Obstructive sleep apnea may affect RNFL thickness, IOP
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Key takeaways:
- Patients with severe OSA had significantly lower RNFL thickness than those with mild or moderate OSA.
- Those with moderate and severe OSA had higher IOP compared with patients with mild OSA.
Obstructive sleep apnea may have an impact on retinal nerve fiber layer thickness and IOP, highlighting the importance of screening affected individuals for glaucoma, according to data published in the Journal of Glaucoma.
“Recurrent episodes of apnea in OSA lead to repeated hypoxemia, hypercapnia, hemodynamic, humoral and neuroendocrine responses, finally affecting the circulation of the optic nerve with retinal ganglion cell apoptosis and subsequent retinal nerve fiber layer reduction,” Thounaojam S. Devi, MD, from the department of ophthalmology at All India Institute of Medical Sciences, and colleagues wrote.
In a hospital-based, prospective cross-sectional study at All India Institute of Medical Sciences, researchers studied 90 eyes of adults (mean age, 49.54 years; 73.3% men) newly diagnosed with obstructive sleep apnea. Participants were separated into groups of mild (38.8%), moderate (30%) and severe (31.1%) OSA according to apnea-hypopnea index (AHI), and underwent comprehensive ocular examinations and OCT to measure retinal nerve fiber layer thickness (RNFLT).
Devi and colleagues reported that the average RNFLT was significantly different across the three groups (P = 0.002) and was inversely associated with AHI (P = 0.02), with thinner average RNFLT observed in individuals with severe OSA (P = .01).
Among the four quadrants of RNFLT, researchers also noted that the superior quadrant was significantly different between OSA groups (P < 0.0001) and inversely associated with AHI (P = 0.01).
Further, patients with moderate and severe OSA had higher IOP than those with mild OSA (P = .002 vs. P = .001, respectively).
“Moderate to severe OSA patients should be screened for glaucoma,” Devi and colleagues wrote. “Early detection of RNFL thinning and raised IOP offers an opportunity for early detection of glaucoma in OSA patients. For known glaucoma patients, screening for OSA may help in monitoring the progression of glaucoma and can prevent blindness in these patients.”
Perspective
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Inadequate flow of information between health care providers is one of the biggest reasons for delayed diagnosis and treatment. In this information age, it is unacceptable for health data to remain siloed, instead of being shared to highlight intersections of risk and potential preventive care.
OSA is a prime example of this multidirectional health superhighway that is needlessly underutilized. Those with glaucoma should be screened for OSA, and those with OSA should be worked up for glaucoma risk. This is not simply a matter of interprofessional referral but bringing health care practice to the highest level.
The finding that RNFL is lower in patients with OSA is not surprising. Education on the connection between glaucoma and OSA (while proven for a while now) is not universally considered by health care professionals.
The glaucoma-OSA nexus is also a reminder that primary open-angle glaucoma is probably not an isolated neurodegenerative process but a problem that requires a holistic evaluation of a patient's systemic health and lifestyle.
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