Journal of Current Glaucoma Practice

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VOLUME 13 , ISSUE 3 ( September-December, 2019 ) > List of Articles

Original Article

Long-term Effect of Continuous Positive Air Pressure Therapy on Intraocular Pressure in Patients with Primary Open-angle Glaucoma with Obstructive Sleep Apnea

Pradtana Hirunpatravong, Tharnsook Kasemsup, Woravipa Na Ayudhya, Polporn Apiwattanasawee

Keywords : Continuous positive air pressure, Glaucoma, Intraocular pressure, Obstructive sleep apnea, Primary open-angle glaucoma

Citation Information : Hirunpatravong P, Kasemsup T, Ayudhya WN, Apiwattanasawee P. Long-term Effect of Continuous Positive Air Pressure Therapy on Intraocular Pressure in Patients with Primary Open-angle Glaucoma with Obstructive Sleep Apnea. J Curr Glaucoma Pract 2019; 13 (3):94-98.

DOI: 10.5005/jp-journals-10078-1262

License: CC BY-NC 4.0

Published Online: 01-04-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Purpose: Prevalence of glaucoma is higher in obstructive sleep apnea (OSA) patients. The gold standard technique to treat OSA is continuous positive airway pressure (CPAP) therapy. The influence of long-term CPAP therapy on intraocular pressure (IOP), blood pressure, ocular perfusion pressure (OPP), and glaucoma progression in primary open-angle glaucoma (POAG) patients was evaluated. Design: Prospective study. Materials and methods: In this study, we enrolled 12 eyes from six POAG patients aged >35 years, with newly diagnosed OSA and with indication for CPAP therapy. The CPAP was performed for 12 months. We monitored the IOP every 3 months. Visual field was determined at baseline and 12 months. Results: The mean IOP after CPAP therapy for 12 months was significantly higher than the mean baseline IOP (average IOP 3 months before CPAP therapy) (19.08 ± 3.47 vs 17.83 ± 2.88 mm Hg; p = 0.006). The IOP rising rate was 0.69 ± 0.47/years (p = 0.138) before CPAP therapy and increased to 1.13 ± 0.47/years (p = 0.016) after CPAP therapy. The OPP after 12 months of CPAP was significantly lower than the baseline (42.21 ± 5.29 vs 45.24 ± 7.09 mm Hg; p = 0.06). Results showed that the pattern standard deviation (PSD) value of 24-2 short wavelength automated perimetry (SWAP) visual field was reduced from 5.34 ± 3.92 to 4.77 ± 3.73 (p = 0.025). Antiglaucoma medication was administered to a patient due to increased IOP without glaucoma progression evidence. Conclusion: The POAG and OSA patients demonstrated significant IOP rising after CPAP therapy but did not show progression of glaucomatous damage. Mean deviation (MD), PSD, and visual field index (VFI) were not significantly different after CPAP therapy. Précis: Prospective study of POAG and OSA patients demonstrated significant IOP rising after CPAP therapy for a year. The study did not show progression of glaucomatous damage.

  1. Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 2009;6(8):e1000132. DOI: 10.1371/journal.pmed.1000132.
  2. Shivalkar B, Van de Heyning C, Kerremans M, et al. Obstructive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure. J Am Coll Cardiol 2006;47(7):1433–1439. DOI: 10.1016/j.jacc.2005.11.054.
  3. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the sleep heart health study. Am J Respir Crit Care Med 2001;163(1):19–25. DOI: 10.1164/ajrccm.163.1.2001008.
  4. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003;290(14):1906–1914. DOI: 10.1001/jama.290.14.1906.
  5. Olson EJ, Moore WR, Morgenthaler TI, et al. Obstructive sleep apnea-hypopnea syndrome. Mayo Clin Proc 2003;78(12):1545–1552. DOI: 10.4065/78.12.1545.
  6. 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(6):989.e3–998.e3. DOI: 10.1016/j.ajo.2011.04.030.
  7. 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(6):638–641. DOI: 10.1034/j.1600-0420.2000.078006638.x.
  8. Moghimi S, Ahmadraji A, Sotoodeh H, et al. Retinal nerve fiber thickness is reduced in sleep apnea syndrome. Sleep Med 2013;14(1):53–57. DOI: 10.1016/j.sleep.2012.07.004.
  9. Mojon DS, Hess CW, Goldblum D, et al. Primary open-angle glaucoma is associated with sleep apnea syndrome. Ophthalmologica 2000;214(2):115–118. DOI: 10.1159/000027478.
  10. Mojon DS, Hess CW, Goldblum D, et al. Normal-tension glaucoma is associated with sleep apnea syndrome. Ophthalmologica 2002;216(3):180–184. DOI: 10.1159/000059625.
  11. Deegan PC, McNicholas WT. Pathophysiology of obstructive sleep apnea. Eur Respir J 1995;8(7):1161–1178. DOI: 10.1183/09031936.95.08071161.
  12. Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes. American Thoracic Society. Official statement adopted March 1944. Am J Respir Crit Care Med 1994;150(6 Pt 1):1738–1745. DOI: 10.1164/ajrccm.150.6.7952642.
  13. Kiekens S, De Groot V, Coeckelbergh T, et al. Continuous positive airway pressure therapy is associated with an increase in intraocular pressure in obstructive sleep apnea. Invest Ophthalmol Vis Sci 2008;49(3):934–940. DOI: 10.1167/iovs.06-1418.
  14. Cohen Y, Ben-Mair E, Rosenzweig E, et al. The effect of nocturnal CPAP therapy on the intraocular pressure of patients with sleep apnea syndrome. Graefes Arch Clin Exp Ophthalmol 2015;253(12):2263–2271. DOI: 10.1007/s00417-015-3153-5.
  15. Baguet JP, Pépin JL, Hammer L, et al. Cardiovascular consequences of obstructive sleep apnea syndrome. Rev Med Interne 2003;24(8):530–537. DOI: 10.1016/S0248-8663(03)00142-5.
  16. Sehi M, Flanagan JG, Zeng L, et al. Relative change in diurnal mean ocular perfusion pressure: a risk factor for the diagnosis of primary open-angle glaucoma. Invest Ophthalmol Vis Sci 2005;46(2):561–567. DOI: 10.1167/iovs.04-1033.
  17. Pépin JL, Chiquet C, Tamisier R, et al. Frequent loss of nyctohemeral rhythm of intraocular pressure restored by nCPAP treatment in patients with severe apnea. Arch Ophthalmol 2010;128(10):1257–1263. DOI: 10.1001/archophthalmol.2010.220.
  18. Agarwal R, Gupta SK, Agarwal P, et al. Current concepts in the pathophysiology of glaucoma. Indian J Ophthalmol 2009;57(4): 257–266. DOI: 10.4103/0301-4738.53049.
  19. Liu JH, Gokhale PA, Loving RT, et al. Laboratory assessment of diurnal and nocturnal ocular perfusion pressures in humans. J Ocul Pharmacol Ther 2003;19(4):291–297. DOI: 10.1089/108076803322279354.
  20. Chen HY, Chang YC, Lin CC, et al. Obstructive sleep apnea patients having surgery are less associated with glaucoma. J Ophthalmol 2014;2014:838912. DOI: 10.1155/2014/838912.
  21. Kadyan A, Asghar J, Dowson L, et al. Ocular findings in sleep apnoea patients using continuous positive airway pressure. Eye (Lond) 2010;24(5):843–850. DOI: 10.1038/eye.2009.212.
  22. Kremmer S, Selbach JM, Ayertey HD, et al. Normal tension glaucoma, sleep apnea syndrome and nasal continuous positive airway pressure therapy–case report with a review of literature. Klin Monbl Augenheilkd 2001;218(4):263–268. DOI: 10.1055/s-2001- 14923.
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