A Prospective Photographic Study of the Ocular Fundus in Obstructive Sleep Apnea

• Type of Material: Article
• Authors: Clare L. Fraser, Emory University; Donald Bliwise, Emory University; Nancy J Newman, Emory University; Cedric Lamirel, Fondation Ophtalmologique Adolphe de Rothschild; Nancy Abbey Collop, Emory University; David Rye, Emory University; Lynn Marie Trotti, Emory University; Valerie Biousse, Emory University; Beau Bruce, Emory University
• Language: English
• Date: 2013-09-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 by North American Neuro-Ophthalmology Society.
• Final Published Version (URL): http://dx.doi.org/10.1097/WNO.0b013e318290194f
• Title of Journal or Parent Work: Journal of Neuro-Ophthalmology
• ISSN: 1070-8022
• Volume: 33
• Issue: 3
• Start Page: 241
• End Page: 246
• Grant/Funding Information: Dr. Bruce receives research support from the NIH/NEI (K23-EY019341).; Dr. Newman is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award.; Dr. Clare Fraser received the RANZCO Eye Foundation Scholarship and the Sydney Eye Alumni Travelling Fellowship Grant.; This study was supported in part by an unrestricted departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York; and by NIH/NEI core grant P30-EY06360 (Department of Ophthalmology).
• Keywords: DISEASE; Life Sciences & Biomedicine; FRACTAL ANALYSIS; FLUID PRESSURE; Clinical Neurology; PAPILLEDEMA; Neurosciences & Neurology; Science & Technology; Ophthalmology; GLAUCOMA; PREVALENCE; OPTIC NEUROPATHY; BLOOD-PRESSURE
• Research Categories: Health Sciences, Opthamology; Health Sciences, Epidemiology; Biology, Neuroscience

Abstract

BACKGROUND: The prevalence of optic nerve and retinal vascular changes within the obstructive sleep apnea (OSA) population are not well-known, although it has been postulated that optic nerve ischemic changes and findings related to an elevated intracranial pressure may be more common in OSA patients. We prospectively evaluated the ocular fundus in unselected patients undergoing overnight diagnostic polysomnography (PSG). METHODS: Demographic data, medical/ocular history, and nonmydriatic fundus photographs were prospectively collected in patients undergoing PSG at our institution and reviewed for the presence of optic disc edema for which our study was appropriately powered a priori. Retinal vascular changes were also evaluated. OSA was defined using the measures of both sleep-disordered breathing and hypoxia. RESULTS: Of 250 patients evaluated in the sleep center, fundus photographs were performed on 215 patients, among whom 127 patients (59%) had an apnea/hypopnea index (AHI) ≥15 events per hour, including 36 with severe OSA. Those with AHI <15 served as the comparison group. None of the patients had optic disc edema (95% confidence interval [CI]: 0%-3%). There was no difference in rates of glaucomatous appearance or pallor of the optic disc among the groups. Retinal arteriolar changes were more common in severe OSA patients (odds ratio: 1.09 per 5 unit increase in AHI; 95% CI, 1.02-1.16; P = 0.01), even after controlling for mean arterial blood pressure. CONCLUSIONS: We did not find an increased prevalence of optic disc edema or other optic neuropathies in our OSA population. However, retinal vascular changes were more common in patients with severe OSA, independent of blood pressure.