Association Between Sleep Apnea Syndrome and Nonarteritic Anterior Ischemic Optic Neuropathy

Abstract

To determine if patients with nonarteritic ischemic optic neuropathy (NAION) have sleep apnea syndrome (SAS), an entity characterized by repetitive upper airway obstructions during sleep, inducing hypoxia and sleep disruption. Methods: We recruited 17 patients with NAION and 17 age-and sex-matched controls from patients referred for treatment because of suspected restless legs syndrome. We performed overnight polysomnography and determined the respiratory disturbance index during night sleep, a value used to diagnose and grade SAS. We compared the proportions of patients with SAS among patients with NAION and matched controls using the 2 test. Additionally, we compared the proportions of patients with SAS among patients with NAION and a large SAS prevalence study using the binomial test. Results: Twelve (71%) of 17 patients with NAION had SAS. According to the respiratory disturbance index, 4 patients (24%) had mild, 4 patients (24%) had moderate, and 4 patients (24%) had severe SAS. Only 3 (18%) of 17 controls had SAS (P =.005). In the 45-to 64-year age group, 4 (50%) of 8 patients with NAION had SAS; 51 (11.9%) of 430 of the random sample in the prevalence study had SAS (P =.005). In the group older than 64 years, 8 (89%) of 9 patients with NAION had SAS; 18 (24%) of 75 of the random sample in the prevalence study had SAS (PϽ.001). Conclusions: We found a high prevalence of SAS in patients with NAION, which supports previous case reports suggesting that such an association exists. This association may explain why approximately 75% of all patients with NAION discover visual loss on first awakening or when they first use vision critically after sleeping. Our findings indicate that SAS may play an important role in the pathogenesis of NAION.

Ocular findings in sleep apnoea patients using continuous positive airway pressure

“…Strong association of OSAHS with NAION has been shown in series of NAION patients when surveyed for symptoms of sleep disturbed breathing and/or on investigation with polysomnography. [31][32][33] The role of OSAHS in the NAION disease mechanism appears significant and at the least a sleep history should be included in the work-up of patients with optic neuropathy.…”

Current concepts in the diagnosis, pathogenesis and management of nonarteritic anterior ischaemic optic neuropathy

“…OSAS can occur in individuals who are neither obese nor overweight and has been reported to be present in up to 89% of patients who develop NAION, [35][36][37][38][39][40] a much higher prevalence than in an age-and gender-matched population with similar other vascular risk factors (eg, diabetes mellitus, hypertension, and tobacco use). It is unclear, however, if OSA is causative or merely further evidence of vascular dysregulation.…”

Non-arteritic Anterior Ischaemic Optic Neuropathy after Uneventful Cataract Extraction

“…1,4,5,6 Non-arteritic anterior ischaemic optic neuropathy has also been associated with blood pressure fluctuation after major surgeries. 1 An ocular risk factor for NAION is a small, "crowded" optic disc with a small cup-to-disc ratio.…”

“…1 An ocular risk factor for NAION is a small, "crowded" optic disc with a small cup-to-disc ratio. 1,4,5,6 The optic nerve infarct in NAION has been previously described as a form of compartment syndrome that causes tissue ischaemia. The rigidity of the sclera confines optic disc swelling causing the compartment syndrome, with resultant ischaemia.…”