Abstract
Purpose:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
Keywords: 629 optic nerve •
498 diabetes •
548 hypoxia