Department of Ophthalmology, University Hospital, Université Joseph Fourier, Grenoble, France.
Invest Ophthalmol Vis Sci. 2011 Dec 16;52(13):9489-96. doi: 10.1167/iovs.11-7936.
Obstructive sleep apnea (OSA) syndrome generates hypertension, atherosclerosis, and endothelial and autonomic dysfunction, which may mutually interact with ocular vascular regulation. Exercise and posture changes can be used to manipulate blood pressure, ocular perfusion pressure (OPP), or both. It was hypothesized that choroidal vascular reactivity in response to isometric exercise and posture changes could be altered in OSA patients.
Healthy men were matched 1:1 for body mass index, sex, and age with patients with newly diagnosed OSA without cardiovascular comorbidities. All subjects underwent sleep studies and cardiovascular phenotyping (24-hour blood pressure monitoring, arterial stiffness measurements, and cardiac and carotid echography). Choroidal reactivity was assessed by laser Doppler flowmetry, which measured subfoveal choroidal blood flow.
During exercise, blood pressure parameters increased significantly within the same range, with a similar profile over time in OSA patients and control subjects. A significant linear relationship (P = 0.0003) was noted between choroidal vascular resistance and the OPP changes during exercise in OSA patients and control subjects. From the sitting to the supine position, a significant decrease in mean arterial pressure occurred in both groups (10.9%-13.4%; P < 0.001). In both populations, no significant change in choroidal blood flow or vascular resistance was found during the posture change. Choroidal blood flow responses to exercise and posture changes were unchanged after 6 to 9 months of continuous positive airway pressure treatment.
This study strongly suggests that the regulation of choroidal blood flow, which depends on the orthosympathetic and parasympathetic systems, is unaltered in men with OSA who have no comorbidities.
阻塞性睡眠呼吸暂停（OSA）综合征会导致高血压、动脉粥样硬化以及内皮和自主神经功能障碍，这些可能会相互影响眼部血管调节。运动和姿势改变可用于调节血压、眼灌注压（OPP）或两者兼而有之。本研究假设，OSA 患者的对向心性运动和姿势改变的脉络膜血管反应可能会发生改变。
健康男性与新诊断为无心血管合并症的 OSA 患者按体重指数、性别和年龄 1:1 匹配。所有受试者均接受睡眠研究和心血管表型分析（24 小时血压监测、动脉僵硬度测量以及心脏和颈动脉超声检查）。通过激光多普勒血流仪评估脉络膜反应性，该方法测量了黄斑下脉络膜血流。
在运动过程中，血压参数以相同的幅度显著增加，OSA 患者和对照组的时间变化曲线相似。在 OSA 患者和对照组中，观察到脉络膜血管阻力与运动过程中的 OPP 变化之间存在显著的线性关系（P = 0.0003）。从坐姿变为仰卧位时，两组的平均动脉压均显著下降（10.9%-13.4%；P < 0.001）。在两组人群中，在姿势改变期间，脉络膜血流或血管阻力均未发生显著变化。在接受持续气道正压通气治疗 6 至 9 个月后，向心性运动和姿势改变对脉络膜血流的反应并未改变。
本研究强烈表明，在无合并症的 OSA 男性中，依赖交感神经和副交感神经系统的脉络膜血流调节未发生改变。
