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Editors Selection IGR 9-2

Intraocular Pressure and Outflow: IOP in sleeping with head-up

Comment by John Liu on:

26306 Effect of sleeping in a head-up position on intraocular pressure in patients with glaucoma, Buys YM; Alasbali T; Jin YP et al., Ophthalmology, 2010; 117: 1348-1351

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Increasing evidence shows that habitual intraocular pressure (IOP) is higher at night than during the day in healthy individuals as well as in glaucoma patients. In this well-designed study, Buys et al. (674) confirmed that the nocturnal IOP in a flat supine position was significantly higher than the well-controlled sitting IOP during daytime in a group of glaucoma patients who presented new optic disc hemorrhage in one eye. All these eyes were treated with various IOP-lowering medications and some of them had received laser trabeculoplasty or trabeculectomy. When the patients slept in a 30-degree head-up position in the same sleep laboratory, the nocturnal IOP levels were reduced in 16 of 17 eyes. The average reduction was 3.2 mmHg and the individual reduction was more than 20% in six eyes. For the first time, it was demonstrated that a simple behavioral technique can lower habitual IOP elevation in a group of glaucoma patients. This result is probably applicable to all glaucoma patients since a postural IOP elevation at night is a fundamental aspect of human physiology.

Research into whether or not a head-up switch for sleep is beneficial to glaucoma patients needs to consider more than just IOP's role as a risk factor for glaucoma progression

Whether or not a head-up switch for sleep is beneficial to glaucoma patients will be interesting to explore. Such research needs to consider more than just IOP's role as a risk factor for glaucoma progression. As the authors pointed out, ocular perfusion pressure and cerebrospinal fluid pressure bathing the optic nerve are also important. As shown in the present study, there seems to be no significant change in ocular perfusion pressure when switching to a 30-degree head-up sleep. How this new sleeping position changes the cerebrospinal fluid pressure on the back of the laminar cribrosa is difficult to measure. A head-up position theoretically can reduce the cerebrospinal fluid pressure and affect the translaminar pressure difference. As a study on glaucoma progression can be time consuming, initial research may focus on acute glaucoma cases when one considers a new head-up sleeping position to lower nocturnal IOP.

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