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El Harith Elsiddig, William S Gange, Ewa Borys, Charles S Bouchard; Is Obstructive Sleep Apnea (OSA) Associated with Systemic Elastin Disease?. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4595.
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© ARVO (1962-2015); The Authors (2016-present)
OSA is a condition of chronic intermittent hypoxia that is associated with widespread physiologic changes. First, in lax eyelid syndrome (LES), which is associated with OSA, there is elastin loss and metalloproteinase elevation in the eyelids, thought to result from ischemia reperfusion injury. Secondly, one report demonstrated elastin changes in the uvula and soft palate of patients with OSA. Thirdly, we clinically observed an increase in globe retropulsion in patients with OSA during cataract surgery, speculating a decrease in orbital elastin. Finally, OSA has been associated with glaucoma. Our hypothesis is that OSA might be associated with systemic upregulation of elastases with reduction in elastic fibers.
We examined presence and amount of elastin in 2 structures:A) Uvulopalatopharyngoplasty (UPPP) specimens: From a pathology database of patients who had undergone a UPPP at Loyola University Medical, we selected 3 groups of patients: 1) non-obese patients without OSA (control) (N=2); 2) obese patients with OSA (N=7); and 3) non-obese patients with OSA (N=6).B) Globe and Orbit: Globes from 3 patients with OSA (N=6) were obtained from the Eversight Eye Bank. The right globe of each patient was stained with hematoxylin and eosin as well as elastin stain (Verhoeff-Van Gieson stain). Semi-quantitative measurements of elastic fiber content were performed using stained color slides projected onto a screen at 30x magnification and measured by planimetry.
A) UPPP: There was an overall decrease in elastic fibers in patients with OSA (N= 13) compared with the non-obese patients without OSA (N=2). For the 7 obese patients with OSA, 4/7 (57%) exhibited a decrease in elastin staining. For the 6 non-obese patients with OSAS, 5/6 (83%) exhibited a decreased in elastin fiber staining compared to controls (N=2).B) Globes and Orbit: For the 3 right globes from patients with OSA we found the following: 1) Trabecular meshwork (TM): scant elastic fibers with fragmented fibers with a beaded appearance; 2) Periorbital soft tissue: fragmented elastic fibers; and 3) Optic nerve: few and fragmented elastic fibers.
UPPP specimens in OSA patients exhibited decreased elastin and increased elastin fragmentation. For the globes, the data is more inconclusive although similar scant elastin staining was evident in the orbit, TM and optic nerve. Further study is warranted to support a systemic elastin pathology.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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