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A Prospective Photographic Study of the Ocular Fundus in Obstructive Sleep Apnea

Fraser, Clare L. MBBS, FRANZCO; Bliwise, Donald L. PhD; Newman, Nancy J. MD; Lamirel, Cédric MD; Collop, Nancy A. MD; Rye, David B. MD, PhD; Trotti, Lynn Marie MD, MS; Biousse, Valérie MD; Bruce, Beau B. MD, MS

doi: 10.1097/WNO.0b013e318290194f
Original Contribution
Japanese Abstract

Background: The prevalence of optic nerve and retinal vascular changes within the obstructive sleep apnea (OSA) population are not well-known, although it has been postulated that optic nerve ischemic changes and findings related to an elevated intracranial pressure may be more common in OSA patients. We prospectively evaluated the ocular fundus in unselected patients undergoing overnight diagnostic polysomnography (PSG).

Methods: Demographic data, medical/ocular history, and nonmydriatic fundus photographs were prospectively collected in patients undergoing PSG at our institution and reviewed for the presence of optic disc edema for which our study was appropriately powered a priori. Retinal vascular changes were also evaluated. OSA was defined using the measures of both sleep-disordered breathing and hypoxia.

Results: Of 250 patients evaluated in the sleep center, fundus photographs were performed on 215 patients, among whom 127 patients (59%) had an apnea/hypopnea index (AHI) ≥15 events per hour, including 36 with severe OSA. Those with AHI <15 served as the comparison group. None of the patients had optic disc edema (95% confidence interval [CI]: 0%–3%). There was no difference in rates of glaucomatous appearance or pallor of the optic disc among the groups. Retinal arteriolar changes were more common in severe OSA patients (odds ratio: 1.09 per 5 unit increase in AHI; 95% CI, 1.02–1.16; P = 0.01), even after controlling for mean arterial blood pressure.

Conclusions: We did not find an increased prevalence of optic disc edema or other optic neuropathies in our OSA population. However, retinal vascular changes were more common in patients with severe OSA, independent of blood pressure.

Departments of Ophthalmology (CLF, NJN, VB, BBB), Neurology (DLB, NJN, DBR, LMT, VB, BBB), Neurological Surgery (NJN), and Medicine (NAC), Emory University School of Medicine, Atlanta, Georgia;

Department of Epidemiology (BBB), Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia; and

Department of ophthalmology (CL), Fondation Ophtalmologique Adolphe de Rothschild and Hôpital Bichat- Claude Bernard, Paris, France.

Address correspondence to Valérie Biousse, MD, Emory Eye Center, Neuro-Ophthalmology Unit, 1365 Clifton Road NE, Atlanta, GA 30322; E-mail:

Supported in part by an unrestricted departmental grant (Department of Ophthalmology) from the Research to Prevent Blindness, Inc, New York, NY, and by the National Institutes of Health/National Eye Institute (NIH/NEI) core grant (P30-EY06360) (Department of Ophthalmology). Dr Bruce received research support from the NIH/NEI (K23-EY019341). Dr. Newman is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award. Dr. Fraser received the RANZCO Eye Foundation Scholarship and the Sydney Eye Alumni Travelling Fellowship Grant. Other authors have no relevant financial disclosures.

The authors report no conflicts of interest.

© 2013 by North American Neuro-Ophthalmology Society