Ministry of Health, Department of Ophthalmology, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
Department of Chest Diseases and Sleep Center, Ankara, Turkey.
Can J Ophthalmol. 2014 Apr;49(2):217-21. doi: 10.1016/j.jcjo.2013.11.010.
To assess the long-term effects of positive airway pressure (PAP) therapy on the ocular surface and eyelid in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).
Single-centred, prospective, and double-blinded study.
Fifty-one patients with OSAHS.
Fifty-one patients with OSAHS were treated with PAP for a period of 18 months. The pre- and post-PAP values for eye examination scores (presence of floppy eyelid syndrome [FES], results of the Ocular Surface Disease Index [OSDI] questionnaire, Schirmer I test, tear film break-up time [TBUT] values, and corneal staining stages) were compared.
Based on the apnea-hypopnea index, 17 patients were followed with moderate and 34 patients were followed with severe OSAHS. The presence of FES before and after PAP was 56.9% and 74.5% (p < 0.01). FES stage was determined as 1.41 ± 0.98 before PAP and 0.78 ± 0.78 after PAP (p < 0.01). Pre-PAP and post-PAP OSDI results were 47.79 ± 21.04 and 42.17 ± 19.97, respectively (p < 0.01). Schirmer values before and after PAP were 7.23 ± 1.95 and 8.49 ± 1.79 mm, respectively (p < 0.01). TBUT values before and after PAP were 7.11 ± 1.82 and 8.68 ± 1.76 seconds, respectively (p < 0.01). Scores of the corneal staining stages before and after PAP were 1.05 ± 0.75 and 0.68 ± 0.54, respectively (p < 0.01).
OSAHS is associated with low Schirmer and TBUT values, and high scores in OSDI questionnaire, and high corneal staining stage. An appropriate PAP therapy helps to relieve both the systemic findings and the ocular surface problems most likely by providing a return to normal sleep patterns. We believe that long-term (at least 1 year) use of PAP improves the clinical picture of FES and can overcome the problem of ocular irritation that is encountered in the early stage of PAP.
评估正压通气（PAP）疗法对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者眼表和眼睑的长期影响。
单中心、前瞻性、双盲研究。
51 例 OSAHS 患者。
51 例 OSAHS 患者接受 PAP 治疗 18 个月。比较治疗前后眼部检查评分（存在眼睑松弛综合征[FES]、眼表疾病指数[OSDI]问卷结果、泪液分泌试验、泪膜破裂时间[TBUT]值和角膜染色分级）的变化。
根据呼吸暂停低通气指数，17 例患者随访为中度 OSAHS，34 例患者随访为重度 OSAHS。PAP 治疗前后 FES 的发生率分别为 56.9%和 74.5%（p < 0.01）。FES 分期分别为 PAP 治疗前 1.41 ± 0.98 和 PAP 治疗后 0.78 ± 0.78（p < 0.01）。PAP 治疗前后 OSDI 评分分别为 47.79 ± 21.04 和 42.17 ± 19.97（p < 0.01）。PAP 治疗前后 Schirmer 值分别为 7.23 ± 1.95 和 8.49 ± 1.79mm（p < 0.01）。PAP 治疗前后 TBUT 值分别为 7.11 ± 1.82 和 8.68 ± 1.76 秒（p < 0.01）。PAP 治疗前后角膜染色分级评分分别为 1.05 ± 0.75 和 0.68 ± 0.54（p < 0.01）。
OSAHS 与 Schirmer 值和 TBUT 值降低、OSDI 问卷评分高、角膜染色分级高有关。适当的 PAP 治疗有助于缓解全身症状和眼表问题，可能是通过恢复正常睡眠模式来实现的。我们认为，长期（至少 1 年）使用 PAP 可改善 FES 的临床症状，并能克服 PAP 早期出现的眼部刺激问题。
