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Editors Selection IGR 15-4

Risk Factors for Glaucoma: Preferred sleeping position

Comment by Yvonne Buys on:

55523 Relationship between preferred sleeping position and asymmetric visual field loss in open-angle glaucoma patients, Kim KN; Jeoung JW; Park KH et al., American Journal of Ophthalmology, 2014; 157: 739-745

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Visual field (VF) progression in the presence of 'controlled' intraocular pressure (IOP) is a challenge to both explain and manage. Kim et al. investigated the influence of sleep position in a cohort of treated (IOP in teens) open-angle glaucoma patients with asymmetric VF loss (defined as a difference of at least two dB between the two eyes). In this retrospective, cross-sectional study, 692 patients completed a questionnaire regarding their preferred sleeping position. They reported that for those with asymmetric VF loss AND a preference for sleeping on one side, in 67.4% (p < 0.001) of patients the eye with the worse VF loss was the dependent eye in the preferred lateral decubitus sleeping position and suggested that sleep position may affect VF loss. Although this finding is interesting and plausible given the current literature on the effect of position on IOP, the authors based their conclusions on those subjects with both asymmetric VF loss and a preference for sleeping on a particular side. Considering the entire cohort of 692 patients only 194 reported a preference for sleeping on one side of which 105 (54.1%, p < 0.001) either did not have asymmetric VF loss or the loss was not in the dependent eye. In addition, of the 430 patients with asymmetric VF loss, only in 89 (20.7%) patients was the eye with the worse loss also the dependent eye in the lateral decubitus position. In the remaining 79.3%, the patients either did not report a preference for sleeping on one side or the eye with the greater VF loss was NOT the dependent eye. Other limitations of the study include that the baseline untreated IOP in the high-tension glaucoma group was significantly higher in the worse eye for those with asymmetric VF loss (2.7 mmHg, p = 0.003). Finally, this study relied on self-reported sleep position preference and was not validated by a sleep study. In any case this study should encourage more investigations on the effects of sleep position on glaucoma with the possibility of developing novel strategies for glaucoma management.

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