Associations between Optic Disc Measures and Obstructive Sleep Apnea in Young Adults

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Abstract

Purpose: Obstructive sleep apnea (OSA) is linked to increased glaucoma risk in middle-aged and older adults. However, little is known about associations between OSA and glaucoma-related optic disc parameters in young adults. We explored associations between overnight polysomnography-derived measures of OSA and the optic disc in young adults. Design: Cross-sectional cohort study. Participants: Eight hundred forty-eight adults 19 to 22 years of age. Methods: Participants underwent an ophthalmic examination that included OCT imaging of the optic disc and measurements of intraocular pressure, axial length, and refractive error. Participants then underwent an overnight polysomnography study that obtained measurements of apnea–hypopnea index (AHI), peripheral oxygen saturation level, and number of cortical arousals from sleep. Based on the AHI results, participants were grouped into no OSA (AHI < 5 events/hour), mild OSA (AHI ≥ 5 and <15 events/hour), moderate OSA (AHI ≥ 15 and <30 events/hour), or severe OSA (AHI ≥ 30 events/hour). Main Outcome Measures: Neuroretinal rim area, horizontal and vertical widths, and peripapillary retinal nerve fiber layer (RNFL) thickness. Results: The median AHI result across the study cohort was 2.2 events per hour (interquartile range, 1.0−4.4 events/hour). Based on the AHI results, 178 participants (21.0%) demonstrated OSA: 150 with mild OSA, 26 with moderate OSA, and 2 with severe OSA. In the unadjusted analyses, participants with OSA on average showed thinner peripapillary RNFL at the inferotemporal (P = 0.026) and superotemporal (P = 0.008) segments compared with those without OSA. Additionally, higher AHI results were associated with thinner RNFL superotemporally (P = 0.007). These findings remained significant after adjusting for gender, body mass index, ethnicity, and potential ocular confounders. There were no significant differences in optic disc measures between groups of OSA severity. Conclusions: Obstructive sleep apnea may be associated with preclinical thinning of the peripapillary RNFL in young adults. This suggests that an increased glaucoma risk already may be present in individuals with OSA since young adulthood. Long-term follow-up of this cohort will allow further optic disc changes in relationship to polysomnography parameters to be documented and associations with future glaucoma diagnosis to be explored.

Original languageEnglish
Pages (from-to)1372-1384
Number of pages13
JournalOphthalmology
Volume126
Issue number10
DOIs
Publication statusPublished - 1 Oct 2019

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Optic Disk
Obstructive Sleep Apnea
Young Adult
Nerve Fibers
Glaucoma
Polysomnography
Cohort Studies
Refractive Errors
Arousal
Intraocular Pressure

Cite this

@article{4bdeda725496490392ea12b933aa8ef1,
title = "Associations between Optic Disc Measures and Obstructive Sleep Apnea in Young Adults",
abstract = "Purpose: Obstructive sleep apnea (OSA) is linked to increased glaucoma risk in middle-aged and older adults. However, little is known about associations between OSA and glaucoma-related optic disc parameters in young adults. We explored associations between overnight polysomnography-derived measures of OSA and the optic disc in young adults. Design: Cross-sectional cohort study. Participants: Eight hundred forty-eight adults 19 to 22 years of age. Methods: Participants underwent an ophthalmic examination that included OCT imaging of the optic disc and measurements of intraocular pressure, axial length, and refractive error. Participants then underwent an overnight polysomnography study that obtained measurements of apnea–hypopnea index (AHI), peripheral oxygen saturation level, and number of cortical arousals from sleep. Based on the AHI results, participants were grouped into no OSA (AHI < 5 events/hour), mild OSA (AHI ≥ 5 and <15 events/hour), moderate OSA (AHI ≥ 15 and <30 events/hour), or severe OSA (AHI ≥ 30 events/hour). Main Outcome Measures: Neuroretinal rim area, horizontal and vertical widths, and peripapillary retinal nerve fiber layer (RNFL) thickness. Results: The median AHI result across the study cohort was 2.2 events per hour (interquartile range, 1.0−4.4 events/hour). Based on the AHI results, 178 participants (21.0{\%}) demonstrated OSA: 150 with mild OSA, 26 with moderate OSA, and 2 with severe OSA. In the unadjusted analyses, participants with OSA on average showed thinner peripapillary RNFL at the inferotemporal (P = 0.026) and superotemporal (P = 0.008) segments compared with those without OSA. Additionally, higher AHI results were associated with thinner RNFL superotemporally (P = 0.007). These findings remained significant after adjusting for gender, body mass index, ethnicity, and potential ocular confounders. There were no significant differences in optic disc measures between groups of OSA severity. Conclusions: Obstructive sleep apnea may be associated with preclinical thinning of the peripapillary RNFL in young adults. This suggests that an increased glaucoma risk already may be present in individuals with OSA since young adulthood. Long-term follow-up of this cohort will allow further optic disc changes in relationship to polysomnography parameters to be documented and associations with future glaucoma diagnosis to be explored.",
author = "Lee, {Samantha S.Y.} and Nigel McArdle and Sanfilippo, {Paul G.} and Seyhan Yazar and Eastwood, {Peter R.} and Hewitt, {Alex W.} and Qiang Li and Mackey, {David A.}",
year = "2019",
month = "10",
day = "1",
doi = "10.1016/j.ophtha.2019.04.041",
language = "English",
volume = "126",
pages = "1372--1384",
journal = "Ophthalmology: journal of the American Academy of Ophthalmology",
issn = "0161-6420",
publisher = "Elsevier",
number = "10",

}

TY - JOUR

T1 - Associations between Optic Disc Measures and Obstructive Sleep Apnea in Young Adults

AU - Lee, Samantha S.Y.

AU - McArdle, Nigel

AU - Sanfilippo, Paul G.

AU - Yazar, Seyhan

AU - Eastwood, Peter R.

AU - Hewitt, Alex W.

AU - Li, Qiang

AU - Mackey, David A.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Purpose: Obstructive sleep apnea (OSA) is linked to increased glaucoma risk in middle-aged and older adults. However, little is known about associations between OSA and glaucoma-related optic disc parameters in young adults. We explored associations between overnight polysomnography-derived measures of OSA and the optic disc in young adults. Design: Cross-sectional cohort study. Participants: Eight hundred forty-eight adults 19 to 22 years of age. Methods: Participants underwent an ophthalmic examination that included OCT imaging of the optic disc and measurements of intraocular pressure, axial length, and refractive error. Participants then underwent an overnight polysomnography study that obtained measurements of apnea–hypopnea index (AHI), peripheral oxygen saturation level, and number of cortical arousals from sleep. Based on the AHI results, participants were grouped into no OSA (AHI < 5 events/hour), mild OSA (AHI ≥ 5 and <15 events/hour), moderate OSA (AHI ≥ 15 and <30 events/hour), or severe OSA (AHI ≥ 30 events/hour). Main Outcome Measures: Neuroretinal rim area, horizontal and vertical widths, and peripapillary retinal nerve fiber layer (RNFL) thickness. Results: The median AHI result across the study cohort was 2.2 events per hour (interquartile range, 1.0−4.4 events/hour). Based on the AHI results, 178 participants (21.0%) demonstrated OSA: 150 with mild OSA, 26 with moderate OSA, and 2 with severe OSA. In the unadjusted analyses, participants with OSA on average showed thinner peripapillary RNFL at the inferotemporal (P = 0.026) and superotemporal (P = 0.008) segments compared with those without OSA. Additionally, higher AHI results were associated with thinner RNFL superotemporally (P = 0.007). These findings remained significant after adjusting for gender, body mass index, ethnicity, and potential ocular confounders. There were no significant differences in optic disc measures between groups of OSA severity. Conclusions: Obstructive sleep apnea may be associated with preclinical thinning of the peripapillary RNFL in young adults. This suggests that an increased glaucoma risk already may be present in individuals with OSA since young adulthood. Long-term follow-up of this cohort will allow further optic disc changes in relationship to polysomnography parameters to be documented and associations with future glaucoma diagnosis to be explored.

AB - Purpose: Obstructive sleep apnea (OSA) is linked to increased glaucoma risk in middle-aged and older adults. However, little is known about associations between OSA and glaucoma-related optic disc parameters in young adults. We explored associations between overnight polysomnography-derived measures of OSA and the optic disc in young adults. Design: Cross-sectional cohort study. Participants: Eight hundred forty-eight adults 19 to 22 years of age. Methods: Participants underwent an ophthalmic examination that included OCT imaging of the optic disc and measurements of intraocular pressure, axial length, and refractive error. Participants then underwent an overnight polysomnography study that obtained measurements of apnea–hypopnea index (AHI), peripheral oxygen saturation level, and number of cortical arousals from sleep. Based on the AHI results, participants were grouped into no OSA (AHI < 5 events/hour), mild OSA (AHI ≥ 5 and <15 events/hour), moderate OSA (AHI ≥ 15 and <30 events/hour), or severe OSA (AHI ≥ 30 events/hour). Main Outcome Measures: Neuroretinal rim area, horizontal and vertical widths, and peripapillary retinal nerve fiber layer (RNFL) thickness. Results: The median AHI result across the study cohort was 2.2 events per hour (interquartile range, 1.0−4.4 events/hour). Based on the AHI results, 178 participants (21.0%) demonstrated OSA: 150 with mild OSA, 26 with moderate OSA, and 2 with severe OSA. In the unadjusted analyses, participants with OSA on average showed thinner peripapillary RNFL at the inferotemporal (P = 0.026) and superotemporal (P = 0.008) segments compared with those without OSA. Additionally, higher AHI results were associated with thinner RNFL superotemporally (P = 0.007). These findings remained significant after adjusting for gender, body mass index, ethnicity, and potential ocular confounders. There were no significant differences in optic disc measures between groups of OSA severity. Conclusions: Obstructive sleep apnea may be associated with preclinical thinning of the peripapillary RNFL in young adults. This suggests that an increased glaucoma risk already may be present in individuals with OSA since young adulthood. Long-term follow-up of this cohort will allow further optic disc changes in relationship to polysomnography parameters to be documented and associations with future glaucoma diagnosis to be explored.

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U2 - 10.1016/j.ophtha.2019.04.041

DO - 10.1016/j.ophtha.2019.04.041

M3 - Article

VL - 126

SP - 1372

EP - 1384

JO - Ophthalmology: journal of the American Academy of Ophthalmology

JF - Ophthalmology: journal of the American Academy of Ophthalmology

SN - 0161-6420

IS - 10

ER -