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Nataliya Semenova, Vladimir Akopyan; Retinal Nerve Fiber Layer And Ganglion Cell Complex Thickness Assessment In Patients With Obstructive Sleep Apnea. Invest. Ophthalmol. Vis. Sci. 2012;53(14):799.
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To investigate the retinal nerve fiber layer (RNFL) and the macular ganglion cell complex (GCC) in patients with obstructive sleep apnea (OSA) and evaluate the relationship with the OSA severity.
This study included 43 previously untreated patients (86 eyes) with OSA and 17 age- and sex-matched healthy controls that had no history of sleep-disordered breathing. Patients with any conditions that can cause optic neuropathy were excluded from the study. Participants with OSA were divided into three groups on the basis of the apnea-hypopnea index (AHI): group I (mild OSA, AHI=5-15) - 17 participants; group II (moderate OSA, AHI=16-30) - 11 participants; group III (severe OSA, AHI>30) - 15 participants. All the subjects underwent polysomnography and complete ophthalmological examination including perimetry (HFA II, Carl Zeiss Meditec Inc., USA), scanning laser polarimetry (SLP; GDx VCC, Laser Diagnostic Technologies Inc., USA), optic coherence tomography (OCT; RTVue-100 FD-OCT, Optovue Inc., USA). RNFL thickness was measured in various segments using SLP and OCT. RNFL thickness standard deviation and Nerve fiber index (NFI) were noted from SLP results. OCT was used to obtain average GCC thickness, global and focal loss volume (GLV & FLV).
There was no significant difference among the groups in terms of visual acuity, IOP, MD and PSD perimetric indices. The patient and control groups differed significantly in terms of average RNFL thickness, NFI, average GCC thickness, GLV and FLV (Mann-Whitney test, p<0,01). There was a statistically significant difference between NFI, GLV and FLV values of healthy and severe OSA patients (Kruskal-Wallis test, p<0,01; Bonferroni-Dunn post hoc test, p<0,05).
We supposed that episodes of OSA lead to nocturnal increase of intracranial and intraocular pressure, transient hypoxemia and hypercapnia, which, in turn, may compromise optic nerve head perfusion and oxygenation, ultimately leading to optic neuropathy. This study showed that OSA is associated with optic neuropathy that could be revealed by OCT and SLP on the preperimetric stage. Further studies of the effect of OSA treatment will clear up the role and contribution of apnea in pathogenesis of glaucoma and anterior ischemic optic neuropathy.
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