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.

Non-arteritic anterior ischaemic optic neuropathy and presumed sleep apnoea syndrome screened by the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ)

“…Despite our finding of an association between NAION and SAS, the proportion of NAION cases with symptoms consistent with SAS in the current study was lower than the prevalence of SAS observed in other studies 11 12. There are several possible reasons for this observation.…”

“…Support for this can be found in a study of patients with epilepsy for whom a lower cut-off point on the SA-SDQ was suggested 17. In fact when those cut-off points are used in the current study the proportion of cases classified as having SAS is approximately 70%, a figure much more consistent with previous reports 11 12. However, despite this increase in prevalence the association between NAION and SAS remains relatively unchanged (OR 2.16).…”

“…The results of the current study suggest, as do previous studies,11 12 that there is an association between NAION and SAS. In the present study individuals with symptoms consistent with SAS were identified by using the SA-SDQ.…”

Non-arteritic anterior ischaemic optic neuropathy and presumed sleep apnoea syndrome screened by the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ)

“…Despite our finding of an association between NAION and SAS, the proportion of NAION cases with symptoms consistent with SAS in the current study was lower than the prevalence of SAS observed in other studies 11 12. There are several possible reasons for this observation.…”

“…Support for this can be found in a study of patients with epilepsy for whom a lower cut-off point on the SA-SDQ was suggested 17. In fact when those cut-off points are used in the current study the proportion of cases classified as having SAS is approximately 70%, a figure much more consistent with previous reports 11 12. However, despite this increase in prevalence the association between NAION and SAS remains relatively unchanged (OR 2.16).…”

“…The results of the current study suggest, as do previous studies,11 12 that there is an association between NAION and SAS. In the present study individuals with symptoms consistent with SAS were identified by using the SA-SDQ.…”

Thrombophilic risk factors in the pathogenesis of non-arteritic anterior ischemic optic neuropathy patients

“…The subsequent visual acuity or visual field loss may be devastating, and can lead to serious visual impairment. More than half of the patients discover visual loss upon first awakening or when they first use vision critically in the morning [4,7]. This was also the case in our study, where 51 (66.2%) of the patients realized the loss immediately after they woke up.…”

Severe obstructive sleep apnea diagnosed after non-arteritic anterior ischaemic optic neuropathy in a young man

“…A sleep study later on revealed an undiagnosed severe OSA. This case is an example to support the idea of recent literature that OSA is a strong risk factor for NAION 2 3 5 12–14…”

Non-arteritic anterior ischaemic optic neuropathy and presumed sleep apnoea syndrome screened by the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ)

“…Despite our finding of an association between NAION and SAS, the proportion of NAION cases with symptoms consistent with SAS in the current study was lower than the prevalence of SAS observed in other studies 11 12. There are several possible reasons for this observation.…”

“…Support for this can be found in a study of patients with epilepsy for whom a lower cut-off point on the SA-SDQ was suggested 17. In fact when those cut-off points are used in the current study the proportion of cases classified as having SAS is approximately 70%, a figure much more consistent with previous reports 11 12. However, despite this increase in prevalence the association between NAION and SAS remains relatively unchanged (OR 2.16).…”

“…The results of the current study suggest, as do previous studies,11 12 that there is an association between NAION and SAS. In the present study individuals with symptoms consistent with SAS were identified by using the SA-SDQ.…”

Thrombophilic risk factors in the pathogenesis of non-arteritic anterior ischemic optic neuropathy patients

“…The subsequent visual acuity or visual field loss may be devastating, and can lead to serious visual impairment. More than half of the patients discover visual loss upon first awakening or when they first use vision critically in the morning [4,7]. This was also the case in our study, where 51 (66.2%) of the patients realized the loss immediately after they woke up.…”

Severe obstructive sleep apnea diagnosed after non-arteritic anterior ischaemic optic neuropathy in a young man

“…A sleep study later on revealed an undiagnosed severe OSA. This case is an example to support the idea of recent literature that OSA is a strong risk factor for NAION 2 3 5 12–14…”

Non-arteritic anterior ischaemic optic neuropathy and presumed sleep apnoea syndrome screened by the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ)

“…Despite our finding of an association between NAION and SAS, the proportion of NAION cases with symptoms consistent with SAS in the current study was lower than the prevalence of SAS observed in other studies 11 12. There are several possible reasons for this observation.…”

“…Support for this can be found in a study of patients with epilepsy for whom a lower cut-off point on the SA-SDQ was suggested 17. In fact when those cut-off points are used in the current study the proportion of cases classified as having SAS is approximately 70%, a figure much more consistent with previous reports 11 12. However, despite this increase in prevalence the association between NAION and SAS remains relatively unchanged (OR 2.16).…”

“…The results of the current study suggest, as do previous studies,11 12 that there is an association between NAION and SAS. In the present study individuals with symptoms consistent with SAS were identified by using the SA-SDQ.…”

Thrombophilic risk factors in the pathogenesis of non-arteritic anterior ischemic optic neuropathy patients

“…The subsequent visual acuity or visual field loss may be devastating, and can lead to serious visual impairment. More than half of the patients discover visual loss upon first awakening or when they first use vision critically in the morning [4,7]. This was also the case in our study, where 51 (66.2%) of the patients realized the loss immediately after they woke up.…”

Severe obstructive sleep apnea diagnosed after non-arteritic anterior ischaemic optic neuropathy in a young man

“…A sleep study later on revealed an undiagnosed severe OSA. This case is an example to support the idea of recent literature that OSA is a strong risk factor for NAION 2 3 5 12–14…”