Prevalence and Predictors of Ocular Complications in Obstructive Sleep Apnea Patients: A Cross-sectional Case-control Study

Morsy, Nesreen Elsayed; Amani, Badawi E; Magda, Ahmad A; Nabil, Awadalla J; Pandi‐Perumal, Seithikurippu R.; BaHammam, Ahmed S.; Spence, D. Warren; Lundmark, Per Olof; Zaki, Nevin F. W.

doi:10.2174/1874306401913010019

Cited by 23 publications

(24 citation statements)

References 50 publications

(61 reference statements)

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“…Unlike previous findings that reported a significant association of cataracts and DM or OSA alone [15], we failed to observe any significant relationship between them in multivariate analysis. Possible explanations for this discrepancy follow.…”

Section: Discussioncontrasting

confidence: 99%

“…Its risk factors include increasing age, female sex, genetic factors (e.g., chromosome 3 in KCNAB1 and chromosome 21 in CRYAA), lifestyle factors (e.g., ultraviolet-B exposure, cigarette smoking, and alcohol consumption), consumption of carbohydrates with a high glycemic index, and systemic and medical problems (e.g., type 2 DM, high systemic blood pressure, and metabolic syndrome) [14]. Although few studies have reported the association of OSA with cataracts, a recent cross-sectional study reported the magnitude and risk factors of ocular complications in OSA patients associated with a greater risk of senile cataracts [15]. However, to our knowledge, no study has investigated the association between OSA and cataracts in a large population-based prospective cohort study.…”

Section: Introductionmentioning

confidence: 99%

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Cataracts are Associated with the Coexistence of Moderate to Severe Obstructive Sleep Apnea and Diabetes Mellitus

et al. 2020

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Background and ObjectiveaaThe individual presence of diabetes mellitus (DM) or obstructive sleep apnea (OSA) is significantly associated with cataract formation, but few studies have examined the association of cataracts with comorbid DM and OSA. Our aim in this study was to confirm the relationship between cataracts and the individual presence of DM or OSA in a large population-based cohort study and evaluate the association between cataracts and the coexistence of OSA and DM. MethodsaaWe included 699 individuals who were enrolled in the Korean Genome and Epidemiology Study and who underwent both nocturnal polysomnography and cataract diagnosis in the study. We assessed the presence and severity of OSA by means of unattended home sleep monitoring. DM was diagnosed based on the fasting blood-glucose level or by the use of antihyperglycemic medications. Cataracts were diagnosed according to the Lens Opacities Classification System III. ResultsaaThe prevalence of cataracts tended to increase as OSA worsened. Diabetes patients had a higher prevalence of cataracts than did normal subjects. In multivariate analysis, there was no significant association of cataracts with DM or OSA alone. In the joint analysis of DM and OSA, however, the odds for cataracts were significantly higher in the DM patients with moderate to severe OSA than in the DM patients without OSA, indicating a significant synergy of moderate to severe OSA and DM on cataracts. ConclusionsaaThe concurrent presence of DM and moderate to severe OSA was associated with cataracts. Thus, OSA should be considered in the prevention or treatment of diabetic cataracts.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cataracts are Associated with the Coexistence of Moderate to Severe Obstructive Sleep Apnea and Diabetes Mellitus

et al. 2020

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“…Moreover, only patients aged over 50 years had been included in that study. Additionally, Morsy et al (2019) found in their study with 80 participants that OSA is associated with a higher risk of vision-threatening and non-threatening ocular disorders. The lowest oxygen desaturation index in OSA patients was a significant predictor of vision-threatening disorders [9].…”

Section: Discussionmentioning

confidence: 98%

“…A link between OSA and glaucoma has been proposed [5][6][7][8][9][10]. Specifically, it is assumed that OSA might partly cause or worsen glaucoma [5].…”

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confidence: 99%

Obstructive sleep apnea as a risk factor for primary open angle glaucoma and ocular hypertension in a monocentric pilot study

et al. 2020

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Background Both glaucoma and obstructive sleep apnea (OSA) are widespread diseases. OSA may presumably partly cause or worsen glaucoma, although the etiopathogenesis is unclear. Here we analyze for the first time the possible association between different glaucoma phenotypes and OSA. Methods 110 patients (47 females, 63 males; median age 64.3 years, median BMI 26.62 kg/m2) with suspected glaucoma and without any prior diagnosis of OSA were prospectively studied by one-night home sleep apnea testing (HSAT), 101 of the patients were analyzed. HSAT parameters, like apnea hypopnea index (AHI) and oxygen desaturation index as well as opthalmological parameters like intraocular pressure (IOP) and mean defect depth (MD) were collected. Moreover, HSAT results were compared across four phenotypic groups: primary open angle glaucoma (POAG), low-tension-glaucoma (LTG), ocular hypertension (OH), and controls. Results There was no strong correlation between IOP or MD and AHI. BMI, age and gender did not differ between groups. Significant differences between POAG and LTG were found for all HSAT parameters. The AHI showed the most prominent group difference (Wilcoxon-Kruskal-Wallis rank sum test was highly significant with chi2 = 22, df = 3 p < 0.0001) with severely lower event rates in the LTG (9.45/h) compared to POAG (22.7/h) and controls (21.9/h; p < 0.0001 and 0.02, respectively). Highly significant differences were found between the four groups regarding AHI (Chi2 = 22, df = 3, p < 0.0001) with significantly lower events per hour in the LTG compared to POAG (Hodges-Lehmann = − 13.8, 95% CI (− 18.6 – − 8.8; p < 0.0001) and to controls (Hodges-Lehmann = 12.1, 95% CI -19.9 – − 2.4; p < 0.02). Severe and moderate OSA was more prevalent in POAG (69.8%) and OH (33.3%) than in LTG (9%). The effect of the glaucoma phenotype on the AHI was more prominent in females (p = 0.0006) than in males (p = 0.011). Conclusion Although physical endpoints, such as MD and IOP, do not correlate with AHI, there was a strong correlation between the POAG and OH clinical glaucoma phenotypes and the AHI. Further studies should investigate the necessity to test routine screening for OSA by HSAT in patients with diagnosed POAG and OH. Besides, some characteristics of LTG differed widely from other glaucoma types and controls. LTG patients had a significantly lower rate of OSA compared to other glaucoma types and even controls. This might be due to a different pathogenesis of LTG. Trial registration Retrospectively registered at DRKS (nr. S00021201) on April 9th 2020.

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“…Besides ocular surface damage, further ocular manifestations of OSA include floppy eyelid syndrome (FES), glaucoma, nonarteritic anterior ischemic optic neuropathy and central serous retinopathy [11,12]. Based on these observations in the published literature, an extensive ophthalmic examination should be implemented in patients with confirmed OSA [13]. Accompanying ocular problems are often not seen in connection with continuous positive airway pressure therapy, increasing communication between ophthalmologists and sleep medicine specialists recognizing DED in patients with OSA.…”

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confidence: 99%

Sleep apnea and dry eye: how sleep apnea affects the eye surface

et al. 2020

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Purpose: The purpose of this study was to determine the presence of dry eye disease and possible treatment options in patients with obstructive sleep apnea and continuous positive airway pressure. Materials and methods: A total of 72 patients (midlife age) with obstructive sleep apnea and continuous positive airway pressure therapy underwent a comprehensive eye examination. Fluorescein staining of the anterior ocular surface and tear break-up test were performed. All of the patients who were diagnosed with dry eye disease received personalized therapy. One month later, re-examination was performed using the same methodology and clinical settings. Results: On the first examination, 48 of 72 patients (66.67%) were diagnosed with dry eye disease. Floppy eyelid syndrome was reported in 26 patients (54.17%) with dry eye disease. The treatment of 40 patients included artificial tear supplements during the day in combination with high-viscosity topical gels before bedtime. In more severe cases (10.42% of all participants), the application of bandage contact lenses for 3 months was necessary. Because of excessive lid laxity, surgical reconstruction of the eyelids was performed in three patients (6.25%). Conclusions: A multidisciplinary approach is essential for obstructive sleep apnea. Practitioners from different specialties must be well acquainted with risk factors, signs, and symptoms. The early detection of dry eye disease in patients with obstructive sleep apnea and appropriate treatments are important for improving the quality of life in this patient group.

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Prevalence and Predictors of Ocular Complications in Obstructive Sleep Apnea Patients: A Cross-sectional Case-control Study

Cited by 23 publications

References 50 publications

Cataracts are Associated with the Coexistence of Moderate to Severe Obstructive Sleep Apnea and Diabetes Mellitus

Cataracts are Associated with the Coexistence of Moderate to Severe Obstructive Sleep Apnea and Diabetes Mellitus

Obstructive sleep apnea as a risk factor for primary open angle glaucoma and ocular hypertension in a monocentric pilot study

Sleep apnea and dry eye: how sleep apnea affects the eye surface

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