The relationship between obstructive sleep apnea (OSA) and eye disorders is not yet well appreciated by the eye care community. However, in 2018, there were several papers published about a number of ophthalmic conditions associated with OSA. Because most are based on retrospective studies, it cannot yet be determined if there is a causative relationship between OSA and these specific eye pathologies. However, to highlight this potential relationship, as well as the need for eye care professionals to appreciate how we can help patients to either be aware of the need for a sleep assessment or to support sleep therapy, my story of the year is the review article, "Obstructive Sleep Apnoea,"1 which summarizes some of these relationships.
Sleep apnea is described as an “episodic upper airway narrowing during sleep,” which can be either partial or complete, and which is qualified as mild, moderate, or severe. It almost seems intuitive that a reduction in airflow, which can cause intermittent hypoxia, blood pressure surges, and heart rate increases, could contribute to retinal vascular compromise in the eye. It should, therefore, not come as a surprise that OSA is associated with vascular conditions like hypertension and diabetes, with possible retinal disease and optic neuropathy sequelae.
How can eye care professionals use this information? As primary healthcare providers, we can help preliminarily identify patients who may have OSA by including questions in our histories that relate to quality and quantity of sleep, especially for seniors and those who appear overweight. Depending on the patient’s responses, a recommendation to be seen by either the patient’s primary care physician or a sleep specialist for a sleep study may be appropriate. Additionally, special attention should be paid to sleep information for those patients with hypertension, diabetes (especially those with diabetic retinopathy), central serous chorioretinopathy (CSCR), glaucoma, age-related macular degeneration, and non-arteritic ischemic optic neuropathy. The relationship between certain systemic and ocular conditions and OSA should encourage information sharing between eye care professionals who are treating and monitoring these ocular pathologies and those clinicians who are treating OSA. And, finally, from a functional and public health perspective, making seniors aware of the effect of both fatigue and aging, a combination which could potentially increase the risk of motor vehicle accidents when response time is important, can be of benefit not only for the patient but also for the community in which the patient drives.
Currently, continuous positive airway pressure (CPAP) is the treatment of choice for OSA (along with weight loss). Importantly, this treatment has the potential to have both positive and negative effects with respect to some ocular pathologies. For example, for patients with CSCR, treatment of undiagnosed OSA “can lead to dramatic resolution of CSCR after treatment of OSA with continuous positive airway pressure therapy,” whereas, for patients with glaucoma, some studies suggest an increase in intraocular pressure for those using a CPAP. In the latter condition, a pre-assessment of intraocular pressure and visual fields may be of value in appreciating that effect, and should be considered.
Hopefully, as more studies are done, there will be a better understanding of the pathophysiological similarities between OSA and eye pathologies, with resultant overall positive therapies.