Optic neuropathy associated with sleep apnea syndrome

doi:10.1016/S0161-6420(98)95030-8

Ophthalmology

Volume 105, Issue 5, 1 May 1998, Pages 874-877

Presented in part at the Annual Meeting of the American Academy of Ophthalmology, Chicago, October, 1996.

https://doi.org/10.1016/S0161-6420(98)95030-8 Get rights and content

Abstract

Objective

The study aimed to determine ocular abnormalities in sleep apnea syndrome (SAS), an entity characterized by repetitive upper airway obstructions during sleep, inducing hypoxia and sleep disruption with the risk of cardiovascular and neurologic sequelae.

Design

The study design was a case series.

Participants

Nine patients referred for evaluation of suspected SAS participated.

Intervention

Complete ophthalmologic examination, including computerized perimetry, was performed.

Main outcome measures

Correlations between the respiratory disturbance index (RDI) during night sleep, a value used to diagnose and to grade SAS, and visual field indices using the Spearman rank correlation coefficient (r_s) were measured.

Results

One patient was excluded from the statistical analysis because of optic nerve drusen with constricted visual fields, another because of tiled discs with corresponding temporal visual field defects. All three patients with severe SAS and one patient with moderate SAS had relative nasal arcuate visual field defects; two patients with severe SAS also had paracentral relative defects. One patient with normal polysomnographic result and two patients with mild or moderate SAS had normal visual fields. The RDI correlated positively with the mean visual field defect (r_s = 0.81, P < 0.05) and with the visual field loss variance (r_s = 0.78, P < 0.05). The clinical ophthalmologic examination results were normal in all seven patients. In two of the three patients with severe SAS treated with continuous positive airway pressure (CPAP), visual field defects remained stable over 18 months. The patient with optic nerve drusen also had severe SAS and was, therefore, treated with CPAP. His constricted visual fields improved dramatically after treatment.

Conclusions

Visual fields of patients with SAS showed defects consistent with an optic neuropathy. The CPAP therapy seems to stabilize or even reverse visual field defects.

Section snippets

Subjects

We included nine patients consecutively admitted for SAS evaluation at the University Hospital of Bern after informed consent was obtained. The protocol and informed consent were approved by the Ethical Committee of the Medical Faculty of the University of Bern, Bern, Switzerland. We excluded from statistical analysis all patients with conditions causing visual field defects.

Ophthalmologic examination

All patients were seen by the same ophthalmologist (DM). At the time of the ophthalmologic examination, the result of the

Results

The clinical and polysomnographic data of the seven patients included in the statistical analysis are summarized in Table 1. According to the RDI, one patient had mild SAS, two patients had moderate SAS, and three patients had severe SAS. One patient referred for suspected SAS had a normal PSG. His final diagnosis was chronic fatigue syndrome. One patient with severe SAS was excluded from our statistical analysis because of optic nerve drusen. Another patient with normal PSG was excluded

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Optic neuropathy associated with sleep apnea syndrome

Abstract

Objective

Design

Participants

Intervention

Main outcome measures

Results

Conclusions

Section snippets

Subjects

Ophthalmologic examination

Results

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Chest

Exp Eye Res

Electroencephalogr Clin Neurophysiol

Chest

Clinical overview of the sleep apnea syndromes