Ocular Manifestations of OSA: The 5 Most Common
Ocular Manifestations of OSA: The 5 Most Common
Retinal vein occlusion is one of the most common nondiabetic causes of blindness. It occurs as a consequence of impaired venous return of the retina and atherosclerotic defects of the feeding arterioles. Several studies have found that retinal vein occlusion is more common among patients with OSA.
The prevalence of both conditions rises with increasing age, and both are associated with hypertension, diabetes, and atherosclerosis. Whether a true causative relationship exists or these 2 conditions concomitantly occur in individuals with similar associated comorbid conditions is not well understood. However, there appears to be a clear association.
Most patients with retinal vein occlusion discover vision loss on awakening, and snoring is commonly reported. In a study of 63 consecutive patients with retinal vein occlusion, 30 (47.6%) reported snoring and daytime sleepiness. Polysomnography in these 30 individuals identified OSA in 23 (77%), with a mean apnea/hypopnea index of 21 events/hr. In an intention-to-treat analysis, the authors concluded that even if all 33 untested patients did not have sleep-disordered breathing, the prevalence of OSA would still have been 37%.
Similarly, in a study of 40 consecutive patients with retinal vein occlusion, 37% were found to have evidence of sleep-disordered breathing by overnight pulse oximetry (42% of men and 33% of women).
Several ocular manifestations of OSA have been described, and there appears to be a more than just a chance relationship between OSA and certain ophthalmologic conditions. The conditions with the greatest known association with OSA include FES, glaucoma, papilledema not associated with trauma or a space-occupying lesion, nonarteritic anterior ischemic optic neuropathy, and retinal vein occlusion. Although the prevalence of these conditions among patients with OSA is small, the prevalence of OSA in individuals with these conditions is significantly higher than the general population. As such, patients with these 5 conditions should be queried regarding symptoms suggestive of OSA and referred for further evaluation.
Retinal Vein Occlusion
Retinal vein occlusion is one of the most common nondiabetic causes of blindness. It occurs as a consequence of impaired venous return of the retina and atherosclerotic defects of the feeding arterioles. Several studies have found that retinal vein occlusion is more common among patients with OSA.
The prevalence of both conditions rises with increasing age, and both are associated with hypertension, diabetes, and atherosclerosis. Whether a true causative relationship exists or these 2 conditions concomitantly occur in individuals with similar associated comorbid conditions is not well understood. However, there appears to be a clear association.
Most patients with retinal vein occlusion discover vision loss on awakening, and snoring is commonly reported. In a study of 63 consecutive patients with retinal vein occlusion, 30 (47.6%) reported snoring and daytime sleepiness. Polysomnography in these 30 individuals identified OSA in 23 (77%), with a mean apnea/hypopnea index of 21 events/hr. In an intention-to-treat analysis, the authors concluded that even if all 33 untested patients did not have sleep-disordered breathing, the prevalence of OSA would still have been 37%.
Similarly, in a study of 40 consecutive patients with retinal vein occlusion, 37% were found to have evidence of sleep-disordered breathing by overnight pulse oximetry (42% of men and 33% of women).
Conclusions
Several ocular manifestations of OSA have been described, and there appears to be a more than just a chance relationship between OSA and certain ophthalmologic conditions. The conditions with the greatest known association with OSA include FES, glaucoma, papilledema not associated with trauma or a space-occupying lesion, nonarteritic anterior ischemic optic neuropathy, and retinal vein occlusion. Although the prevalence of these conditions among patients with OSA is small, the prevalence of OSA in individuals with these conditions is significantly higher than the general population. As such, patients with these 5 conditions should be queried regarding symptoms suggestive of OSA and referred for further evaluation.