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Sleeping position may worsen glaucoma, researchers find
Sleeping positions and asymmetric visual field loss in open-angle glaucoma patients may be related, according to a study in the American Journal of Ophthalmology.
“People generally spend between one-quarter and one-third of their lives sleeping,” Kim and colleagues wrote. “During sleep, body position varies between the supine position and the lateral decubitus position, often more on one side than the other. Thus, IOP elevation related to the lateral decubitus position might play a role in glaucoma progression.”
The authors studied 692 patients with bilateral normal-tension glaucoma or high-tension glaucoma in the retrospective, cross-sectional study. Participants took a questionnaire to determine their preferred sleeping positions and were labeled with a better eye and worse eye, based on the study’s definition of asymmetric vision field loss as “a difference in mean deviation between the two eyes of at least 2 dB.”
Results showed that of the enrolled participants, 62.1% had asymmetric visual field loss between their eyes. Among the 309 bilateral normal-tension glaucoma patients, 100 preferred to sleep on their side, and 66 of those patients chose to sleep with their worse eye downward. Among the 121 high-tension glaucoma patients, 32 preferred to sleep on their side, and 23 of those patients chose to sleep with their worse eye downward.
“Results of the present study strongly suggest that the sleep position habitually preferred by open-angle glaucoma patients may be associated with greater visual loss. To confirm our speculation, long-term follow-up study will be necessary,” the authors concluded.
“The limitation of this study is that the preferred sleeping position results were based on a questionnaire; collection of more exact and reliable data using video recording is warranted,” they said. “Another limitation is the retrospective and cross-sectional nature of our study; a further study with a prospective design is required to overcome this limitation.”
Perspective
Back to TopIt is well accepted that supine IOP levels are higher than those measured when seated. Further studies have confirmed that the extent of this difference is greater in glaucoma patients than in normal subjects. Additionally, preferred sleeping position may contribute some asymmetry to this equation.
The exact mechanism for this difference is not yet determined, but likely relates to blood flow changes within the episcleral venous system and the choroid. The authors suggest these dynamics may be significantly related to sleeping position and may remain independent of optic nerve perfusion.
One limitation of this study is the retrospective cross-sectional nature of the analysis. It has been acknowledged that further study with a prospective design and more exact data collection is in order.
We have all had glaucoma patients that we thought were well controlled with stable IOP measurements in the office, yet they seemed to be losing additional visual field, perhaps more in one eye than the other. It is worth considering that the patient’s preferred lying position during sleep may be a contributing factor. Remember to include this questioning when appropriate, educate patients when necessary and always remain vigilant to the small details.
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