Skip to main content

Advertisement

SpringerLink
Log in

Obstructive Sleep Apnea and Optic Neuropathy: Is There a Link?

  • Neuro-Ophthalmology (A Kawasaki, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Over the last decade, there has been an emerging interest in the link between obstructive sleep apnea (OSA) and ocular health. Though the evidence for OSA playing a role in cerebrovascular disease risk seems clear, the same cannot be said for optic neuropathies. The association between OSA and glaucoma or non-arteritic anterior ischemic optic neuropathy (NAION) has been postulated to be secondary to direct hypoxia or mechanisms of optic nerve head vascular dysregulation. Papilledema and increased intracranial pressure have also been reported in OSA and are thought to be due to increased cerebral perfusion pressure and cerebral venous dilation secondary to hypoxia and hypercapnia. This article reviews the evidence for possible pathophysiological links between OSA and optic nerve pathology. The epidemiologic and clinical evidence for an association, direct or indirect, between OSA and glaucoma, non-arteritic anterior ischemic optic neuropathy (NAION), and papilledema or idiopathic intracranial hypertension is presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Myers KA, Mrkobrada M, Simel DL. Does this patient have obstructive sleep apnea: the rational clinical examination systematic review. JAMA. 2013;310:731–41.

    Article  CAS  PubMed  Google Scholar 

  2. Health Quality Ontario Group. Polysomnography in patients with obstructive sleep apnea: an evidence-based analysis. Ontario Health Technology Assessment Series 6. 2006:1–38.

  3. Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation. 2008;118:1080–111.

    Article  PubMed  Google Scholar 

  4. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Int Med. 1999;131:485–91.

    Article  CAS  PubMed  Google Scholar 

  5. Thurtell MJ, Bruce BB, Rye DB, Newman NJ, Biousse V. The Berlin questionnaire screens for obstructive sleep apnea in idiopathic intracranial hypertension. J Neuroophthalmol. 2011;31:316–9.

    Article  PubMed  Google Scholar 

  6. Lattimore JD, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. J Am Cardiol. 2003;41:1429–37.

    Article  Google Scholar 

  7. Pepin JL, Tamisier R, Baguet JP, Levy P. Arterial health is related to obstructive sleep apnea severity and improves with CPAP treatment. Sleep Med Rev. 2013;17:3–5.

    Article  PubMed  Google Scholar 

  8. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84.

    Article  CAS  PubMed  Google Scholar 

  9. Shankar A, Peppard PE, Young T, et al. Sleep-disordered breathing and retinal microvascular diameter. Atherosclerosis. 2013;226:124–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. 2013;62:569–76.

    Article  PubMed  Google Scholar 

  11. Durgan DJ, Bryan Jr RM. Cerebrovascular consequences of obstructive sleep apnea. J Am Heart Assoc. 2012;1:e000091. An excellent review of the cerebral effects of OSA.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40:408–19. Article contains a good discussion of the pathophysiological links that may exist between OSA and glaucoma.

    Article  Google Scholar 

  13. Siebler M, Nachtmann A. Cerebral hemodynamics in obstructive sleep apnea. Chest. 1993;103:1118–9.

    Article  CAS  PubMed  Google Scholar 

  14. Bokinsky G, Miller M, Ault K, Husband P, Mitchell J. Spontaneous platelet activation and aggregation during obstructive sleep apnea and its response to therapy with nasal continuous positive airway pressure. A preliminary investigation. Chest. 1995;108:625–30.

    Article  CAS  PubMed  Google Scholar 

  15. Sergi M, Salerno DE, Rizzi M, et al. Prevalence of normal tension glaucoma in obstructive sleep apnea syndrome patients. J Glaucoma. 2007;16:42–6.

    Article  PubMed  Google Scholar 

  16. Caples SM, Garcia-Touchard A, Somers VK. Sleep-disordered breathing and cardiovascular risk. Sleep. 2007;30:291–303.

    PubMed  Google Scholar 

  17. Levy P, Pepin JL, Arnaud C, et al. Obstructive sleep apnea and atherosclerosis. Prog Cardiovasc Dis. 2007;51:400–10.

    Article  Google Scholar 

  18. Foster GE, Poulin MJ. Hanly PJ Intermittent hypoxia and vascular function: implications for obstructive sleep apnoea. Exp Physiol. 2007;92:51–65.

    Article  PubMed  Google Scholar 

  19. Atkeson A, Yeh A, Malhotra A, Jelic S. Endothelial function in obstructive sleep apnea. Prog Cardiovasc Dis. 2009;5:351–62.

    Article  Google Scholar 

  20. Winklewski PJ, Frydrychowski AF. Cerebral blood flow, sympathetic nerve activity and stroke risk in obstructive sleep apnoea. Is there a direct link? Blood Pressure. 2013;22:27–33. Review of the basic science of cerebral blood flow in OSA.

    Article  PubMed  Google Scholar 

  21. Urbano F, Roux F, Schindler J, Mohsenin V. Impaired cerebral autoregulation in obstructive sleep apnea. J Appl Physiol. 2008;105:1852–7.

    Article  PubMed  Google Scholar 

  22. Karakucuk S, Goktas S, Aksu M, et al. Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS). Graefes Arch Clin Exp Ophthalmol. 2008;246:129–34.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Hayreh SS. Blood supply of the optic nerve head and its role in optic atrophy, glaucoma, and oedema of the optic disc. Br J Ophthalmol. 1969;53:721–48.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Zetlan SR, Sponsel WE, Stodtmeister R. Retinal capillary hemodynamics, visual-evoked potentials, and pressure tolerance in normal human eyes. Invest Ophthalmol Vis Sci. 1992;33:1857–63.

    CAS  PubMed  Google Scholar 

  25. Harris A, Arend O, Wolf S, Cantor LB, Martin BJ. CO2 dependence of retinal arterial and capillary blood velocity. Acta Ophthalmol Scand. 1995;73:421–4.

    Article  CAS  PubMed  Google Scholar 

  26. Roff EJ, Harris A, Chung HS, et al. Comprehensive assessment of retinal, choroidal and retrobulbar haemodynamics during blood gas perturbation. Graefes Arch Clin Exp Ophthalmol. 1999;237:984–90.

    Article  CAS  PubMed  Google Scholar 

  27. Geiser MH, Riva CE, Dorner GT, et al. Response of choroidal blood flow in the foveal region to hyperoxia and hyperoxia-hypercapnia. Curr Eye Res. 2000;21:669–76.

    Article  CAS  PubMed  Google Scholar 

  28. Tonini M, Khayi H, Pepin JL, et al. Choroidal blood-flow responses to hyperoxia and hypercapnia in men with obstructive sleep apnea. Sleep. 2010;33:811–8.

    PubMed Central  PubMed  Google Scholar 

  29. Frydrychowski AF, Wszedybyl-Winklewska M, Bandurski T, Winklewski PJ. Flow-induced changes in pial artery compliance registered with a non-invasive method in rabbits. Microvasc Res. 2011;82:156–62.

    Article  PubMed  Google Scholar 

  30. Kohler M, Stradling JR. Mechanisms of vascular damage in obstructive sleep apnea. Nat Rev Cardiol. 2010;7:677–85.

    PubMed  Google Scholar 

  31. Boland LL, Shahar E, Wong TY, et al. Sleep-disordered breathing is not associated with the presence of retinal microvascular abnormalities: the Sleep Heart Health Study. Sleep. 2004;27:467–73.

    PubMed  Google Scholar 

  32. Ikram MK, de Jong FJ, Vingerling JR, et al. Are retinal arteriolar or venular diameters associated with markers for cardiovascular disorders? The Rotterdam Study. Invest Ophthalmol Vis Sci. 2004;45:2129–34.

    Article  PubMed  Google Scholar 

  33. Fraser CL, Bliwise DL, Newman NJ, et al. A prospective photographic study of the ocular fundus in obstructive sleep apnea. J Neuroophthalmol. 2013;33:241–6.

    Article  PubMed  Google Scholar 

  34. Mojon DS, Hess CW, Goldblum D, et al. Primary open-angle glaucoma is associated with sleep apnea syndrome. Ophthalmologica. 2000;214:115–8.

    Article  CAS  PubMed  Google Scholar 

  35. Onen SH, Mouriaux F, Berramdane L, et al. High prevalence of sleep-disordered breathing in patients with primary open-angle glaucoma. Acta Ophthalmol Scand. 2000;78:638–41.

    Article  CAS  PubMed  Google Scholar 

  36. Mojon DS, Hess CW, Goldblum D, et al. Normal-tension glaucoma is associated with sleep apnea syndrome. Ophthalmologica. 2002;216:180–4.

    Article  PubMed  Google Scholar 

  37. Mojon DS, Hess CW, Goldblum D, et al. High prevalence of glaucoma in patients with sleep apnea syndrome. Ophthalmology. 1999;106:1009–12.

    Article  CAS  PubMed  Google Scholar 

  38. Geyer O, Cohen N, Segev E, et al. The prevalence of glaucoma in patients with sleep apnea syndrome: same as in the general population. Am J Ophthalmol. 2003;136:1093–6.

    Article  PubMed  Google Scholar 

  39. Kargi SH, Altin R, Koksal M, et al. Retinal nerve fibre layer measurements are reduced in patients with obstructive sleep apnoea syndrome. Eye. 2005;19:575–9.

    Article  CAS  PubMed  Google Scholar 

  40. Lin PW, Friedman M, Lin HC, et al. Decreased retinal nerve fiber layer thickness in patients with obstructive sleep apnea/hypopnea syndrome. Graefes Arch Clin Exp Ophthalmol. 2011;249:585–93.

    Article  PubMed  Google Scholar 

  41. Huseyinoglu N, Ekinci M, Ozben S, et al. Optic disc and retinal nerve fiber layer parameters as indicators of neurodegenerative brain changes in patients with obstructive sleep apnea syndrome. Sleep Breathing. 2014;18:95–102.

    Article  PubMed  Google Scholar 

  42. Nowak MS, Jurowski P, Gos R, Prost ME, Smigielski J. Pulsatile ocular blood flow in subjects with sleep apnoea syndrome. Arch Med Sci. 2011;7:332–6.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Sagiv O, Fishelson-Arev T, Buckman G, et al. Retinal nerve fibre layer thickness measurements by optical coherence tomography in patients with sleep apnoea syndrome. Clin Exp Ophthalmol. 2014;42:132–8.

    Article  Google Scholar 

  44. Casas P, Ascaso FJ, Vicente E, et al. Retinal and optic nerve evaluation by optical coherence tomography in adults with obstructive sleep apnea-hypopnea syndrome (OSAHS). Graefes Arch Clin Exp Ophthalmol. 2013;251:1625–34.

    Article  PubMed  Google Scholar 

  45. Boland MV, Quigley HA. Risk factors and open-angle glaucoma: classification and application. J Glaucoma. 2007;16:406–18.

    Article  PubMed  Google Scholar 

  46. Tsang CS, Chong SL, Ho CK, Li MF. Moderate to severe obstructive sleep apnoea patients is associated with a higher incidence of visual field defect. Eye. 2006;20:38–42.

    Article  CAS  PubMed  Google Scholar 

  47. Bilgin G. Normal-tension glaucoma and obstructive sleep apnea syndrome: a prospective study. BMC Ophthalmol. 2014;14:27.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Goldblum DMJ, Bohnke M, Bassetti C, et al. Nocturnal measurements of intraocular pressure in patients with normal-tension glaucoma and sleep apnea syndrome. Klin Monbl Augenheilkd. 2000;216:246–9.

    Article  CAS  PubMed  Google Scholar 

  49. Bendel RE, Kaplan J, Heckman M, Fredrickson PA, Lin SC. Prevalence of glaucoma in patients with obstructive sleep apnoea—a cross-sectional case-series. Eye. 2008;22:1105–9.

    Article  CAS  PubMed  Google Scholar 

  50. Wang YX, Xu L, Li JJ, et al. Snoring and glaucoma. PLoS ONE. 2014;9:e88949.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Stein JD, Kim DS, Mundy KM, et al. The association between glaucomatous and other causes of optic neuropathy and sleep apnea. Am J Ophthalmol. 2011;152:989–98. e983.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Girkin CA, McGwin Jr G, McNeal SF, Owsley C. Is there an association between pre-existing sleep apnoea and the development of glaucoma? Brit J Ophthalmol. 2006;90:679–81.

    Article  CAS  Google Scholar 

  53. Lin CC, Hu CC, Ho JD, Chiu HW, Lin HC. Obstructive sleep apnea and increased risk of glaucoma: a population-based matched-cohort study. Ophthalmology. 2013;120:1559–64. Large, population based study which uses confirmed clinical diagnosis of glaucoma, rather than diagnostic codes.

    Article  PubMed  Google Scholar 

  54. Archer EL, Pepin S. Obstructive sleep apnea and non-arteritic anterior ischemic optic neuropathy: evidence for an association. J Clin Sleep Med. 2013;9:613–8. Excellent review paper, with good discussion of the pathophysiological links between OSA and NAION.

  55. Bilgin G, Koban Y, Arnold AC. Non-arteritic anterior ischemic optic neuropathy and obstructive sleep apnea. J Neuroophthalmol. 2013;33:232–4. A well-designed prospective study, with appropriate OSA diagnostic criteria.

  56. Arnold AC. Pathogenesis of non-arteritic anterior ischemic optic neuropathy. J Neuroophthalmol. 2013;23:157–63.

  57. Hayreh SS, Podhajsky PA, Zimmerman B. Non-arteritic anterior ischemia optic neuropathy: time of onset of visual loss. Am J Ophthalmol. 1997;124:641–7.

  58. Baguet JP, Levy P, Barone-Rochette G, et al. Masked hypertension in obstructive sleep apnea syndrome. J Hypertens. 2008;26:885–92.

    Article  CAS  PubMed  Google Scholar 

  59. Palombi K, Renard E, Levy P, et al. Non-arteritic anterior ischaemic optic neuropathy is nearly systematically associated with obstructive sleep apnoea. The Br J Ophthalmol. 2006;90:879–82.

  60. Mojon DS, Hedges III TR, Ehrenberg B, et al. Association between sleep apnea syndrome and non-arteritic anterior ischemic optic neuropathy. Arch Ophthal. 2002;120:601–5.

  61. Arda H, Birer S, Aksu M, et al. Obstructive sleep apnoea prevalence in non-arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol. 2013;97:206–9.

  62. Li J, McGwin Jr G, Vaphiades MS, Owsley C. non-arteritic anterior ischaemic optic neuropathy and presumed sleep apnoea syndrome screened by the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ). Br J Opthalmol. 2007;91:1524–7.

  63. Behbehani R, Mathews MK, Sergott RC, Savino PJ. Non-arteritic anterior ischemic optic neuropathy in patients with sleep apnea while being treated with continuous positive airway pressure. Am J Ophthalmol. 2005;139:518–21.

  64. Sugita Y, Iijima S, Teshima Y, et al. Marked episodic elevation of cerebrospinal fluid pressure during nocturnal sleep in patients with sleep apnea hypersomnia syndrome. Electroencephalogr Clin Neurophysiol. 1985;60:214–9.

    Article  CAS  PubMed  Google Scholar 

  65. Pesek M, Kibler K, Easley RB, et al. The upper limit of cerebral blood flow autoregulation is decreased with elevations in intracranial pressure. Neurosurgery. 2014; [Epub ahead of print].

  66. Fischer AQ, Chaudhary BA, Taormina MA, Akhtar B. Intracranial hemodynamics in sleep apnea. Chest. 1992;102:1402–6.

    Article  CAS  PubMed  Google Scholar 

  67. O’Donoghue FJ, Briellmann RS, Rochford PD, et al. Cerebral structural changes in severe obstructive sleep apnea. Am J Respir Crit Care Med. 2005;171:1185–90.

    Article  PubMed  Google Scholar 

  68. Jennum P, Borgesen SE. Intracranial pressure and obstructive sleep apnea. Chest. 1989;95:279–83.

    Article  CAS  PubMed  Google Scholar 

  69. Hanigan WC, Zallek SN. Headaches, shunts, and obstructive sleep apnea: report of two cases. Neurosurgery. 2004;54:764–9.

    Article  PubMed  Google Scholar 

  70. Purvin VA, Kawasaki A, Yee RD. Papilledema and obstructive sleep apnea syndrome. Arch Ophthalmol. 2004;118:1626–30.

    Article  Google Scholar 

  71. Peter L, Jacob M, Krolak-Salmon P, et al. Prevalence of papilloedema in patients with sleep apnoea syndrome: a prospective study. J Sleep Res. 2007;16:313–8.

    Article  PubMed  Google Scholar 

  72. Bucci Jr FA, Krohel GB. Optic nerve swelling secondary to the obstructive sleep apnea syndrome. Am J Ophthalmol. 1988;105:428–30.

    Article  PubMed  Google Scholar 

  73. Lee AG, Golnik K, Kardon R, et al. Sleep apnea and intracranial hypertension in men. Ophthalmology. 2002;109:482–5.

    Article  PubMed  Google Scholar 

  74. Marcus DM, Lynn J, Miller JJ, et al. Sleep disorders: a risk factor for pseudotumor cerebri? J Neuroophthalmol. 2001;21:121–3.

    Article  CAS  PubMed  Google Scholar 

  75. Bruce BB, Kedar S, Van Stavern GP, et al. Idiopathic intracranial hypertension in men. Neurology. 2009;72:304–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  76. Thurtell MJ, Trotti LM, Bixler EO, et al. Obstructive sleep apnea in idiopathic intracranial hypertension: comparison with matched population data. J Neurol. 2013;260:1748–51.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  77. Fraser JA, Bruce BB, Rucker J, et al. Risk factors for idiopathic intracranial hypertension in men: a case–control study. J Neurol Sci. 2010;290:86–9.

    Article  PubMed Central  PubMed  Google Scholar 

  78. Fraser CL, White AJR, Plant GT, Martin KR. Optic nerve cupping and the neuro-ophthalmologist. J Neuroophthalmol. 2013;33:377–89.

    Article  PubMed  Google Scholar 

  79. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046–53.

    Article  PubMed  Google Scholar 

  80. Doherty LS, Kiely JL, Swan V, McNicholas WT. Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest. 2005;127:2076–84.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Clare Fraser declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Save Sight Institute, University of Sydney, 8 Macquarie Street, Sydney, NSW, 2000, Australia

    Clare L. Fraser

  2. Department of Ophthalmology, Macquarie University, 3 Technology Place, Sydney, NSW, 2109, Australia

    Clare L. Fraser

Authors
  1. Clare L. Fraser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Clare L. Fraser.

Additional information

This article is part of the Topical Collection on Neuro-Ophthalmology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

L. Fraser, C. Obstructive Sleep Apnea and Optic Neuropathy: Is There a Link?. Curr Neurol Neurosci Rep 14, 465 (2014). https://doi.org/10.1007/s11910-014-0465-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-014-0465-5

Keywords

Search

Navigation