Ophthalmologists can play a role in diagnosis of obstructive sleep apnea
The cover story in this issue of Healio | OSN provides a comprehensive review of obstructive sleep apnea and its potential impact on the body and eye. I will emphasize a few of the extensive points discussed.
The first is that obstructive sleep apnea (OSA) is common and underdiagnosed in both children and adults. It is also associated with many systemic and ocular comorbidities. My conclusion is that we ophthalmologists can save lives, enhance quality of life and preserve vision by keeping this diagnosis in mind. The patient with obesity, hypertension, coronary artery disease, atrial fibrillation, or a history of transient ischemic attack (TIA) or stroke can encourage a question about snoring and quality of sleep. A family member in the room is often a helpful observer.
As to ocular comorbidities, lax lids, floppy eyelid syndrome, nocturnal exposure, diabetic eye diseases, glaucoma and nonarteritic anterior ischemic optic neuropathy (NAION) are associated with OSA. Cotton wool spots in the retina are a significant objective finding. Patients with these diagnoses benefit from stopping smoking and reducing alcohol intake, so we are already counseling the patient and family. A question about snoring or restless sleeping might suggest OSA and encourage a referral to their primary care physician.
The management of OSA is not within the scope of practice of an ophthalmologist, but similar to many other disorders, we can make a difference in our patients’ general health, quality of life and even the prognosis of their eye diseases by seeing that patients with symptoms suggestive of OSA are evaluated. Evaluation is complex and requires nighttime observation in a sleep laboratory or at home with serial pulse oximetry and observation by a family member.
Therapy includes behavioral modification with cessation of smoking, weight loss and reduced alcohol intake. Most patients with significant OSA are treated with a continuous positive airway pressure (CPAP) device. These devices can also cause ocular disorders including nocturnal exposure with dry eye syndrome. Some patients require eyelid surgery after long-term CPAP use, and periocular edema or ecchymosis may require management.
When caring for the elderly patient with obesity and diabetic eye disease, advanced age-related macular degeneration, glaucoma, a history of TIA/stroke or NAION, along with the usual questions about smoking, diet and alcohol consumption, we can add another query about snoring. Those systemic and ocular conditions made worse by smoking are usually also made worse by snoring and OSA. Both induce hypoxia, which can damage tissue and organs. Early diagnosis and management can save lives and preserve vision.
- For more information:
- Richard L. Lindstrom, MD, can be reached at rllindstrom@mneye.com.
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