The application of continuous positive airway pressure in association with obstructive sleep apnea syndrome and subconjunctival hemorrhage due to hypertensive attacks: case reports

Abstract

Introduction Spontaneous subconjunctival hemorrhage associated with hypertension (HT) is common. Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for HT. Blood pressure during obstructive sleep apnea can increase up to 20% and reaches its highest level with the end of apnea. Materials and methods Case: 60-year-old male patient, BMI: 30.9 kg/m 2 , had complaints of subconjunctival hemorrhage in the morning after sleeping, repeated three times in the last two years. He described occasional complaints of snoring and daytime sleepiness. There was no history of trauma, antiplatelet therapy, and bleeding disorders. He was being taken regular medication for 5 years with a diagnosis of hypertension. In the color fundus imaging, hypertensive retinopathy was detected. Twice Holter monitoring was performed in patient with hypertension (Table 1). Day–night rates of the critical levels of systolic BP, day: 0%, 7%, and night: increased to 15%, 13%, diastolic BP, day: 0%, 0%, and night: increased to 0% to 13% were found. Oxygen saturation was monitored during sleep at night, and desaturation was observed. Then polysomnography test was performed. In polysomnography, apnea hypopnea index (AHI) was 45.8, and the patient was diagnosed with OSAS. Results Consequently, continuous positive airway pressure (CPAP) therapy was given. After the current antihypertensive treatment and CPAP treatment, systole: 2% at night, 1% critical level during the day was found significantly lower in the Holter monitoring. There was no recurrence of bleeding after CPAP treatment. Conclusion In our case, recurrence of subconjunctival hemorrhage due to hypertensive episodes caused by OSAS was observed. After CPAP treatment, subconjunctival hemorrhage due to hypertensive attacks did not relapse, because of regular course of blood pressure. The patients with complications of hypertension should be considered in terms of OSAS, because CPAP treatment prevents hypertensive episodes by night. Acknowledgements OSAS, subconjunctival hemorrhage due to hypertensive attacks.