Assessment of the Effectiveness of Obstructive Sleep Apnea Treatment Using Optical Coherence Tomography to Evaluate Retinal Findings.

Gloria Tejero-Garcés,Carlos O’Connor-Reina,Francisco J Ascaso,Peter Baptista,Maria I Adiego,Eugenio Vicente,Paula Casas,Guillermo Plaza

doi:10.3390/jcm11030815

Abstract

Retinal findings may change in patients with obstructive sleep apnea syndrome (OSAS). The present study aims to evaluate several retinal findings, such as macula layer thickness, the peripapillary retinal nerve fiber layer, and the optic nerve head in patients with OSAS, using optical coherence tomography (OCT); it also aims to monitor the result of several types of treatment of OSAS with OCT. A prospective comparative study was designed. Patients were recruited at a Sleep Unit of a University Hospital and underwent comprehensive ophthalmological examinations. Following exclusion criteria, fifty-two patients with OSAS were finally included. Patients were examined by OCT twice: once before treatment, and again after six months of treatment. In mild–moderate patients, where retinal swelling had been demonstrated, retinal thicknesses decreased [fovea (p = 0.026), as did inner ring macula (p = 0.007), outer ring macula (p = 0.015), and macular volume (p = 0.015)]. In severe patients, where retinal atrophy had been observed, retinal thickness increased [fovea (p < 0.001)]. No statistically significant differences in efficacy between treatments were demonstrated. In conclusion, OCT can evaluate the retina in patients with OSAS and help to monitor results after treatment. In severe OSAS, retinal thickness increased six months after treatment.

Highlights

Obstructive sleep apnea syndrome (OSAS) is one of the most frequent sleep disorders in our population [1]
We aimed to evaluate optical coherence tomography (OCT) as a tool to monitor the response to therapy through retinal changes such as macula thickness, retinal nerve fiber layer (RNFL), and optic nerve head (ONH), after CPAP therapy and after surgical treatment, in two related groups of patients with obstructive sleep apnea syndrome (OSAS); we aimed to review the current role of OCT as a monitoring tool after OSAS treatment through the literature
Intermittent airway obstruction in OSAS leads to hypoxia, hypercapnia, and changes in intrathoracic pressure

Summary

Introduction

Obstructive sleep apnea syndrome (OSAS) is one of the most frequent sleep disorders in our population [1]. Continuous and maintained oxygen desaturation during sleep results in metabolic, cardiovascular, and neuropsychiatric consequences that impact quality of life and increase mortality [1,3]. In particular, been associated with both the reduction in the overall performance and the memory abilities of patients with OSAS [4]. Intermittent hypoxia enhances a sympathetic response and oxidative stress that result in systemic and local inflammation [5]. Intermittent hypoxemia and sleep fragmentation cause continuous sympathetic stimulation with increased cardiac arrhythmogenic risk [6]. Intermittent hypoxemia disorder is correlated with degeneration of the gray matter of the central nervous system, with increased risk for autonomic pathologies and systemic inflammation [7]

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