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Side sleeping found to elevate IOP
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The lateral decubitus posture affects IOP in the lower positioned eye, with further increase when it is maintained over 30 minutes, and in eyes with progressing glaucoma, according to a study.
Body posture is a well-known contributor to IOP elevation. Lateral decubitus was investigated as a potential cause of elevation in previous studies, but this new study evaluated the effect over a more extended length of time and with the patients’ own pillows.
Twenty-eight glaucoma patients who habitually slept on their side were included. IOP was measured with the Tonopen Avia (Reichert) in the sitting and supine position, and subsequently in the lateral decubitus posture after 5 and 30 minutes, in the lower (dependent) and upper (nondependent) eye.
While no significant differences were found between fellow eyes in the sitting and supine positions, IOP was significantly higher in the dependent than in the nondependent eye both at 5 and 30 minutes and significantly increased between 5 and 30 minutes in the dependent eye. A higher increase was found in patients with progressive glaucoma.
Pillow characteristics were also found to have in impact on pressure. In particular, thinner and softer pillows were correlated with greater IOP rise in the dependent eye.
“Our observation suggests that there may be a link between glaucoma progression and an intraocular pressure rise in side sleeping,” the authors wrote.
They noted that the mechanisms of posture-induced IOP elevation are not completely understood, but may involve compression of neck vessels, changes in episcleral venous pressure, gravity, shift of body fluid and choroidal vascular congestion.
“Further studies are needed to verify the clinical implications of these observations,” they concluded. – by Michela Cimberle
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Mark Eltis, OD, FAAO
Would patients feel regret if they found out their behavior accelerated disease progression? Possibly, but for many being told that they have no control over the course of the disease is most disturbing. Therefore, the possibility that sleep posture may influence glaucoma is of great interest to both practitioners and patients alike.
These are preliminary results with a small study population (n = 28). Further, the patients in the study were not actually sleeping but were lying down. Therefore, testing conditions may not replicate either the exact posture or physiological responses of true sleep cycles. It is also possible that IOP may change beyond the 30-minute mark, as typical sleep cycles are 6 to 8 hours long.
Even with these reservations, I’m ready to cautiously suggest that avoiding side sleeping and the use of firmer pillows may be beneficial in glaucoma sufferers. Nothing makes patients doubt medical science as much as when we advocate for one course of action only to suggest the direct opposite a few years later. We must be transparent in sharing the degree of uncertainty. Ideally, future studies will include more patients and use more precise IOP measurement devices.
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