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T. A. Alasbali, M. Smith, P. Gouws, N. Geffen, Y. M. Buys, Y. Jin, J. Flanagan, C. Shapiro, G. E. Trope; Effect of Sleeping Position on Iop in Progressive Glaucoma. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5839.
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To determine if a 30 degree sleeping position improves nocturnal IOP control in patients with progressive glaucoma.
Patients with progressive NTG or POAG as evidenced by disc hemorrhage despite well-controlled IOP were evaluated in a sleep laboratory on two separate nights one week apart. During the first night patients were evaluated lying flat and during the second night they were elevated to 30 degree head up. IOP and blood pressure (BP) were measured at 10 PM as the baseline measurement and at 12 PM, 2 AM, 4 AM and 6 AM. IOP was measured as the average of two reading with less than 5% error using a Tonopen. Ocular perfusion pressure was calculated using mean arterial BP - IOP. Data were analyzed with profile analysis to take into account the correlation of repeated IOP readings from the same individuals.
Seventeen eyes of 17 patients were included. There were no significant differences between the IOP levels at baseline and the two sleeping positions (flat versus elevated) (p=0.6131). Between 2400 and 0600 IOP was a mean of 3.2 mmHg lower in the 30 degree elevated position (p=0.03). 16 of 17 patients (94.1%) had lower IOP in the 30 degrees position and this reduction was 20% or more in 35% of patients. There was no statistically significant difference comparing the two sleeping positions in mean ocular perfusion pressure over time.
A 30-degree sleeping position lowers nocturnal IOP in patients with progressive glaucoma. Although this benefit varies between individual patients, mean IOP was 20% lower in a third of patients in this series.
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