Early corneal and optic nerve changes in a paediatric population affected by obstructive sleep apnea syndrome.

Erika Bonacci,Adriano Fasolo,Francesca Bosello,Alessandra De Gregorio,Giacomo Brocoli,Angelo Pietrobelli,Rosa Longo,Maria Clemente,Emilio Pedrotti,Marco Zaffanello,Giorgio Marchini,Tommaso Merz

doi:10.1007/s10792-021-02115-2

Abstract

The relation between OSAS and eye diseases is well known in adults, while very few and contradictory data can be found regarding paediatric ages. The aim of this study is to explore the early corneal, macular and optic nerve changes in paediatric patients with OSAS. Prospective study that enrolled children aged ≥ 4years referred to the Paediatric Pneumology Clinic in Verona for suspected obstructive sleep apnoea syndrome (OSAS) and investigated with the overnight respiratory polygraphy. Patients with apnoea-hypopnea index (AHI) > 1 were classified as OSAS, while those with AHI < 1 were classified non-OSAS. All patients underwent comprehensive eye examination including slit lamp, refraction, intraocular pression (Goldman applanation tonometry), corneal tomography (corneal astigmatism, corneal keratometry at the apex, surface asymmetry index, central corneal thickness and thinnest corneal thickness) and optical coherence tomography (central macular thickness, macular volume and retinal nerve fibre layer). Seventy-two children were enrolled in the study. The overall prevalence of OSAS was 48.6%. Statistically significant differences were found between OSAS and non-OSAS group for corneal asymmetry (0.9 ± 0.5 and 0.6 ± 0.3, respectively; p = 0.02), thinnest corneal thickness (551.8 ± 33.9 and 563.7 ± 32.5; p = 0.04), average retinal nerve fibre layer (102.8 ± 10.5µm and 98.1 ± 12.3µm; p = 0.012) and in nasal quadrant (76.2 ± 15.4µm and 66.5 ± 12.6µm; p = 0.0002). A comprehensive eye examination with corneal and optic nerve imaging showed early corneal and optic nerve changes in children newly diagnosed with OSAS. These could be prelude of the known ocular manifestations associated with OSAS in adult patients.

Highlights

Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder characterized by repetitive collapse of the upper airway during sleep [1,2] reported in 1–3% of the general paediatric population.[3]The most frequent causes of obstructive sleep apnea syndrome (OSAS) are adenotonsillar hypertrophy and regional deposition of fat in the neck [3,4,5,6]
Significant differences were found between OSAS and non-OSAS group for corneal asymmetry (0.9 ± 0.5 and 0.6 ±0.3, respectively; p=0.02), thinnest corneal thickness (551.8 ± 33.9 and 563.7 ±32.5; p= 0.04), average retinal nerve fiber layer (102.8 μm ± 10.5 and 98.1 μm ±12.3; p=0.012) and in nasal quadrant (76.2±15.4 μm and 66.5 ±12.6 μm; p= 0.0002)
We examined children assessed for OSAS by overnight respiratory polygraphy (RP), to investigate for early signs of ocular changes related to airway obstruction during sleep, poorly documented and understood in the previous literature[10,11]

Summary

Introduction

Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder characterized by repetitive collapse of the upper airway during sleep [1,2] reported in 1–3% of the general paediatric population.[3]. The most frequent causes of OSAS are adenotonsillar hypertrophy and regional deposition of fat in the neck [3,4,5,6]. The result of airway collapse is the reduction of the inspiratory flow leading to hypoxemia and hypercapnia which cause injury of blood vessels and organ involvement, [6, 7] including the eyes. Several studies have linked OSAS with glaucoma, keratoconus, papilloedema, nonarteritic ischemic optic neuropathy, age-related maculopathy and floppy eyelid syndrome (8–9); while very few and contradictory data can be found regarding paediatric ages.(10–11)

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