仰卧位对青光眼患者眼压的影响。

Effect of sleeping in a head-up position on intraocular pressure in patients with glaucoma.

机构信息

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.

出版信息

Ophthalmology. 2010 Jul;117(7):1348-51. doi: 10.1016/j.ophtha.2009.11.015. Epub 2010 Feb 25.

DOI:10.1016/j.ophtha.2009.11.015

PMID:20188421

Abstract

PURPOSE

To determine whether a 30-degree head-up sleeping position decreases nocturnal intraocular pressure (IOP) compared with lying flat in patients with glaucoma.

DESIGN

Prospective, nonrandomized comparative case series.

PARTICIPANTS

Seventeen eyes of 17 patients with glaucoma with controlled IOP and new disc hemorrhage.

METHODS

Patients with a new disc hemorrhage despite well-controlled IOP were evaluated in a sleep laboratory on 2 separate nights, the first night lying flat and the second night in a 30-degree head-up position. Intraocular pressure and blood pressure (BP) were measured every 2 hours from 6 PM to 8 AM. For the 6 PM, 8 PM, 10 PM, and 8 AM measurements (awake period) the subjects were sitting for both nights. For the midnight, 2 AM, 4 AM, and 6 AM measurements (sleep period), the subjects were supine for the first night and 30 degrees head up for the second night.

MAIN OUTCOME MEASURE

Difference in IOP during the sleep period (midnight to 6 AM) between lying flat and 30-degree head-up positions.

RESULTS

Seventeen eyes of 17 patients were included. There were no significant differences (P=0.68) between the 2 study visits in IOP during the awake period (6 PM, 8 PM, 10 PM, and 8 AM) when patients were sitting upright. During the sleep period (midnight to 6 AM) the mean IOP was 3.2 mmHg lower in the 30-degree head-up position compared with the flat position (P=0.03; 95% confidence interval, 0.25-6.1 mmHg). Sixteen of 17 patients (94.1%) had lower IOP in the 30-degree head-up position. The reduction in IOP in the 30-degree head-up position was 20% or more in 35% of patients (6/17). There were no differences in BP or ocular perfusion pressure between the 2 positions.

CONCLUSIONS

The 30-degree head-up sleeping position lowers IOP compared with the flat position. Although this effect varies between individual patients, mean IOP was 20% lower in one third of patients in this series.

FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

摘要

目的

确定与平卧相比，30 度头高位睡眠是否能降低青光眼患者的夜间眼内压（IOP）。

设计

前瞻性、非随机对照病例系列研究。

参与者

17 例眼压控制良好且新发盘状出血的青光眼患者的 17 只眼。

方法

对眼压控制良好但仍有新发盘状出血的患者，在睡眠实验室进行了 2 次独立的夜间评估，第一次夜间平卧，第二次夜间 30 度头高位。从下午 6 点到早上 8 点，每 2 小时测量一次眼内压和血压（BP）。对于下午 6 点、8 点、10 点和早上 8 点的测量（清醒期），受试者在两晚均为坐位。对于午夜、凌晨 2 点、凌晨 4 点和早上 6 点的测量（睡眠期），受试者在第一晚为仰卧位，第二晚为 30 度头高位。

主要观察指标

平卧和 30 度头高位睡眠期间（午夜至早上 6 点）IOP 的差异。

结果

共纳入 17 例患者的 17 只眼。当患者坐直时，两次研究访问之间在清醒期（下午 6 点、8 点、10 点和早上 8 点）的 IOP 无显著差异（P=0.68）。在睡眠期（午夜至早上 6 点），30 度头高位的平均 IOP 比平卧位低 3.2mmHg（P=0.03；95%置信区间，0.25-6.1mmHg）。17 例患者中有 16 例（94.1%）在 30 度头高位时眼压更低。30 度头高位时，IOP 降低 20%或以上的患者占 35%（6/17）。两种体位之间的血压或眼灌注压无差异。