fiber layer measurement by Stratus OCT and GDx VCC, II: structure/function regression analysis in glaucoma. Invest Ophthalmol Vis Sci. 2005;46:3702–11.CrossRefPubMed

42.

Nilforushan N, Nassiri N, Moghimi S, et al. Structure-function relationships between spectral-domain OCT and standard achromatic perimetry. Invest Ophthalmol Vis Sci. 2012;53:2740–8.CrossRefPubMed

43.

Bowd C, Zangwill LM, Medeiros FA, et al. Structure-function relationships using confocal scanning laser ophthalmoscopy, optical coherence tomography, and scanning laser polarimetry. Invest Ophthalmol Vis Sci. 2006;47:2889–95.CrossRefPubMed

44.

Ajtony C, Balla Z, Somoskeoy S, Kovacs B. Relationship between visual field sensitivity and retinal nerve fiber layer thickness as measured by optical coherence tomography. Invest Ophthalmol Vis Sci. 2007;48:258–63.CrossRefPubMed

45.

Costello F, Coupland S, Hodge W, et al. Quantifying axonal loss after optic neuritis with optical coherence tomography. Ann Neurol. 2006;59:963–9.CrossRefPubMed

46.

Nouri-Mahdavi K, Hoffman D, Tannenbaum DP, Law SK, Caprioli J. Identifying early glaucoma with optical coherence tomography. Am J Ophthalmol. 2004;137:228–35.CrossRefPubMed

47.

Bowd C, Weinreb RN, Williams JM, Zangwill LM. The retinal nerve fiber layer thickness in ocular hypertensive, normal, and glaucomatous eyes with optical coherence tomography. Arch Ophthalmol. 2000;118:22–6.CrossRefPubMed

Title: Visual field defects and retinal nerve fiber imaging in patients with obstructive sleep apnea syndrome and in healthy controls
Authors: Paula Casas
Francisco J. Ascaso
Eugenio Vicente
Gloria Tejero-Garcés
María I. Adiego
José A. Cristóbal
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Ophthalmology / Issue 1/2018
Electronic ISSN: 1471-2415
DOI: https://doi.org/10.1186/s12886-018-0728-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Visual field defects and retinal nerve fiber imaging in patients with obstructive sleep apnea syndrome and in healthy controls

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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