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Noriko Himori, Erika Yamada, Hiromasa Ogawa, Masakazu Ichinose, Toru Nakazawa; The effectiveness of continuous positive airway pressure therapy in glaucoma patients with obstructive sleep apnea syndrome. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2451.
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© ARVO (1962-2015); The Authors (2016-present)
Obstructive sleep apnea syndrome (OSAS) is considered to contribute to glaucoma by causing intermittent hypoxia. We previously found that the speed of visual field deterioration was higher in patients with both open angle glaucoma (OAG) and OSAS than in OAG patients without OSAS. Here, we measured oxidative stress and the speed of glaucoma progression before and after the application of continuous positive airway pressure (CPAP) therapy.
This was a non-randomized clinical trial recruiting Japanese OAG patients with OSAS.All subjects underwent full-night comprehensive polysomnography to confirm the presence of OSAS before and after CPAP therapy. The polysomnography results included the apnea hypopnea index (AHI). Diacron reactive oxygen metabolites (dROMs) and biological antioxidant potential (BAP) were measured with a free radical analyzer. Clinical and ophthalmological parameters were also recorded. Glaucoma progression was assessed according to MD slope, which was calculated with HfaFiles software based on 5 or more reliable sets of data. Findings before and after CPAP therapy were compared with the Student’s t test.
This study included 17 Japanese patients with OAG (14 male and 3 female), including 13 NTG patients and 4 POAG patients. In the OAG patients, AHI and dROMs were significantly lower after than before CPAP therapy (AHI 32.25 ± 16.16 events/h vs. 2.37 ± 2.00 events/h, P < 0.01, dROMs 390.24 ± 54.74 U. CARR vs. 344.25 ± 42.70 U. CARR, P = 0.01). BAP showed no significant difference before and after CPAP therapy. The OAG patients showed slower progression after than before CPAP therapy (MD slope -1.16 ± 1.20 dB/Y vs. -0.39 ± 1.01 dB/Y, P = 0.01)
We found that OAG patients with OSAS had significantly lower oxidative stress and slower glaucoma progression after CPAP therapy. This finding suggests that intermittent hypoxia may induce systemic oxidative stress and promote glaucoma progression. We hope that this finding will lead to new therapeutic strategies and improve understanding of the connected risks of glaucoma and OSAS.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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