Ocular Implications in Patients with Sleep Apnea

Nicoleta Anton,Alina Cantemir,Ciprian Danielescu,Anisia Iuliana Alexa,Camelia Margareta Bogdănici,Roxana Elena Ciuntu,Daniel Constantin Brănișteanu,Dorin Chiseliţă,Bogdan Doroftei

doi:10.3390/app112110086

Abstract

Sleep apnea syndrome (SAS) is a condition characterized by recurrent episodes of total or partial collapse of the upper respiratory tract associated with daytime drowsiness that cannot be explained by other factors. SAS is a pathology that can cause ophthalmological damage both directly through the pathophysiological mechanism characteristic of the disease on the ocular system, and indirectly by promoting the development of other pathologies (cardiovascular, metabolic), which are a risk factor for ocular morbidity in the absence of sleep apnea syndrome. The aim of this paper is to highlight the ocular symptoms determined by sleep apnea syndrome (SAS), by analyzing literature over the past 20 years. Method: A mini-review that collected data from Pub Med Central, ResearchGate, GoogleScholar, DovePress, ScienceDirect, Elsevier, related to the ocular implications given by sleep apnea syndrome, with or without continuous positive airway pressure (CPAP) treatment. The study included articles that identified a number of eye conditions associated with sleep apnea, such as: dry eye syndrome and impaired ocular surface, glaucoma, non-arteritic anterior ischemic optic neuropathy, floppy eyelid syndrome, keratoconus, central serous chorioretinopathy, central vein occlusion, corneal neovascularization, and age-related macular degeneration. Sleep apnea syndrome is a pathology that can cause the onset or worsening of varying degrees of severity eye diseases by its pathophysiological mechanism, with a different impact on the quality of the individual’s life. On one hand, the purpose of this review is to identify studies in literature that associate sleep apnea syndrome with eye alterations; on the other hand, to inform the Romanian medical staff in different fields of the patients’ guidance diagnosed with SAS to an ophthalmology clinic since early and mild symptoms, so that these patients benefit from an ophthalmological approach and monitoring, in an attempt to diagnose and treat eye diseases in time and prevent their worsening.

Highlights

Sleep apnea syndrome (SAS) is a condition characterized by recurrent episodes of total or partial collapse of the upper respiratory tract, associated with daytime drowsiness that cannot be explained by other factors, or which “experience two or more of the following factors: episodes of suffocation during sleep, recurrent episodes of awakening during sleep, fatigue during the day, impaired ability to concentrate, restless sleep” [1,2]
The most common ocular manifestations found in association with SAS are dry eye syndrome and ocular surface damage, glaucoma, non-arteritic anterior ischemic optic neuropathy, floppy eyelid syndrome, keratoconus, central serous chorioretinopathy, neural occlusion, corneal vein, central venous occlusion, and age-related macular degeneration
The study included articles that identified a number of eye conditions associated with sleep apnea, such as: dry eye syndrome, glaucoma, non-arteritic anterior ischemic optic neuropathy, floppy eyelid syndrome, keratoconus, central serous chorioretinopathy, central vein occlusion, corneal neovascularization, and age-related macular degeneration

Summary

Introduction

Sleep apnea syndrome (SAS) is a condition characterized by recurrent episodes of total or partial collapse of the upper respiratory tract (lasting at least 10 s and a frequency greater than 10 per hour), associated with daytime drowsiness that cannot be explained by other factors, or which “experience two or more of the following factors: episodes of suffocation during sleep, recurrent episodes of awakening during sleep, fatigue during the day, impaired ability to concentrate, restless sleep” [1,2]. The severity of SAS can be estimated using the Apnea Hypopnea Index (AHI), apnea being defined by the total obstruction of the CRS, and hypopnea by a partial one. SAS represents a pathology could at can cause ophthalmological damage both directly, through the pathophysiological mechanism characteristic of the disease on the ocular system, and indirectly by promoting the development of other pathologies (cardiovascular, metabolic, etc.), which are a risk factor for ocular morbidity in the absence of sleep apnea syndrome. An Annalisa Pace study was conducted to evaluate the relation between OSA (obstructive sleep apnea) and allergic rhinitis (AR). Data showed that there was an increased risk of OSA in NARES patients respect to AR patients and healthy patients [13]

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