Do Optic Nerve Head and Visual Field Parameters in Patients with Obstructive Sleep Apnea Syndrome Differ from those in Control Individuals?

Abstract

Background: It has been suggested that sleep apnea syndrome may play a role in normal-tension glaucoma contributing to optic nerve damage. The purpose of this study was to evaluate if optic nerve and visual field parameters in individuals with sleep apnea syndrome differ from those in controls. Patients and Methods: From the records of the sleep laboratory at the University Hospital in Bern, Switzerland, we recruited consecutive patients with severe sleep apnea syndrome proven by polysomnography, apnea-hypopnea index > 20, as well as no sleep apnea controls with apnea-hypopnea index < 10. Participants had to be unknown to the ophtalmology department and had to have no recent eye examination in the medical history. All participants underwent a comprehensive eye examination, scanning laser polarimetry (GDx VCC, Carl Zeiss Meditec, Dublin, California), scanning laser ophthalmoscopy (Heidelberg Retina Tomograph II, HRT II), and automated perimetry (Octopus 101 Programm G2, Haag-Streit Diagnostics, Koeniz, Switzerland). Mean values of the parameters of the two groups were compared by t-test. Results: The sleep apnea group consisted of 69 eyes of 35 patients; age 52.7 ± 9.7 years, apnea-hypopnea index 46.1 ± 24.8. As controls served 38 eyes of 19 patients; age 45.8 ± 11.2 years, apnea-hypopnea index 4.8 ± 1.9. A difference was found in mean intraocular pressure, although in a fully overlapping range, sleep apnea group: 15.2 ± 3.1, range 8–22 mmHg, controls: 13.6 ± 2.3, range 9–18 mmHg; p < 0.01. None of the extended visual field, optic nerve head (HRT) and retinal nerve fiber layer (GDx VCC) parameters showed a significant difference between the groups. Conclusion: Visual field, optic nerve head, and retinal nerve fiber layer parameters in patients with sleep apnea did not differ from those in the control group. Our results do not support a pathogenic relationship between sleep apnea syndrome and glaucoma.

Zusammenfassung

Hintergrund: Die Rolle des Schlafapnoe-Syndroms als mögliche Ursache des Normaldruckglaukoms wird kontrovers diskutiert. Das Ziel dieser Studie war, herauszufinden, ob sich Nervus opticus- und Gesichtsfeldparameter von Personen mit Schlafapnoe-Syndrom von der Kontrollgruppe unterscheiden. Patienten und Methoden: Aus den Aufzeichnungen des Schlaflabors des Universitätsspitals Bern haben wir laufend Patienten mit per Polysomnographie diagnostiziertem schwerem Schlafapnoe-Syndrom, Apnoe-Hypopnoe Index > 20, und normale Kontrollen ohne Schlafapnoe-Syndrom, Apnoe-Hypopnoe Index < 10 rekrutiert. Die Teilnehmer waren in der Augenklinik nicht bekannt. Die Teilnehmer erhielten eine komplette ophthalmologische Untersuchung, scanning Laser Polarimetrie (GDx VCC, Carl Zeiss Meditec, Dublin, California), scanning Laser Ophthalmoskopie (Heidelberg Retina Tomograph II, HRT II) automatisierte weiß-auf-weiß Perimetrie (Octopus 101, Programm G2, Haag-Streit Diagnostics, Koeniz, Switzerland). Die Mittelwerte der Parameter der 2 Gruppen wurden mittels T-Test verglichen. Ergebnisse: Die Schlafapnoegruppe bestand aus 69 Augen von 35 Patienten; Durchschnittsalter 52,7 ± 9,7 Jahre, Apnoe-Hypopnoe Index 46,1 ± 24,8. Die Kontrollgruppe bestand aus 38 Augen von 19 Patienten, Durchschnittsalter 45,8 ± 11,2 Jahre, Apnoe-Hypopnoe Index 4,8 ± 1,9. Es gab einen signifikanten Unterschied im Augendruck, obwohl sich die Bereiche überlappen. Schlafapnoegruppe: Augendruck 15,2 ± 3,1 mmHg, range 8–22 mmHg, Kontrollen: Augendruck 13,2 ± 2,3 mmHg, range 9–18 mmHg; p < 0,01. Keiner der zahlreichen Gesichtsfeld-, Papillen- (HRT) und Nervenfaserschicht- (GDx VCC) Parameter zeigte einen signifikanten Unterschied zwischen den Gruppen. Schlussfolgerung: Gesichtsfeld-, Papillen- und Nervenfaserschichtparameter von Patienten mit Schlafapnoe unterscheiden sich nicht von der Kontrollgruppe. Unsere Resultate bestätigen den Zusammenhang zwischen Schlafapnoe-Syndrom und Glaukom nicht.

Key words

sleep apnea - normal- tension glaucoma - RNFL thickness - nerve fiber layer - optic nerve head - visual field

Schlüsselwörter

Schlafapnoe - Normaldruckglaukom - Nervenfaserschicht - Nervenfaserschichtdicke - Nervus opticus - Gesichtsfeld

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