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Editors Selection IGR 12-1
Sleep apneu syndrome: Sleep apneu syndrome and bloodflow
Comment by Alon Harris on:
20428 Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS), Karakucuk S; Goktas S; Aksu M et al., Graefe's Archive for Clinical and Experimental Ophthalmology, 2008; 246: 129-134
Obstructive sleep apnea syndrome patients may experience retrobulbar blood fl ow reductions which are associated with glaucomatous visual fi eld defectsObstructive sleep apnea syndrome (OSAS) has been reported to be linked to repetitive episodes of blood pressure and intraocular pressure fluctuations as well as oxidative stress, hypoxia and hypercapnia. OSAS has been implicated in many vascular pathologies and may contribute to glaucomatous optic neuropathy. In the present study, Karakucuk et al. (211) investigated the presence of glaucoma in patients with OSAS and the authors attempt to reveal how vascular pathologies may be related to the pathogenesis of glaucoma. The authors found that the prevalence of glaucoma patients with OSAS was 12.9% (4/31); with all four of these patients categorized as 'severe' OSAS. A positive correlation was found between the vascular resistance in the ophthalmic and central retinal arteries and visual field mean defect. Further, central retinal artery vascular resistance and loss variance values were positively correlated. There was also a positive correlation between IOP and the apnea-hypopnea index. This data suggests that OSAS patients may experience retrobulbar blood flow reductions which are associated with glaucomatous visual field defects. This investigation highlights a growing interest linking diurnal fluctuations in vascular deficits, blood pressure, perfusion pressure and intraocular pressure to glaucoma pathology. The current study is strengthened by the careful attention paid to exclusion and inclusion criteria as well as the author's investigation of hypertension, smoking and blood cholesterol levels of participants. One limitation of the current study is the low number of OSAS glaucoma subjects (4) which provide the data for the relationships described in this investigation. Another limitation is the single time-point assessment of the retrobulbar blood vessels with color Doppler imaging. Follow-up investigations utilizing larger patient populations with multiple assessment windows throughout the 24-hour period may further reveal how OSAS patients' vascular and glaucomatous pathophysiologies are related.
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