Abstract
Obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) are in terms of nosography different pathologies, however they share a stress-related physio-pathogenetic component, not yet explored in depth. Therefore, the aim of the present study was to ascertain whether OSA and CSC share a common profile, specifically in cortisol production focusing on the cortisol awake response (CAR), the area under curve (AUCCAR) and the SLOPECAR compared with healthy matched controls. Furthermore, standardized self-administered questionnaires were used to identify mental health status related to depression, anxiety and subjective stress perception levels in the study populations. The results showed hypothalamus-pituitary-adrenal (HPA) axis activity anomalies, represented by a flattening CAR in the OSA group and a statistically significant increase in cortisol production in CSC patients at awakening. This disarrangement of the HPA axis activity associated with elevated distress and mental health scores, and its presence in both patients with OSA and patients with CSC, might represent the shared path explaining the stress-related component in these diseases. Further research is needed to investigate the psycho-neuro-endocrinological aspects of OSA and CSC to determine whether psychoeducation on effective stress coping strategies might be of value in improving the quality of life of OSA and CSC patients.
Highlights
The pathogenic role of obstructive sleep apnea (OSA), characterized by repetitive upper airway occlusion episodes leading to apnea and excessive daytime sleepiness [1,2,3], is increasingly accepted in cardiovascular and cerebrovascular diseases [4].In selected patients, the local and systemic consequences of OSA might contribute to the occurrence and/or the aggravation of the ocular pathologies
One-way ANOVA followed by post-hoc test for multiple comparisons reveals that there were no significant differences in the somatic and baseline clinical data among the control group participants, the OSA and the central serous chorioretinopathy (CSC) patients
The aforementioned anomalies affecting salivary cortisol production at awakening, are consistent with HPA axis dysregulation in both OSA and CSC subjects who may share a common pathogenetic process in association with elevated subjective stress perceptions induced by daily hassles and significant Hamilton Rating Scale for Depression (HDS) scores in comparison with healthy controls, while a moderate level of Hamilton Anxiety Rating Scale (HAS) is detectable in OSA patients only
Summary
The pathogenic role of obstructive sleep apnea (OSA), characterized by repetitive upper airway occlusion episodes leading to apnea and excessive daytime sleepiness [1,2,3], is increasingly accepted in cardiovascular and cerebrovascular diseases [4].In selected patients, the local and systemic consequences of OSA might contribute to the occurrence and/or the aggravation of the ocular pathologies. Since autonomic activation can stimulate hypothalamic-pituitary-adrenal (HPA) axis activity [15,16] and nocturnal awakenings have been related to pulsatile cortisol release [17], OSA would be expected to activate the HPA axis [18]. Apneic events, both directly and indirectly, can lead to increased cortisol levels by disrupting the hormone regulatory response and activating the HPA axis [5,19]
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