Association of asymmetrical normal tension glaucoma, obstructive sleep apnoea and side sleeping.
Tun Tin A, Tan Nicholas Y Q, Tan Royston K Y, Syn Yamon Thant, Chan Hiok Hong, Yu Qing Chang, Porporato Natalia, Narayanaswamy Arun, Foo Reuben Chao-Ming, Husain Rahat
AI Summary
This study linked asymmetrical NTG-OSA to side-sleeping, finding reduced optic nerve head blood flow in the lower eye during side-lying, suggesting a positional role in glaucoma progression.
Abstract
Purpose
To describe asymmetrical normal tension glaucoma (NTG) with obstructive sleep apnoea (OSA; apnoea-hypopnoea-index ≥5) in habitual side-sleepers, and to compare optic nerve head (ONH) blood flow velocity across sleeping positions using laser speckle flowgraphy (LSFG; Softcare, Japan).
Design
Cross-sectional study.
Methods
Participants underwent ocular assessments and reported sleeping positions via questionnaires. Intraocular pressure (IOP) and LSFG-derived mean blur rates for vascular (MV), tissue (MT), and entire area (MA) were measured after 5minutes in supine and lateral decubitus (LD) positions.
Results
We enrolled forty NTG-OSA patients (21 unilateral; 19 bilateral but asymmetrical) and 29 controls (70% male; mean age 62.9 ± 8.7 years). Interocular characteristics were comparable except that worse eyes had thinner central corneas and reduced MV, MT, and MA in LD positions. In worse eyes, MT was less in the lower LD position (9.00 ± 2.07 au) than in the upper LD (9.27 ± 1.97 au; P = 0.037) and supine (9.61 ± 1.95 au; P = 0.011) positions. Among participants who slept with the worse eye lower, MV, MT, and MA were less in the worse eyes in both lower and upper LD positions versus the fellow eye (all P < 0.05), but not in supine. Among those who slept with the worse eye upper, MV and MT were less in the worse eyes only in the lower LD position (both P < 0.05), with no differences in other positions.
Conclusions
We report an association of asymmetrical NTG-OSA who habitually sleep laterally. Interocular differences, particularly reduced ONH blood flow velocity in the lower LD position, may provide insights into glaucoma pathogenesis.
Key Concepts5
An association was reported between asymmetrical normal tension glaucoma (NTG) with obstructive sleep apnoea (OSA; apnoea-hypopnoea-index ≥5) in habitual side-sleepers.
In worse eyes of NTG-OSA patients, mean blur rate for tissue (MT) was less in the lower lateral decubitus (LD) position (9.00 ± 2.07 au) compared to the upper LD position (9.27 ± 1.97 au; P = 0.037) and supine position (9.61 ± 1.95 au; P = 0.011), suggesting reduced optic nerve head blood flow velocity in the lower LD position.
Among NTG-OSA participants who slept with the worse eye lower, mean blur rates for vascular (MV), tissue (MT), and entire area (MA) were less in the worse eyes in both lower and upper lateral decubitus (LD) positions versus the fellow eye (all P < 0.05), but not in the supine position.
Among NTG-OSA participants who slept with the worse eye upper, mean blur rates for vascular (MV) and tissue (MT) were less in the worse eyes only in the lower lateral decubitus (LD) position (both P < 0.05), with no differences in other positions.
The study involved a cross-sectional design to investigate associations in asymmetrical normal tension glaucoma (NTG) patients with obstructive sleep apnoea (OSA) and side sleeping.
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