Sleep-disordered breathing a neglected risk factor in primary open-angle glaucoma

Dr Mandeep Kaur,Dr Jagdeepak Singh,Dr Inderjit Kaur

doi:10.17511/jooo.2021.i04.04

Abstract

Background: Sleep-disordered breathing (SDB) is accompanied by large swings in blood pressureand the repetitive hypoxic period during sleep, which may accelerate anoxic optic nerve damageseen in glaucoma. There are many associated risk factors in primary open-angle glaucoma (POAG),but recently, SDB, though a neglected one, is coming up as a risk factor. However, various studieshave reported controversial findings. Objective: To evaluate the relationship between SDB andPOAG. Design: A hospital-based case-control study. Methods: A total of 400 patients between 30–70 years were recruited from eye OPD between 2008- 2010. They were divided into two groups, 200cases with established POAG and 200 age and sex-matched healthy subjects with normal IOP in thecontrol group. Detailed history, complete ophthalmic and ENT examination was made along withBMI, blood pressure and neck girth measurement. Both groups were interviewed with aquestionnaire regarding SDB and were recorded on the Epworth sleepiness scale (ESS). Results:The mean age being 55.02 ± 8.66 in the POAG group and male predominance noted both in POAGand SDB patients with ESS> 10 was statistically significant (p < 0.05). Also, patients in the POAGgroup with ESS > 10 had more IOP and BMI, greater neck girth, high BP and more ENT problemswith p-value < 0,001, which is highly significant, thus showing the relationship between SDB andPOAG. Conclusions: Increased community awareness and earlier detection of glaucoma and itscorrelation with SDB results in decreased morbidity.

Highlights

Sleep-disordered breathing (SDB), or upper-airway obstruction during sleep or sleep apnoea initially demonstrated in the 1960s, is a common chronic disorder that results in recurrent nocturnal asphyxia, fragmented sleep, major fluctuations in blood pressure and increased sympathetic nervous system activity.[1]
primary open-angle glaucoma (POAG) is defined as a chronic progressive optic neuropathy [13] in adults and is multifactorial. [14,15] It develops due to the death of retinal ganglion cells by elevated intraocular pressure (IOP) and vascular insufficiency resulting from reduced ocular blood flow, decreased ocular perfusion pressure, generalized vascular deregulation or increased trans lamina cribrosa pressure [16]. and leads to typical visual field defects and increased cupping of the optic disc
Many studies have reported the association between glaucoma and obstructive sleep apnoea syndrome (OSAS), and most of them focused on the Prevalence of glaucoma in OSAS patients and indicated it as a risk factor. [9,22] McNab recently proposed an association between POAG and sleep apnea

Summary

Background

Sleep-disordered breathing (SDB) is accompanied by large swings in blood pressure and the repetitive hypoxic period during sleep, which may accelerate anoxic optic nerve damage seen in glaucoma. Methods: A total of 400 patients between 30– 70 years were recruited from eye OPD between 2008- 2010 They were divided into two groups, 200 cases with established POAG and 200 age and sex-matched healthy subjects with normal IOP in the control group. Complete ophthalmic and ENT examination was made along with BMI, blood pressure and neck girth measurement. Both groups were interviewed with a questionnaire regarding SDB and were recorded on the Epworth sleepiness scale (ESS). Patients in the POAG group with ESS > 10 had more IOP and BMI, greater neck girth, high BP and more ENT problems with p-value < 0,001, which is highly significant, showing the relationship between SDB and POAG.

Introduction

Material and methods

Methodology

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