Chuang Lan-Hsin, Koh Yeo-Yang, Chen Henry S L, Lo Yu-Lun, Yu Chung-Chieh, Yeung Ling, Lai Chi-Chun
Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung.
College of Medicine, Chang Gung University, Taoyuan.
Medicine (Baltimore). 2020 Mar;99(13):e19468. doi: 10.1097/MD.0000000000019468.
This study characterized and evaluated normal tension glaucoma (NTG) in obstructive sleep apnea syndrome (OSAS).In this retrospective, cross-sectional study, all participants were examined with polysomnography (PSG). Functional parameters of standard automated perimetry (SAP) were recorded. Structural parameters in optical coherence tomography angiography (OCTA) included peripapillary superficial vessel density (VD RPC), peripapillary whole-layer (VD NH), and superficial and deep macular area VD. Participants were categorized into perimetric and nonperimetric groups by SAP result. Low reliability of SAP and signal strength index <50 in OCTA were excluded.Severity of OSAS was graded by apnea-hypopnea index (AHI) in PSG. Those with moderate/severe OSAS (AHI ≥ 15, n = 39) had longer neck circumference and shorter ocular axial length than mild OSAS (AHI < 15, n = 14). Furthermore, there was significantly higher AHI and larger neck circumference in the NTG perimetric group (n = 27) than in the control group (n = 26; p < 0.001 and p = 0.047, respectively). Superficial and deep-layer peripapillary and macular area VD significantly decreased in the perimetric group. Overall, structural and functional parameters show that VF PSD was negatively correlated with VD NH and VD RPC (p = 0.007, p = 0.015); and VF MD was positively correlated with VD NH (p = 0.029), but not significantly to VD RPC (p = 0.106).OSAS is a risk factor of NTG. With aid of OCTA, whole-layer retinal capillary dropout supports that the vascular dysregulation of OSAS leads to NTG.
本研究对阻塞性睡眠呼吸暂停综合征（OSAS）中的正常眼压性青光眼（NTG）进行了特征描述和评估。在这项回顾性横断面研究中，所有参与者均接受了多导睡眠图（PSG）检查。记录了标准自动视野计（SAP）的功能参数。光学相干断层扫描血管造影（OCTA）中的结构参数包括视乳头周围浅表血管密度（VD RPC）、视乳头周围全层（VD NH）以及浅表和深层黄斑区血管密度。根据SAP结果将参与者分为视野缺损组和非视野缺损组。排除了SAP可靠性低以及OCTA中信号强度指数<50的情况。通过PSG中的呼吸暂停低通气指数（AHI）对OSAS的严重程度进行分级。中度/重度OSAS（AHI≥15，n = 39）患者的颈围比轻度OSAS（AHI<15，n = 14）患者更长，眼轴长度更短。此外，NTG视野缺损组（n = 27）的AHI显著高于对照组（n = 26；分别为p<0.001和p = 0.047），颈围也更大。视野缺损组视乳头周围和黄斑区的浅表和深层血管密度显著降低。总体而言，结构和功能参数表明视野平均缺损（VF PSD）与VD NH和VD RPC呈负相关（p = 0.007，p = 0.015）；视野平均偏差（VF MD）与VD NH呈正相关（p = 0.029），但与VD RPC无显著相关性（p = 0.106）。OSAS是NTG的一个危险因素。借助OCTA，全层视网膜毛细血管缺失支持OSAS的血管调节异常导致NTG这一观点。
