Obstructive Sleep Apnea and Ophthalmologic Diseases

According to the American Sleep Apnea Association, Obstructive Sleep Apnea is a chronic sleep disorder affecting over 20 million Americans. Sleep apnea is characterized by repeated cycles of paused breathing that occur throughout the night resulting in reduced blood oxygen levels. This oxygen desaturation is associated with serious comorbidities, including cardiovascular disease, high blood pressure and diabetes. While sleep apnea has been well-researched within the field of sleep medicine, its connection to the field of ophthalmology is still gaining traction. New studies reveal the association between sleep apnea and several eye disorders, including glaucoma, Floppy Eyelid Syndrome and NAION.

Glaucoma is a disease involving the eye’s optic nerve, the part of the eye responsible for clear, healthy vision. According to the Mayo Clinic, glaucoma is the second most common cause of blindness and the most common cause of irreversible blindness. Optometrists.org reports that patients with obstructive sleep apnea are ten times more likely to develop glaucoma. While doctors agree on the connection between these diseases, the underlying cause of the association remains unclear. The American Academy of Ophthalmology reports that the interruption of breathing during an apnea event may lead to a lack of oxygen in and around the optic nerve, increasing the risk of glaucoma. The Glaucoma Research Foundation believes the elevation in blood pressure that is common in patients with OSA may also change the balance of the pressure in the eye, known as intraocular pressure. While research connecting OSA and glaucoma is still inconclusive, physicians recommend a comprehensive eye exam for their patients exhibiting sleep apnea symptoms.

Floppy Eyelid Syndrome (FES) is another ocular side effect of obstructive sleep apnea. Patients with FES have enlarged upper eyelids that can easily be inverted, which often occurs while tossing and turning during sleep. This results in irritated and itchy eyes, with conjunctivitis as another possible reaction. According to Optometry Times, less than five percent of OSA sufferers have FES, but nearly 100 percent of FES patients have obstructive sleep apnea. The commonality between the two diseases is obesity, which often results in enlarged eyelids. Perhaps the most serious eye disease associated with obstructive sleep apnea is Non-arteritic Anterior Ischemic Optic Neuropathy (NAION). This disease is characterized by a sudden, although painless, loss of vision in one eye caused by a loss of blood flow to the optic nerve. Patients with NAION often notice vision loss upon waking, prompting researchers to investigate further the nighttime changes in blood pressure that occur with obstructive sleep apnea. NAION has no cure and is not reversible. Several large studies have confirmed a connection to sleep apnea, and in cases of severe sleep apnea, it can lead to a second eye NAION or total blindness if there is non-compliance with prescribed CPAP.

Ophthalmologists are becoming more familiar with sleep apnea and its connection to a number of serious eye diseases. Yearly eye exams are the best way to detect any eye conditions and to protect eye health. This is especially true for patients with obstructive sleep apnea who may have a higher risk for many serious eye diseases.

To learn more about how BetterNight can help you provide more effective and efficient care to your at-risk sleep apnea patients, contact us.