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      Normal-tension glaucoma and obstructive sleep apnea syndrome: a prospective study

      research-article
      1 ,
      BMC Ophthalmology
      BioMed Central
      Normal-tension glaucoma, Obstructive sleep apnea

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          Abstract

          Background

          Today, identified risk factors for normal-tension glaucoma (NTG) include abnormal ocular blood flow, abnormal blood coagulation, systemic hypotension, ischemic vascular disorders, and autoimmune diseases. However, pathogenesis of the condition remains unclear. On the other hand, there are also a few studies suggesting that the obstructive sleep apnea syndrome (OSAS) may compromise optic nerve head perfusion and cause glaucomatous optic neuropathy by creating transient hypoxemia and increasing vascular resistance. In this study, we evaluated the possible association between OSAS and NTG.

          Methods

          We recruited 24 patients with NTG and 24 age and sex matched controls who were also similar for systemic risk factors such as diabetes mellitus (DM), hypertension (HT) and hypercholesterolemia. All patients and controls underwent over-night polysomnography (PSG) for the diagnosis of OSAS and calculation of Apnea-Hypopnea Index (AHI).

          Results

          Patients and controls were statistically similar in terms of age, sex, gender, smoking, systemic risk factors, neck circumference and body mass index. The subjects with AHI ≥ 20 were accepted as OSAS. Ten (41.7%) of 24 patients with NTG and 3 (12.5%) of 24 controls had OSAS (p < 0.05).

          Conclusions

          The prevalence of OSAS was higher in patients with NTG and the difference between patient and control groups was statistically significant (p < 0.05).

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          Most cited references16

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          Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders.

          We measured 24-hour ambulatory blood pressure monitoring and diurnal curve of the intraocular pressure in 166 white patients with anterior ischemic optic neuropathy, normal-tension glaucoma, primary open-angle glaucoma, and other optic nerve head disorders. Hourly average blood pressure data analyses showed a significant (P < .0001) decrease in mean systolic (26%) and diastolic (33%) blood pressure measurements at night. A significantly (P = .0028) lower nighttime mean diastolic blood pressure and a significantly (P = .0044) greater mean percentage decrease in diastolic blood pressure were noted in normal-tension glaucoma than in anterior ischemic optic neuropathy. Patients with arterial hypertension taking oral hypotensive therapy showed a significant association between progressive visual field deterioration and nocturnal hypotension, particularly in anterior ischemic optic neuropathy. Intraocular pressure showed no significant correlation with visual field deterioration in any of these conditions. Our findings suggest that nocturnal hypotension, in the presence of other vascular risk factors, may reduce the optic nerve head blood flow below a critical level, and thereby may play a role in the pathogenesis of anterior ischemic optic neuropathy and glaucomatous optic neuropathy; that is, nocturnal hypotension may be the final insult in a multifactorial situation. The same mechanisms may be true of a number of other ocular ischemic disorders. This finding opens a new dimension in the understanding and management of these visually disabling diseases.
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            The vascular concept of glaucoma.

            The regulation of ocular perfusion is different for different parts of the eye. Observations on the retina can, therefore, not be extrapolated to the optic nerve head. Extraocular vessels, especially the short posterior ciliary arteries, might play a major role in regulation of ocular circulation, but additional regulation takes place in the eye itself. Dysregulation might be transient and, thus, not necessarily present and detectable at any one examination. Older patients with arteriosclerotic vessels may behave differently in this regard than do young, healthy animals. Not only the arterial but also the venous side of the circulation may be disturbed. Disk hemorrhages can not only be a sign of damage; they can also provoke ischemia. Besides hypoxia, diseased vessel walls might play a direct role in the pathogenesis of optic nerve head cupping. Finally, a relation between vascular dysregulation and aqueous-humor dynamics is conceivable.
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              Obstructive sleep apnea and cardiovascular disease.

              Obstructive sleep apnea (OSA) is a common disorder associated with an increased risk of cardiovascular disease and stroke. As it is strongly associated with known cardiovascular risk factors, including obesity, insulin resistance, and dyslipidemia, OSA is an independent risk factor for hypertension and has also been implicated in the pathogenesis of congestive cardiac failure, pulmonary hypertension, arrhythmias, and atherosclerosis. Obesity is strongly linked to an increased risk of OSA, and weight loss can reduce the severity of OSA. The current standard treatment for OSA-nasal continuous positive airway pressure (CPAP)-eliminates apnea and the ensuing acute hemodynamic changes during sleep. Long-term CPAP treatment studies have shown a reduction in nocturnal cardiac ischemic episodes and improvements in daytime blood pressure levels and left ventricular function. Despite the availability of effective therapy, OSA remains an underdiagnosed and undertreated condition. A lack of physician awareness is one of the primary reasons for this deficit in diagnosis and treatment.
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                Author and article information

                Contributors
                Journal
                BMC Ophthalmol
                BMC Ophthalmol
                BMC Ophthalmology
                BioMed Central
                1471-2415
                2014
                10 March 2014
                : 14
                : 27
                Affiliations
                [1 ]Ophthalmologist, Hacettepe University Gün Hospital, Beytepe, 06800 Ankara, Turkey
                Article
                1471-2415-14-27
                10.1186/1471-2415-14-27
                3975309
                24612638
                6b0c3f85-3534-4433-aead-8eea71d7e5ae
                Copyright © 2014 Bilgin; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                History
                : 20 May 2013
                : 28 February 2014
                Categories
                Research Article

                Ophthalmology & Optometry
                normal-tension glaucoma,obstructive sleep apnea
                Ophthalmology & Optometry
                normal-tension glaucoma, obstructive sleep apnea

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