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Yuan-Yao Fan, Ming-Hui Sun; Glaucoma Progression in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome: Study of The CGMH Polysomnography Database. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5110.
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To evaluate the correlations between severity of obstructive sleep apnea (OSA), and glaucoma progression in patients with primary open-angle glaucoma (POAG) or normal-tension glaucoma (NTG).
This retrospective study included subjects from database in Chang Gung Memorial Hospital, which consisted of 14152 patients who underwent polysomnography between June 1st, 2009 and June 1st, 2017. We selected our study subjects from the database by identifying subjects with a diagnosis of POAG or NTG (ICD-9-CM codes 365.11 or 365.12). Patients with other optic neuropathy or retinal disorders were excluded. We further excluded patients who had follow-up for less than 3 years, and who had less than 3 consecutive Humphrey visual field (VF) examinations. Data including age, sex, body mass index (BMI), comorbidities, polysomnography (PSG) results, treatment for OSA, and ophthalmology examinations such as visual acuity, intraocular pressure (IOP), mean deviation in VF and optical coherence tomography (OCT) of peripapillary retinal nerve fiber layer (RNFL) were recorded. Linear regression trend analysis was performed to determine if there was progression in VF mean deviation or global RNFL thickness. The statistical analysis was performed by SPSS 17 (SPSS, Inc., Chicago, IL, USA).
Among our study subjects, 58.8% were diagnosed of NTG, and 41.2% were diagnosed of POAG. There was no OSA in 11.8% of patients, mild OSA in 41.2%, moderate OSA in 23.5%, and severe OSA in 23.5% of patients. All the patients received prompt medical treatment for glaucoma. However, 14.3% patients with mild OSA, 25.0% patients with moderate OSA and 50.0% patients with severe OSA need filtering surgery for better control of IOP in at least one eye. Progression of overall RNFL thickness was noted in 50% patients without OSA, 50% patients with mild OSA, 42.9% patients with moderate OSA, and 75% patients with severe OSA. Progression of VF was noted in 25.0% patients with severe OSA. No visual field progression was noted in the normal, mild OSA or moderate OSA group.
Change in RNFL thickness on OCT is more significant than VF mean deviation for the detection of glaucoma progression. Severe OSA is associated with more glaucoma progression. Clinicians should be aware of possible undiagnosed severe OSA once patients have progression of glaucoma despite adequate treatment.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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