光学相干断层扫描血管造影和 Humphrey 视野在阻塞性睡眠呼吸暂停患者中的应用。
Optical coherence tomography angiography and Humphrey visual field in patients with obstructive sleep apnea.
机构信息
Department of Ophthalmology, Augusta University Medical Center, Augusta, Georgia.
Vanderbilt Eye Institute, Nashville, Tennessee.
出版信息
J Clin Sleep Med. 2022 Sep 1;18(9):2133-2142. doi: 10.5664/jcsm.10054.
STUDY OBJECTIVES
To determine if obstructive sleep apnea syndrome (OSAS) predisposes patients to glaucoma and macular disease due to vascular compromise by evaluating retinal and optic nerve vasculature and function using optical coherence tomography angiography and Humphrey visual field testing, respectively.
METHODS
In this prospective, observational, cross-sectional study 45 patients undergoing polysomnography ordered per standard of care were selected and stratified based on apnea-hypopnea index (AHI). Medical history, visual acuity testing, 24-2 Humphrey visual field, intraocular pressure measurement, and optical coherence tomography angiography studies of the macular and peripapillary retina were obtained. Correlations between polysomnography parameters and imaging data were analyzed.
RESULTS
The radial peripapillary capillary vascular density demonstrated no relationship to AHI (95% confidence interval [CI] [-0.026,0.038]) or severity of OSAS (95% CI: [-0.772, 3.648]) for moderate OSAS compared to mild/normal and (-1.295, 3.1421) for severe compared to mild/normal. Optical coherence tomography angiography superficial parafoveal vascular density (95% CI: [-0.068,0.011], deep parafoveal vascular density (95% CI: [-0.080,0.009]), and foveal avascular zone (95% CI: [-0.001, 0.001]) showed no statistically significant relationship to AHI or OSAS severity after controlling for confounders. Optical coherence tomography retinal nerve fiber layer thickness increased with AHI ( = .014), but there was no statistically significant correlation with OSAS severity with retinal nerve fiber layer thickness (95% CI: [-12.543, 6.792] for moderate comparing to normal and [-2.883, 16.551] for severe comparing to normal). Visual field parameters were unaffected by OSAS (95% CI: mean deviation [-0.21,0.29], pattern standard deviation: [-0.351, 0.121], visual field index: [-0.166, 0.329]). Optical coherence tomography choroidal thickness showed a statistically significant decrease when OSAS was grouped by severity ( = .0092) but did not correlate with AHI ( = .129, 95% CI: [-1.210, 0.095]).
CONCLUSIONS
The severity of OSAS did not show a statistically significant effect on parameters associated with glaucoma or macular vascular disease. Larger cohorts may be required to determine the physiologic consequences of OSAS on the macular and optic nerve vasculature, structure, and function.
CITATION
Davanian A, Williamson L, Taylor C, et al. Optical coherence tomography angiography and Humphrey visual field in patients with obstructive sleep apnea. 2022;18(9):2133-2142.
研究目的
通过分别使用光相干断层扫描血管造影和 Humphrey 视野检查评估视网膜和视神经血管及功能，来确定阻塞性睡眠呼吸暂停综合征 (OSAS) 是否因血管受限而使患者易患青光眼和黄斑疾病。
方法
在这项前瞻性、观察性、横断面研究中，根据呼吸暂停低通气指数 (AHI) 选择了 45 名按标准护理进行多导睡眠图检查的患者，并进行分层。获取了病史、视力检查、24-2 Humphrey 视野、眼压测量和黄斑及视盘周围视网膜的光相干断层扫描血管造影研究。分析了多导睡眠图参数与影像学数据之间的相关性。
结果
与轻度/正常相比，中度 OSAS 患者的视盘周围毛细血管血管密度的放射状无统计学意义（95%置信区间 [CI]：[-0.026，0.038]）或 OSAS 严重程度（95%CI：[-0.772，3.648]）；与轻度/正常相比，重度 OSAS 患者的视盘周围毛细血管血管密度的放射状为（-1.295，3.1421）。光相干断层扫描血管造影浅层旁中心凹血管密度（95%CI：[-0.068，0.011]）、深层旁中心凹血管密度（95%CI：[-0.080，0.009]）和中心凹无血管区（95%CI：[-0.001，0.001]）与 AHI 或 OSAS 严重程度无统计学显著相关性，在控制混杂因素后。光相干断层扫描视网膜神经纤维层厚度随 AHI 增加（=0.014），但与 OSAS 严重程度与视网膜神经纤维层厚度无统计学显著相关性（与正常相比，中度 OSAS 为[-12.543，6.792]，重度 OSAS 为[-2.883，16.551]）。视野参数不受 OSAS 影响（95%CI：平均偏差[-0.21，0.29]，模式标准差：[-0.351，0.121]，视野指数：[-0.166，0.329]）。当 OSAS 按严重程度分组时，光相干断层扫描脉络膜厚度显示出统计学显著降低（=0.0092），但与 AHI 无关（=0.129，95%CI：[-1.210，0.095]）。
结论
OSAS 的严重程度与青光眼或黄斑血管疾病相关参数无统计学显著影响。可能需要更大的队列来确定 OSAS 对黄斑和视神经血管、结构和功能的生理后果。
引文
Davanian A, Williamson L, Taylor C, et al. Optical coherence tomography angiography and Humphrey visual field in patients with obstructive sleep apnea. 2022;18(9):2133-2142.
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