Abstract
Background: The possible association between SAHS and open-angle or normotensive glaucoma needs further investigation.
Methods: Patients in whom polysomnography was indicated upon the clinical suspicion of SAHS underwent comprehensive ophthalmologic evaluation in the search of glaucomatous optic neuropathy and increased intra-ocular pressure (IOP).
Results: Nine-two patients (mean age 54±11 years, 37% female) were included. In 16 of them, the Apnea-Hypopnea Index (AHI) was < 5, thus ruling out the diagnosis of SAHS. In 49 patients (53%) severe SAHS was established (AHI of higher than 30). Direct visualization of the optic disc head was suspicious of glaucomatous affectation in 12,8% of the examined eyes. Patients with a positive suspicion of glaucomatous optic neuropathy (GON, group 1) were older (59±10 vs. 54±12 years; p < 0.05) and presented with a higher IOP (18±2 vs. 15±3 mmHg; p < 0.001) as opposed to those with normal visual optic nerve examination (group 2). We found more structural glaucomatous changes in men (17% of them) than in women (4,5%; p = 0,012). The AHI was significantly higher in group 1 as compared to group 2 (AHI of 51±10 vs. 32±11, respectively; p<0,001). In a multivariate analysis, both increased AHI and IOP remained as independent risk factors of GON (p = 0.017 and p = 0.005, respectively). Therefore, an increased AHI favored the development of GON independently of the IOP.
Conclusions: Sleep apnea-hypopnea syndrome increases the susceptibility to glaucomatous damage of the optic nerve head. In some SAHS patients, this risk of glaucomatous optic neuropathy lays upon a distinct mechanism other than increased intra-ocular pressure (normotensive glaucoma).
- © 2011 ERS