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In the news: Sleep Apnea & Ophthalmology; Metabolic Syndrome & Cataracts

Obstructive Sleep Apnea & Ocular Disorders

Obstructive Sleep Apnea (OSA) is a sleep disorder characterized by pharyngeal collapse and partial obstruction of the upper airway, resulting in intermittent hypoxia. The hypoxia caused by repeated lapses in breathing during the night increases the risk and progression of coronary artery disease, heart failure, stroke, and diabetes.

OSA can also affect the eyes, which are particularly susceptible to both vascular and mechanical consequences of the condition. OSA is associated with floppy eye lid syndrome, anterior ischemic optic neuropathy, glaucoma, and diabetic retinopathy as well as other ocular conditions.

It’s estimated that 12% of adults suffer from OSA in the United States and that 80% of the patient population is undiagnosed. Obesity and particularly central adiposity (accumulation of fat in the lower torso and abdomen) are potential risk factors for sleep apnea. Thus, it’s no surprise that the prevalence of OSA is on the rise along with the epidemic of obesity here in the US.

There is growing recognition that eye care professionals have a role to play in OSA, not only in detecting and monitoring pathology associated with the condition but in referring patients to appropriate health care providers for OSA treatment. Several recent review articles on OSA and eye disorders are highlighted below, along with links to the abstract or full paper in the reference section.

Several articles(1,2) worth reading discuss the possible mechanisms for how OSA might affect the eye, and review the literature with respect to diabetic retinopathy, central serous retinopathy, retinal vein occlusion, glaucoma, floppy eye syndrome, non-arteritic ischaemic optic neuropathy, keratoconus and AMD. The authors also highlight gaps that remain in the evidence and in our knowledge.

Another potentially useful article(3) discusses newer home-based sleep apnea testing which can be implemented via physician clinics, with oversight by certified sleep physician. While CPAP is the gold-standard, the author also emphasizes that OSA management should also include diet and exercise. Patients with OSA and ocular disorders would benefit by the sharing of information by eye care professionals, primary health care providers, nutritionists and those that are treating OSA.

Metabolic Syndrome and Cataract Extraction

The metabolic syndrome (METS) is a cluster of metabolic risk factors for cardiovascular disease and type 2 diabetes, which include obesity (particularly abdominal fat), elevated blood glucose, high blood pressure and dyslipidemia.

A previous prospective study found that having METS or some of its components raised the risk of cataract extraction in women, especially those 65 years or less. To see if these findings might apply to men as well, Swedish researchers(4) examined the relationship of the individual METS components of abdominal adiposity, diabetes and hypertension to cataract extraction in a prospective cohort of over 45,000 men.

Over the 15‐year follow‐up, 7573 incident cases of cataract extraction were identified. After controlling for potential confounders, all three individual METS components raised the risk of cataract removal. The risk of cataract extraction increased with increasing numbers of metabolic syndrome components (p < 0.0001), and men who were 65 or younger at baseline with all three METS components had a 2.43-fold higher risk for cataract extraction.

These findings underscore the importance of weight control and a healthy lifestyle in cataract prevention.

References

1. West SD and Turnbull C. Review. Obstructive sleep apnoea. Eye. 32:889-903, 2018. (https://www.nature.com/articles/s41433-017-0006-y)
2. Santos M and Hofmann J. Review. Ocular manifestations of obstructive sleep apnea. J Clin Sleep Med. 13:1345–48, 2017. (Full paper: http://jcsm.aasm.org/ViewAbstract.aspx?pid=31125)
3. Fraser CL. Update on obstructive sleep apnea for neuro-ophthalmology. Curr Opin Neurol. 32:124-130, 2019. (https://www.ncbi.nlm.nih.gov/pubmed/30418196)
4. Lindblad BE, et al. Metabolic syndrome and some of its components in relation to risk of cataract extraction. A prospective cohort study of men. Acta Ophthalmol. Epub ahead of print, Oct. 2018.