Deleterious systemic effects of OSA: how much evidence do we need?

Kohler, Malcolm

doi:10.1136/thoraxjnl-2015-207247

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…The most prominent feature of this condition is chronic intermittent hypoxia, which stimulates chronic inflammatory processes, attenuates antioxidant mechanisms, and increases the production of reactive oxygen products during the reoxygenation phase (Vaccaro et al, 1992;Vakil et al, 2018;Ma et al, 2019). Patients with OSAHS have an increased risk of cardiovascular diseases (CVDs), like hypertension, heart failure, and coronary heart disease (Kohler, 2015;Stansbury and Strollo, 2015). Oxidative stress, sympathetic activity, and systemic inflammatory reactions are linked to chronic intermittent hypoxia that might impact the ocular vasculature (Kohler and Stradling, 2010).…”

Section: Introductionmentioning

confidence: 99%

Comparison of ocular surface assessment outcomes between healthy controls and patients with obstructive sleep apnea–hypopnea syndrome: a meta-analysis of the literature

Sun

Liang

2023

Front. Physiol.

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Objective: This meta-analysis aims to determine whether ocular surface alterations are associated with disease severity in patients with obstructive sleep apnea–hypopnea syndrome (OSAHS).Methods: The protocol for this systematic review and meta-analysis was registered in PROSPERO. We conducted the search in six electronic databases (China National Knowledge Infrastructure, EMBASE, Cochrane Library, Web of Science, Wanfang, and PubMed) from since the construction of the databases to 30 December 2022. The standard mean difference (SMD) and correlation coefficients are reported as measures of the effect size in the presence of retrieved data. In addition, the random effects model or fixed effects model was used in a combined analysis. Stata 11.0 and R 3.6.1 were used for statistical analyses of the data.Results: A total of 15 studies satisfied the inclusion criteria for this study. The prevalence of floppy eyelid syndrome (FES) and dry eye syndrome in patients with obstructive sleep apnea–hypopnea syndrome was 40 and 48%, respectively. In addition, the Schirmer 1 value and tear break-up time (TBUT) were remarkably reduced in patients with OSAHS when compared to that of the controls. The ocular surface disease index (OSDI) scores, Oxford corneal staining scores, and the rates of loss in the meibomian glands were elevated in patients with obstructive sleep apnea–hypopnea syndrome when compared to that of the controls, especially those with severe disease. Moreover, the Schirmer 1 value and tear break-up time exhibited a negative correlation with the apnea–hypopnea index (AHI), and the OSDI showed a positive association with the apnea–hypopnea index.Conclusion: Patients with OSAHS had a greater prevalence of FES than the healthy controls. They also showed lower Schirmer 1 value and tear break-up time but had a higher OSDI, Oxford corneal staining scores, and rates of loss in the meibomian glands than the healthy controls.Clinical Trial Registration: (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392527).

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Section: Introductionmentioning

confidence: 99%

Comparison of ocular surface assessment outcomes between healthy controls and patients with obstructive sleep apnea–hypopnea syndrome: a meta-analysis of the literature

Sun

Liang

2023

Front. Physiol.

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“…Long-term intermittent hypoxia, hypercapnia, heightened sympathetic nervous system activity and increased catecholamine levels constitute the pathophysiological mechanism of OSAHS ( 4 ). The systemic hypertension, atheromatosis and autonomic nerve dysfunction caused by OSAHS may give rise to a series of complications, such as coronary atherosclerotic heart disease, diabetes mellitus, heart failure and even death ( 5 , 6 ). Ocular blood vessels are also affected by these mechanisms, including increased oxidative stress, systemic inflammation and sympathetic activity ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Ocular Surface and Meibomian Gland in Obstructive Sleep Apnea Hypopnea Syndrome

Liu

et al. 2022

Front. Med.

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PurposeTo assess the ocular surface and meibomian gland (MG) of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and to explore the effects of surgery for OSAHS on the ocular surface and MG.MethodsBased on the apnea hypopnea index (AHI), 21 patients with mild OSAHS (Group A, 5/h ≤ AHI < 15/h), 20 patients with moderate OSAHS (Group B, 15/h ≤ AHI < 30/h), 62 patients with severe OSAHS (Group C, AHI ≥ 30/h) were examined. The ocular surface and MG were evaluated using Keratograph 5M. In addition, detailed Ophthalmic examination including visual acuity, refraction, slit-lamp examination of the anterior segment, corneal fluorescein staining (CFS), ocular surface disease index (OSDI) scoring, Schirmer I test (SIT) and serum lipid measurement was performed. For OSAHS patients with dry eye syndrome (DES) who underwent uvulopalatopharyngoplasty for improving AHI, the conditions of the ocular surface and MG were compared before surgery and 3 months after surgery. Only the data of the right eyes were analyzed.ResultsThere were no significantly different in the OSDI score, tear meniscus height (TMH), or loss ratio of the lower eyelid (LRLE) among these groups. The first non-invasive tear film breakup time (fNIBUT), average non-invasive tear film breakup time (avNIBUT), bulbar redness index (BRI), lipid layer grading (LLG), CFS, plugged orifices and distortion in MG, the loss ratio of upper eyelid (LRUE), and the incidence of DES, floppy eyelid syndrome (FES) and meibomian gland dysfunction (MGD) showed significant differences between Groups A and C (p = 0.015, p = 0.018, p < 0.001, p = 0.022, p = 0.036, p = 0.007, p = 0.019, p = 0.017, p = 0.045, p = 0.013, and p = 0.029, respectively). The SIT in the Group A was significantly higher than in Group B (p = 0.025) and in Group C (p < 0.001). In the correlation analyses, the fNIBUT, avNIBUT, SIT and LLG had negative correlations with the AHI (p = 0.013, p = 0.010, p = 0.003, p < 0.001, and p = 0.006, respectively). The BRI, CFS and LRUE were positively correlated with the AHI (p = 0.006, p = 0.007, and p = 0.046, respectively). Three months after surgery, there were no significant differences in the ocular surface or MG.ConclusionPatients with severe OSAHS have poor stability of tear film and are prone to lipid-deficient dry eye as a result of the loss of meibomian gland. By improving the AHI, the ocular surface damage of OSAHS patients cannot be reversed in a short time.

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“…The cyclical desaturations, intermittent hypoxia, arousals and catecholamine surges of OSA have been well studied 2 . These pathophysiological features affect more than the sleep-wake cycle; impacts on hypertension, atherosclerosis, endothelial dysfunction, insulin resistance and autonomic dysfunction have been found 3,4 . There is clear potential for OSA to cause or worsen ocular disease through these mechanisms and interest in this area is increasing.…”

Section: Introductionmentioning

confidence: 99%