Thread: Eye Conditions Linked With Obstructive Sleep Apnea

Eye Conditions Linked With Obstructive Sleep Apnea

Article Date: 11 Nov 2008 - 0:00 PST


If a good night's sleep helps the brain and body perform better, it's a good guess that sleep problems can cause more than just fatigue. Numerous studies have shown a connection between sleep disorders and medical conditions such as cardiovascular disease, cerebrovascular disease, and metabolic disorders, including the risk of obesity and diabetes mellitus. In the November issue of Mayo Clinic Proceedings, Mayo Clinic researchers outline several interesting associations between sleep disorders and eye disease.


Obstructive sleep apnea and eye disorders


More than 12 million people in the United States have obstructive sleep apnea -- a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep. Sleep apnea has several types. The most common is obstructive sleep apnea (OSA), which occurs when throat muscles relax and block the airway.


Multiple studies have identified OSA as an independent risk factor for the development of several medical conditions, including high blood pressure, which are related to impairments or alterations in a person's vascular (circulatory) system. With their own complex and sensitive vascular system, the eyes can sometimes signal and be affected by systemic vascular problems.


"Given the vascular consequences of OSA, it is not surprising that ophthalmologic manifestations exist," explains the article's lead author, E. Andrew Waller, M.D., a Mayo Clinic pulmonologist and sleep specialist.

The researchers conducted a literature search focused on sleep disorders and eye disease. In the article, they discuss a variety of ophthalmologic conditions associated with obstructive sleep apnea.



Highlighted below are a few findings.


-- Floppy eyelid syndrome: This disorder causes eyelids to evert (turn inside-out) spontaneously during sleep, resulting in excessive watering, stickiness, discomfort and blurred vision. While not a serious medical problem, this syndrome can signal that a person also has OSA, which can lead to more significant health problems.


-- Glaucoma: This condition is the second most common cause of blindness and the most common cause of irreversible blindness. OSA is linked to two forms of this disease -- primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). The severity of glaucoma appears to correlate with the number and duration of apnea episodes in patients with OSA.


-- Nonarteritic anterior ischemic optic neuropathy (NAION): Research shows an increased incidence of OSA in people diagnosed with NAION. This condition is characterized by the sudden painless onset of vision loss in one eye, often noticed upon awakening. Up to 6,000 patients annually in the United States are diagnosed with this condition, which can cause irreversible vision loss.


-- Papilledema: People with OSA may have a higher incidence of papilledema, swelling of the optic nerve in both eyes. Papilledema typically occurs due to increased pressure within the skull and can lead to progressively worsening vision and, in some cases, blindness.


According to Dr. Waller, knowing the links between these eye conditions and OSA may hasten early diagnosis and appropriate treatment.

"Our understanding of the mechanisms that link these disorders is minimal," says Dr. Waller. "However, the recognition of these associations is important for primary care physicians, ophthalmologists, and sleep physicians. For patients with OSA, a routine eye examination to evaluate for early signs of glaucoma, particularly in the setting of visual loss or change, should be recommended. Patients with ophthalmologic diseases known to be associated with sleep apnea should be screened clinically for sleep apnea and referred to a sleep center if signs or symptoms are present."


The authors from Mayo Clinic are Rick Bendel, M.D., ophthalmologist and Joseph Kaplan, M.D., pulmonologist and sleep specialist.


A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at Mayo Clinic Proceedings.

To obtain the latest news releases from Mayo Clinic, go to News from Mayo Clinic. MayoClinic.com (Mayo Clinic medical information and tools for healthy living - MayoClinic.com) is available as a resource for your health stories.

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Lack Of Sleep And Rising Nighttime Blood Pressure Linked To Cardiovascular Disease

Article Date: 11 Nov 2008 - 0:00 PST

A report published in the November 10 issue of Archives of Internal Medicine finds that people who sleep less than 7.5 hours per day may have a higher future risk of heart disease. Kazuo Eguchi, M.D., Ph.D. (Jichi Medical University, Tochigi, Japan) and colleagues also find an increased risk of heart disease among people who have little sleep combined with overnight elevated blood pressure.

Sleep is becoming a rarer commodity in today's world even though it is likely to have preventive powers against ailments such as obesity and diabetes. "Reflecting changing lifestyles, people are sleeping less in modern societies," write the authors. They also point out that inadequate sleep - and conditions such as sleep-disordered breathing and night-time high blood pressure (hypertension) - are risk factors for cardiovascular disease.

Eguchi and colleagues studied the sleeping behaviors of 1,255 individuals with hypertension for about 50 months. The sample was about 70.4 years of age, on average. The research team collected details on each patient such as sleep duration, daytime and nighttime blood pressure, and events indicating cardiovascular disease such as stroke, heart attack, and sudden cardiac death.

In the total sample, there were 99 cardiovascular disease events during follow-up. Those who slept for less than 7.5 hours were more likely to develop incident cardiovascular disease. The authors add that, "The incidence of cardiovascular disease was 2.4 per 100 person-years in subjects with less than 7.5 hours of sleep and 1.8 per 100 person-years in subjects with longer sleep duration."

The researchers also noticed high rates of heart disease in patients who both slept for shorter durations and had overnight increases in blood pressure compared to patients with normal sleep duration and no overnight blood pressure increase. However, among participants who did not experience an overnight elevation in blood pressure, the occurrence of cardiovascular disease was similar for those with longer and shorter sleep durations.

"Shorter duration of sleep is a predictor of incident cardiovascular disease in elderly individuals with hypertension," conclude the authors. This predictor is strongest when combined with elevated nighttime blood pressure. "Physicians should inquire about sleep duration in the risk assessment of patients with hypertension."

Short Sleep Duration as an Independent Predictor of Cardiovascular Events in Japanese Patients With Hypertension
Kazuo Eguchi; Thomas G. Pickering; Joseph E. Schwartz; Satoshi Hoshide; Joji Ishikawa; Shizukiyo Ishikawa; Kazuyuki Shimada; Kazuomi Kario
Archives of Internal Medicine (2008); 168[20]: pp. 2225-2231.
Click Here to View Abstract

Written by: Peter M Crosta
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