Ocular Complications of Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is characterized by repetitive episodes of paused breathing during sleep, which in turn induces transient nocturnal hypoxia and hypercapnia. The high prevalence of OSA and its associated health consequences place a heavy burden on the healthcare system. In particular, the consequent episodic oxygenic desaturation/reoxygenation series and arousals from sleep in patients with OSA have the potential to trigger oxidative stress, elevated systemic inflammatory responses, and autonomic dysfunction with sympathetic activation. Given these adverse side-effects, OSA is highly correlated to many eye diseases that are common in everyday ophthalmic practices. Some of these ocular consequences are reversible, but they may permanently threaten a patient’s vision if not treated appropriately. Here, this article seeks to review the ocular consequences and potential pathophysiologic associations in patients with OSA. Understanding these OSA-related eye diseases may help clinicians provide comprehensive care to their patients.

Assessment of the Effectiveness of Obstructive Sleep Apnea Treatment Using Optical Coherence Tomography to Evaluate Retinal Findings

“…In this circumstance, a two-eye analysis produces a slightly conservative estimate of precision [52]. In fact, most ocular complications of OSAS are usually symmetric, except keratoconus [53]. Additionally, a more extended follow-up period could have given us more significant results; nevertheless, both were enough to provide clinically relevant outcomes in our study, and these findings should be supported by large-scale studies.…”

Corneal Refractive Surgery Considerations in Patients with Cystic Fibrosis and Cystic Fibrosis Transmembrane Conductance Regulator-Related Disorders

“…As CF patients are predisposed to developing OSA, screening them for floppy eyelid syndrome (FES) and keratoconus (KCN) may be indicated as these conditions have been significantly correlated with OSA. 21 , 22 Proposed mechanisms for FES and KCN suggest that inflammatory mediators, such as matrix metalloproteinases (MMPs), may play a role in their pathogenesis, which can be elevated in CF patients. 22 , 23 Regarding malnutrition, vitamin A deficiency can cause xerophthalmia, conjunctival xerosis, and night blindness.…”

“… 21 , 22 Proposed mechanisms for FES and KCN suggest that inflammatory mediators, such as matrix metalloproteinases (MMPs), may play a role in their pathogenesis, which can be elevated in CF patients. 22 , 23 Regarding malnutrition, vitamin A deficiency can cause xerophthalmia, conjunctival xerosis, and night blindness. 15 , 24 These can be screened for while performing a medical history and physical exam.…”

Commentary: Obstructive sleep apnoea as a risk factor for glaucoma

“…There are multiple theories: (i) increased IOP due to supine posture, increased episcleral venous pressure, and autonomic dysfunction; (ii) optic nerve ischemia due to recurrent hypoxia; and (iii) vascular dysregulation at the optic nerve. [ 8 ] All of them remain to be proven. Other facts to be considered are that OSA patients are likely to have other comorbidities, such as ischemic heart disease, hypertension, and diabetes mellitus.…”

“…Though a clear relationship exists between OSA and NPG, high-pressure primary open-angle glaucoma (POAG) is also reported. [ 8 ] From a clinical standpoint, evaluating additional risk factors for glaucoma becomes essential in patients with rapidly progressive glaucoma (despite adequate control) and NPG. Thus, there may be a case for OSA evaluation by polysomnography, where indicated, in these patients.…”