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Corneal Hysteresis Is Reduced in Obstructive Sleep Apnea Syndrome

Nadarajah, Suchitra MSOphth1; Samsudin, Amir PhD1*; Ramli, Norlina MSOphth1; Tan, Chong Tin MD2; Mimiwati, Zahari MSOphth1

doi: 10.1097/OPX.0000000000001117

SIGNIFICANCE To our knowledge, this is the first time a study looking at the association between corneal hysteresis (CH) and obstructive sleep apnea syndrome (OSAS) severity has been reported. We provide evidence that CH is lower in OSAS and speculate on the possible causes.

PURPOSE The present study aims to look at the association between CH and severity of OSAS, and whether CH could be another link between OSAS and the development of glaucoma.

METHODS This was a cross-sectional, observational study at the University Malaya Medical Centre, Kuala Lumpur. Patients undergoing polysomnography for assessment of OSAS were recruited. We measured central corneal thickness (CCT) using optical biometry, and CH using ocular response analysis. Intraocular pressure (IOP) and Humphrey visual field (HVF) indices were also measured. The Apnea Hypopnea Index (AHI) divided patients into normal, mild, moderate, and severe OSAS categories. The normal and mild categories (47.9%) were then collectively called group 1, and the moderate and severe categories (52.1%) were called group 2. T tests, Pearson correlation tests, and general linear model analysis were performed, with P <.05 considered statistically significant.

RESULTS One eye each from 117 patients (75 men, 42 women) was included. Patients in group 2 had lower CH (9.8 ± 1.4 vs. 10.3 ± 1.1 mm Hg, P = .029), with unchanged estimated marginal means after correcting for age, sex, CCT, and IOP (P = .026). There were no statistically significant differences in IOP, CCT, or HVF indices between the two groups (all P > .05). CH correlated negatively with AHI (r = −0.229, P = .013) and positively with lowest oxygen saturation (r = 0.213, P = .022).

CONCLUSIONS CH is lower in moderate/severe OSAS than in normal/mild cases. This may be another link between OSAS and the development of glaucoma; further studies are indicated to determine the significance of this connection.

1Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

2Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia *

Submitted: November 17, 2016

Accepted: May 21, 2017

Funding/Support: This study was supported by a grant from the University of Malaya (grant reference: PPP2961).

Conflict of Interest Disclosure: None of the authors have reported a conflict of interest.

Author Contributions and Acknowledgments: Conceptualization: SN, CTT, ZM; Data Curation: SN; Formal Analysis: SN, AS, NR; Funding Acquisition: SN, CTT, ZM; Investigation: SN; Methodology: SN; Resources: CTT; Project Administration: SN, AS; Supervision: AS, CTT, NR, ZM; Validation: AS, NR; Writing – Original Draft: SN, AS, NR, ZM; Writing – Review & Editing: SN, AS, NR, ZM.

The authors would like to thank Dr. Mohamedreza Peyman for his help with the statistical analysis in this study. This study was presented as a poster at the 2015 Association for Research into Vision and Ophthalmology meeting, May 3–7, 2015, in Denver, CO.

© 2017 American Academy of Optometry