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T.K. Leveque, D. Zacks, R.D. Chervin, D. Musch; Prevalence of Sleep Apnea in Patients With Central Serous Chorioretinopathy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3291.
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Purpose: Patients with obstructive sleep apnea, in comparison to controls, have increased levels of circulating epinephrine and norepinephrine, both risk factors for development of central serous chorioretinopathy (CSCR). We employed a well–validated survey instrument to estimate the frequency of sleep apnea in a sample of patients with active CSCR, and compared the result to published prevalence estimates for all adults (2–24%). Methods: A review of patient charts with the billing diagnosis of CSCR from 2000–2003 was performed to find cases of active, acute CSCR. The Berlin Questionnaire, a validated research tool to assess risk for sleep–study proven apnea, was administered via telephone by a single surveyor to a randomly–sampled group of patients who met previously published diagnostic criteria for CSCR. Power calculations using a one–sided binomial hypothesis test with a target significance level of 0.05 were performed to determine ideal sample size. Results: Charts of 117 patients were reviewed, and 61 patients were determined to have active acute CSCR: 46 (75.4%) patients were male and 15 (24.6%) were female. The age range was 29–77 with a mean of 48.1 years. Forty–one randomly selected patients were called on the telephone, but 5 phones were no longer in service, and 18 additional patients were unreachable. A total of 18 patients were contacted, including 14 (77.8%) male and 4 (22.2%) female, with an age range of 29–72 with a mean of 46.4 years. Survey scores showed 11 of the 18 patients (61.1%) to be at high risk for sleep apnea (95% CI: 35.8% to 82.7%) , and 7 patients (38.8%) to be at low risk. If we assume an expected prevalence of sleep apnea in the general population to be 5% (for example in a sample of 20 patients), the prevalence of sleep apnea in the CSCR population is significantly higher (Fisher's exact test, P=0.0003). Even if the expected prevalence in the general population were as high as the published upper limit of 24% (again in a sample of 20 patients, for example), the difference is still significant (Fisher's exact test, P=0.01). Patients in the high risk and low risk groups did not differ significantly in age or gender. Conclusions: Patients with CSCR may be more likely than other adults to have obstructive sleep apnea, and screening for this sleep disorder should be considered in CSCR patients. Further research is warranted to confirm the results, determine whether sleep apnea may contribute to the development of CSCR, and assess whether treatment of sleep apnea might offer a new therapeutic opportunity for some patients with CSCR.
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