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G. Leroux les Jardins, A. Glacet-Bernard, S. Lasry, B. Housset, E. Souied, G. Coscas, G. Soubrane; Sleep Apnea Syndrom and Retinal Vein Occlusion : About 33 Patients. Invest. Ophthalmol. Vis. Sci. 2009;50(13):394.
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Obstructive Sleep Apnea Syndrome (OSAS) is a very common disease and has been recently increasingly implicated in numerous cardiovascular, neurologic and ophthalmologic diseases. The already known risks of undiagnosed obstructive sleep apnea include heart attack, stroke, impotence, irregular heartbeat, high blood pressure and heart disease.In ophthalmologic practice, it could be linked with glaucoma, nonarteritic anterior ischemic optic neuropathy, visual field defects, papilledema, floppy eyelid syndrome and Retinal Vein Occlusion(RVO).
We report the observations of 33 patients who presented with retinal vein occlusion and who were investigated for OSAS with nocturnal polygraphy.
.In the general population the prevalence of OSAS is approxymately 2% to 7% (men and women). In this serie 76% (25 on 33) patients were OSAS positive. Among this patient, the average apnea-hypopnea index during sleep was 21 per hour (min 7/hour; max 74/hour). The local and systemic effects of OSAS could explain, in some patients, the occurrence and/or the aggravation of RVO. First stage effects of OSAS are nocturnal hypoxemia, reoxygenation, hypercapnia, intra-thoracic pressure changes, arousals and sleep fragmentation. RVO could be a consequence of a slow-down of blood flow circulation secondary to hypoxemia and elevated nocturnal intracranial pressure. The arousals cause an additional acute increase of arterial blood pressure. Ancillary effects are increased platelet aggregability, an increased sympathic activation, oxydative stress, vascular endothelial dysfunction, inflammation and metabolic dysregulation.
This serie of 33 patients showed for the first time a strong correlation between RVO and OSAS. This suggests that OSAS, by acting on retinal microcirculation, could be an additional risk factor for the occurrence or the aggravation of RVO. Further studies are needed to confirm this possible relationship.
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