Changes in Retinal Nerve Fiber Layer Thickness in Obstructive Sleep Apnea/Hypopnea Syndrome: A Meta-Analysis

Abstract

Purpose: To evaluate and compare changes in retinal nerve fiber layer (RNFL) thickness in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Methods: The Cochrane Library, Medline, and Embase were screened using our key words. Results were carefully reviewed to ensure that the included studies met the inclusion/exclusion criteria, and the quality of the studies was assessed using the Newcastle-Ottawa Scale. All included studies categorized patients with OSAHS into 3 groups (mild, moderate, and severe), and measured average and 4-quadrant (temporal, superior, nasal, and inferior) RNFL thickness. All studies included a healthy control group. The weighted mean differences and 95% confidence intervals were calculated for the continuous outcomes. Results: Ten case-control studies were included in the meta-analysis, consisting of a total of 811 OSAHS group and 868 healthy eyes. A meta-analysis of the data showed that the average RNFL thicknesses in the mild, moderate, and severe OSAHS groups were significantly decreased compared to healthy controls. Additionally, RNFL thickness was significantly reduced in all but the temporal quadrant in the moderate and severe OSAHS groups when compared to healthy controls. Conclusions: On the basis of these results, we suggest that peripapillary RNFL thickness as measured by optical coherence tomography could be a useful tool to monitor and assess the severity of OSAHS in patients. Further studies are required in order to differentiate these RNFL changes from glaucomatous changes. This has not been properly examined in any of the studies we were able to identify.

Correlation between structural progression in glaucoma and obstructive sleep apnea

“…The prevalence of NTG was also significantly higher in patients with moderate or severe OSA than in those with no or mild OSA [27]. Several similar studies regarding RNFL thickness and OSA severity were later conducted, and a meta-analysis by Yu et al [37] showed that both moderate and severe OSA were associated with a significant decrease in average, superior, inferior, and nasal RNFL thickness on OCT [37]. Other meta-analysis studies have also provided similar results [38][39][40][41].…”

Evaluation of Possible Changes in Intraocular Pressure and Optical Coherence Tomography Measurements in Severe OSAS Patients After 3 Month Positive Airway Pressure Treatment

“…Increasing evidence has shown that the longer the duration of oxygen desaturation, the more severe the disease on the optic nerve, thus the thinner the RNFL become [13,22]. Based on this fact, the current study aimed to establish the effects of PAP treatment on RNFL and macula of patients with severe OSAS by using OCT to understand if the effects of OSAS related hypercapnia and hypoxia on these parameters were reversible by PAP treatment or not.…”

“…Therefore, temporal RNFL is thought to be less susceptible to hypoxemic stress as well as to intracranial hypertension caused by hypoxic and hypercapnic episodes of OSAS. Indeed, in a meta-analysis including 10 studies that analyzes a large sample of OSAS patients with healthy controls, it was found that RNFL in OSAS patients had thinning mostly in the mean, upper, nasal and lower sectors [13].…”

“…Various ocular diseases such as ischemic optic neuropathy, central serous chorioretinopathy, retinal vein occlusion, oppy eyelid syndrome and papilledema have been associated with OSAS in the literature [10][11][12]. However, studies investigating the relationship between OSAS, intraocular pressure (IOP) and OCT measurements have con icting results, and there are a limited number of studies investigating positive airway pressure (PAP) treatment on these parameters in patients with severe OSAS [13]. Therefore, this study aimed to identify and compare possible changes in intraocular pressure, macular thickness, and RNFL thickness before and after 3 months of PAP in patients with severe OSAS.…”

Characterization of Retinal Fundus Opalescent Sheen in the Retinal Nerve Fiber Layer in Relation to Other Visual Assessment Parameters in A 16-Year-Old Teenage Group in Taiwan

“…Retinal injuries will in turn lead to functional degenerations in contrast sensitivity, dark adaptation, and color vision perception [5]. Moreover, assessments of RNFL thickness have been reported to be indicative of the severity of obstructive sleep apnea/hypopnea syndrome (OSAHSs) [6] and of glaucoma status [7,8].…”