By Anthony S. Ekong, MD Retina/Uveitis Specialist
Illinois Retina Institute of Peoria, Peru and Galesburg
Obstructive sleep apnea (OSA) is associated with multiple brief periods where no breathing occurs during the night, resulting in an intermittent drop in oxygen supply to the body and marked transient increase in blood pressure. Ultimately, the resulting excessive stress on the blood vessels leads to complications such as heart disease, stroke, arrhythmias and eye disorders.
In this part, we will look at, NAION- nonarteritic anterior ischemic optic neuropathy (a stroke of the optic nerve) and papilledema, two of the five eye disorders associated with Obstructive Sleep Apnea.
Nonarteritic antior ischemic optic neuropathy (NAION):
NAION, or a stroke of the optic nerve, is the most common cause of sudden, painless vision loss in one eye in patients over 50 years of age, due to damage of the optic nerve from poor blood supply. The optic nerve fibers carry signals of sight from the eye to the brain translating into images. These patients also have about a 15% risk of developing it in the other eye within 5 years. Recurrence in the same eye occurs in less than 5% of cases.
Patients frequently report visual impairment upon awakening in the morning, possibly due to a drop in blood pressure during the night. Diabetes, high blood pressure, high cholesterol, and drugs such as amiodarone (used to correct problems in the electrical activity of the heart) and Viagra and Cialis (erectile dysfunction agents) have all been implicated as risk factors. About 70 to 80% of patients with this condition have been found to have OSA, and may benefit from a sleep study.
There is no proven therapy for NAION. Treatment of sleep apnea may help prevent an attack in the other eye but has not been proven. If possible, people with high blood pressure should avoid taking their medication at bedtime because their blood pressure may drop considerably during sleep and affect blood flow to vital organs including nerves in the eye.
This condition, which occurs mostly in young overweight women, results in optic nerve head swelling in both eyes due to increased intracranial (within the skull) pressure. Patients present with headache, nausea, vomiting and episodes of vision loss ,lasting seconds, that often occur after rising from a lying or sitting position.
Optic nerve head swelling may result from a variety of conditions including brain tumor, hydrocephalus, meningitis, and most commonly Idiopathic intracranial hypertension, an elevated spinal fluid pressure in the brain, (arising either spontaneously, medication induced or related to cerebral venous obstruction).
Suspicion of papilledema requires an urgent MRI of the brain to rule out a brain tumor. A normal MRI of the brain, together with a higher spinal fluid opening pressure during a spinal tap and normal spinal fluid warrants a diagnosis of Idiopathic intracranial hypertension. Initial treatment usually involves weight loss and daily water pills such as Diamox.
People with OSA may have a higher incidence of papilledema, which may be associated with increased venous blood flow in the brain. It’s speculated that in predisposed individuals, interrupted breathing during sleep increases carbon dioxide concentration resulting in dilated blood vessels and increased pressure in the brain. The increased pressure is transmitted to the optic nerve causing swelling.
Patients with papilledema should be questioned about symptoms of sleep apnea and those who reports symptoms may benefit from a sleep study.
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