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Corinne Dot, Emilie Agard, Hussam El Chehab, Ikrame Douma, Guillaume Ract-Madoux, Olivier Coste; Normal tension glaucoma prevalence in sleep apnea patients with type 2 diabetes, interest of a new medical device Ru-Sleeping© in ophthalmology. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3493.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the prevalence of normal tension glaucoma (NTG) in sleep apnea (SAS) patients with type 2 diabetes, and to determine the predictive value of a new medical device RU-sleeping © (Philips-respironics inc.) in the detection of SAS.
Prospective study of 90 patients. The patients were divided into 3 groups: group 1: SAS (n = 28), group 2 SAS + type 2 diabetes (n = 33), group 3 patients diagnosed NTG (n = 29). All patients receive a dual recording RU-Sleeping© / polysomnography for the diagnosis of SAS and a complete ophthalmologic examination in group 1 and 2. . Group 3 has an Epworth test and RU-sleeping © registration of respiratory events.
The mean age of patients was 50.5 years + / - 4.9 years, 65.5 + / -6.4 years and 73.5 + / - 0.7 years, respectively in groups 1, 2 and 3. NTG prevalence in group 2 was 15.1% versus 32.1% in the control group 1. The mean cup/disk measure in SAS groups (1 + 2) was 0.36. The mean thickness of RNFL was 92.2 μm +/-6.9 in group 1 versus 92.6 μm +/- 0.8 in group 2 (p<0,001), with an I/S index of 1.03 +/-0.1 versus 1.03 +/- 0.4 in groups 1 and 2 (p<0,001). The positive predictive value of RU-sleeping © for SAS screening was 86.6% in group 1 and 91.3% in group 2, the apnea /hypopnea index (AHI) was respectively of 44,4 / h and 41,2 / h (severe SAS). The prevalence of SAS in group 3 was 32.1%, nearly half of them were severe (AHI> 30).As it has been previously reported, the prevalence of NTG in SAS is higher than in the general population. Screening NTG should not stop at clinical examination alone which could ignore 64% of glaucoma patients on the sole criterion of the excavation. Conversely, for NTG patients we follow, RU-sleeping © could be an interesting medical device easy to use, lightweight and economic. It allows SAS screening at home, with excellent positive predictive value for severe SAS.
Diabetes does not appear to be a vascular risk factor in combination with an additional SAS for the occurrence of a NTG in this preliminary study. Our preliminary results suggest high prevalences of NTG or SAS, a larger sample in this prospective study will allow to confirm it in the future. Routine screening NTG should be recommended to any patient SAS. Conversely, RU-sleeping © device could determine the NTG patients to take charge of a priority because of severe presumed SAS.
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